The next item of business is a debate on motion S4M-09558, in the name of Jim Hume, on improving Scotland’s mental health.
15:50
A little over 15 months have passed since the Parliament last had the chance to thoroughly debate mental health issues. On that occasion, the Scottish Government conducted a welcome discussion of its “Mental Health Strategy for Scotland: 2012-2015”. Back then, I described the Scottish Government’s task as a stark one and today its challenge remains unenviable.
As my motion states, one in four Scots will experience mental ill health at some point in their lifetime, with the resulting social and economic costs on the health service and sufferers totalling something in the region of £10.7 billion annually.
Mental illness continues to be the dominant health problem of people of working age, and the distress that is caused to sufferers and their families damages careers, relationships and lives. Sufferers of mental illness can feel isolated and experience significant stress. Imagine coping with that and trying to hold down a full-time job or raise a family. Without medical intervention, suffering is prolonged and that only serves to increase the likelihood that treatment will be more difficult or complex than it otherwise need have been.
That is why effective and timely treatment for those who are suffering from mental illness is critical to safeguarding their welfare and returning them to full health. I cannot stress enough how important treatment is and, thankfully, the Scottish Government also acknowledges that, which is why it introduced a national health improvement, efficiency and governance, access and treatment target for at least 90 per cent of patients to receive psychological therapy within 18 weeks of a referral.
As members will recall, the mental health strategy contained 36 commitments that covered a broad range of issues relating to the provision of mental health services, such as early interventions, older people’s mental health and so on. Commitment 13 is:
“We will continue our work to deliver faster access to psychological therapies. By December 2014 the standard for referral to the commencement of treatment will be a maximum of 18 weeks, irrespective of age, illness or therapy.”
By December this year, then, no more than 10 per cent of patients treated should have waited more than 18 weeks for psychological therapy. In July last year, however, the figure stood at 16 per cent, albeit that was well over a year from the target so there was still time for improvement. Unfortunately, by December 2013 the figure had risen to 17 per cent of patients. With just a year to go, the figures are going in the wrong direction.
A similar picture is being painted of the percentage of those who are waiting for treatment. In July 2013, 22 per cent of patients who were waiting for treatment had done so for longer than 18 weeks. Five months later, that figure remained at 22 per cent.
When we break the numbers down health board by health board, that is when we begin to realise that, across Scotland, access to psychological therapies is riddled with inequities and it is getting worse. Good progress is being made in some areas, but we should compare those areas to NHS Highland, where 19 per cent of patients waited more than 18 weeks in July, and Tayside where that figure was 15 per cent. In December in those areas, those figures increased to 27 and 25 per cent respectively.
There were similar significant increases between July and December in those who had waited longer than 18 weeks and had yet to receive treatment in health board areas such as Fife, Grampian, Lothian and the Borders. When we look at the per capita ratio of psychologist distribution across Scotland, we see that there is an applied psychologist for every 7,000 people or fewer in the Lanarkshire, Fife, Tayside and Greater Glasgow and Clyde health board areas. In the Borders and the Highlands, the figure is 11,000 people and in Forth Valley it is approaching 14,000. In the past 12 months, those figures have increased further in the Fife, Lanarkshire, Dumfries and Galloway, Borders and Forth Valley health board areas.
Why is that happening? It is true that, during the past few years, the Scottish Government has increased the number of clinical and other applied psychologists who are working in the NHS; that is undeniable. It was imperative that it did so.
The stigma attached to mental ill health is starting to diminish, albeit slower than any of us would like it to do, I am sure. People are feeling more comfortable about admitting that they are experiencing mental illness and, crucially, are beginning to seek treatment in increasing numbers. That means that demand for psychological therapies across our health boards is greater. I know from recent discussions with the Scottish Association for Mental Health that soon-to-be-published research will reveal that many general practitioners are deciding against referring patients for psychological therapy, because waiting lists are too long.
The key question is therefore whether the new staff members are going to the right places. It appears that they are not. Regardless of the community to which a person in Scotland belongs, if they are suffering from mental ill health and need treatment they must have the same access to psychological therapy as someone in every other part of the country has.
The way to provide an efficient and effective NHS is to ensure that the provision of services constantly evolves and improves. That is why the Sandra Grant report, which was published a decade ago, was such a useful exercise. Dr Grant reviewed mental health services in Scotland and made valuable recommendations on organisational culture and the workforce. She also made observations on inequity and said:
“The quality and quantity of available services for people with mental health problems differs across Scotland.”
As I said, the Scottish Government has yet to address areas with regard to inequity and clearly has not taken full cognisance of Dr Grant’s report. However, I welcome the first commitment in the mental health strategy, which is to commission a 10-year follow-up review on the Grant report. I look forward to the review’s publication later this year. As it says in the motion, I invite the minister to give us an update today on the review’s progress and an indication of what service users and NHS staff might expect from it.
We must accept that the problem of mental illness in sections of our population cannot be solved overnight, particularly given the link with inequality. People in areas of deprivation are more likely to experience mental illness. It is a scandal that those who suffer from mental illness, particularly severe mental illness, die far sooner than the rest of us—in some cases, a couple of decades sooner. Indeed, in its 2012 report, “Health inequalities in Scotland”, Audit Scotland said that although progress on inequalities has been made in some areas, such as coronary heart disease,
“other indicators, such as ... mental health ... remain significantly worse in the most deprived parts of Scotland.”
Organisations such as SAMH should be praised for their work in helping people whose lives have been impacted by inequality. SAMH’s know where to go campaign does excellent work to signpost people who have problems accessing information and support for mental illness to the appropriate service providers. We know that people from deprived areas are less likely to know how and where to access support and even whether they should be accessing support—as opposed to just manning up, as society has for too long wrongly led people to believe that they should do. Any campaign to eradicate that problem gets my support.
We must focus on providing the best outcomes for people who suffer from mental illness by ensuring that they have access to timely and appropriate treatment. We must also ensure that we tackle the causes of inequality, which so often creates the environment in which depression and mental illness can thrive. Let us help those who are experiencing mental trauma and let us help to prevent people from ever reaching that point. Let us put the stigma of mental ill health behind us and put mental health on a par with physical health in Scotland.
I move,
That the Parliament notes that one in four adults will experience mental ill health in their lifetime; recognises the enormous personal, social and economic costs of mental health problems, which are estimated to cost £10.7 billion per year in Scotland; further recognises that mental ill health is now the dominant health problem for people of working age, with it accounting for around 45% of all people not working due to ill health; notes that 13,986 people were waiting to start treatment with psychological therapy services in Scotland on 31 December 2013; understands with concern that 708 young people had been waiting more than 26 weeks for treatment; notes with concern that child and adolescent unit psychiatric hospital admissions in 2012-13 were 21.2 per 100,000, which is up from 19.2 in 2011-12; recognises the increasing demand for psychological therapies across Scotland and is concerned by the disparity in access to such therapies in different NHS board areas; would welcome an update from the Scottish Government on its commitment set out in the Mental Health Strategy for Scotland 2012-2015 to commission a 10-year follow up to the report, National Mental Health Services Assessment: Towards implementation of the Mental Health (Care and Treatment) (Scotland) Act 2003 (the Grant report) to review the state of mental health services in Scotland; believes that more work is needed to continue to reduce the stigma attached to mental health issues, and further believes that Scotland should follow the lead of the UK Government by enshrining in law parity between mental and physical health.
15:58
I welcome the opportunity to have this debate. Mental health issues have a high profile in Scotland. Indeed, this Parliament has regularly debated mental health.
I want us to think about mental and physical health in the same way. That is what we are doing, in our approach to improving mental health services in Scotland. We have set access targets to measure performance, as we have done in the context of physical health. We publish data on how services operate, so that we can identify how services vary and where we need to make improvements. I measure success by what happens on the ground, and across Scotland there are improvements in services, while more transparent data allow us to identify areas where further improvement is needed.
Faster access to specialist mental health services for children and young people and to psychological therapies for people of all ages is one of our key challenges. Scotland is unique in developing that approach to improving access to mental health services. We want more people who are experiencing mental ill health to seek support. We know that people are increasingly likely to go to their general practitioner when they are experiencing problems and that they are more likely to receive a diagnosis of depression or anxiety and an evidence-based treatment for that. That reflects the reduction in stigma, the work that has been undertaken in primary care to improve diagnosis rates and better access to treatments.
We want more psychological therapies to be available. NHS boards have been working to increase the capacity of their services, using service redesign to improve the efficiency of the services and increasing the number of staff who are able to deliver evidence-based therapies. We now have data on how many people are accessing psychological therapies and how long they are waiting. We are also developing national workforce data on the staff who are delivering psychological therapies. We are now in a stronger position, with transparent information and a better understanding of how services are working in each health board area, which allows us to identify their priorities for further improvement. We do not expect all health boards to deliver identical services, but we expect them to use the information to identify where there are gaps in services and to support them in meeting their local needs.
We have set a challenging target for our NHS boards, and it was meant to be a challenging target. NHS Scotland delivered more than 8,000 psychological therapies in the past quarter and that number will continue to increase as data from other services are included. Half of those people started their treatment in nine weeks or less. Most important, we want people to get better as a result of the treatment that they receive and we have seen an increase in the routine use of clinical outcome measures to ensure the quality of the mental health services that are being delivered.
Ensuring access to mental health services for children and young people is a key priority. Since 2008, the specialist child and adolescent mental health services workforce has increased by over 40 per cent as a result of the significant investment that we have made in the service. The number of children who are being seen in CAMHS in a three-month period has varied from 2,400 to 3,900 and there has been a consistent performance on waiting times, with half of them starting treatment in eight weeks or less—a period that was reduced to seven weeks during the past quarter.
Richard Simpson’s amendment raises an important issue. We have recently seen an increase in the number of admissions of children to adult wards, but the answer is not simply to provide more beds for children and young people. We need a fundamental redesign of intensive CAMHS services. In the south-east of Scotland, the health boards invested heavily in the development of intensive treatment teams—hospital at home services—which provide treatment for young people at home and in a familiar environment. That has resulted in many admissions being avoided altogether, and when admissions do take place they tend to be for a shorter period. Therefore, the outcomes for children and families are good. We have seen an increasing number of admissions, but they have involved a shorter length of stay, which has built additional capacity into the system so that beds have been available when they have been needed.
However, the picture is not uniform across Scotland. Some areas have not progressed plans to develop intensive treatment teams as quickly as we would have liked, and an increase in the number of referrals of young people to in-patient units has created pressure in the system. In response to that, we will facilitate work across the three regions this year to address the pressure in the system and to reduce the number of admissions of young people to adult wards.
The progress that we have seen in the improvement of mental health services has been established on data that have helped us to understand the variation across Scotland, to identify gaps and to prioritise our work. The 10-year review that has been referred to is currently being undertaken by the Mental Health Foundation, voices of experience and Healthcare Improvement Scotland, and the report will be published later this year.
Tackling stigma and discrimination remain Government priorities. We have increased funding for the see me campaign, and the Scottish Government provides £1 million, alongside £500,000 from Comic Relief, bringing the total annual budget to £1.5 million.
Will the member give way?
The member is in his last minute.
It is important that we build on the good progress that we have made in recent years in order to reduce discrimination against and stigma towards mental ill health.
We are making good progress on the commitments set out in the mental health strategy and in improving access to services. I do not underestimate the challenges that we face and I always welcome the Parliament’s interest in mental health issues.
I move amendment S4M-09558.2, to leave out from “13,986 people” to end and insert:
“Scotland is the only country in the world to have introduced a waiting times target for access to psychological therapies; welcomes the increasing access to psychological therapies across Scotland and the progress that NHS boards are making in developing services, while recognising the challenges in delivering the target; notes that the Mental Health Foundation, Voices of Experience and Healthcare Improvement Scotland are currently doing the field work to deliver the commitment in the Mental Health Strategy for Scotland 2012-2015 to commission a 10-year follow up to the report, National Mental Health Services Assessment: Towards implementation of the Mental Health (Care and Treatment) (Scotland) Act 2003 (the Grant report) to review the state of mental health services in Scotland, which will be published later in 2014, and notes that ‘see me’, Scotland’s programme to end mental health stigma and discrimination, has been refounded for the next three years.”
16:05
Mental illness is one of our time’s most prevalent conditions. Its economic, social and personal impacts can be, and often are, devastating. Across Europe, mental illness is one of the top public health challenges, with depression alone responsible for more than 13 per cent of the disability burden, making it the leading chronic condition. That is a staggering statistic.
As austerity bites, unemployment and underemployment rise, people’s living standards are squeezed and, as national and local public services are cut, we see mental ill health rise and the services needed to support people cut.
We know that mental illness does not respect status, power or wealth and that it can affect anyone, but it is no surprise that communities that suffer high levels of unemployment and poverty are more likely to see higher rates of mental ill health. According to NHS Scotland, women, black and minority ethnic groups, refugees, sex workers, people living with disabilities, addictions or chronic illnesses, homeless people and older people living on reduced incomes are those at greatest risk. Health inequality is Scotland’s greatest shame and the inequality is starkly laid before us when we look at mental illness and its impact on a person’s overall wellbeing.
Major life events are often at the root of mental illness, and bereavement, job loss, retirement, relationship breakdown and abuse of one kind or another can all contribute to a mental health condition. The reality is that many people go untreated for very long periods and half of them do not seek or get help. Estimates suggest that almost one in five of us will experience, for example, depression at some point in our lives. That means more than 1 million people living in Scotland will experience varying symptoms of the condition, yet more than half—500,000 people—will not receive any help or support.
Across the age range, access to mental health services is a growing concern. The Government’s mental health strategy makes it clear that, as the minister mentioned, access to psychological therapies for children and access to adolescent mental health services is vital. The aim is that, by March 2014, someone will be seen in 26 weeks, falling to 18 weeks by December 2014. However, Jim Hume’s motion states that more than 700 young people have waited beyond 26 weeks. That is clearly unacceptable. It must be hard enough for a young person and their family to live with mental illness without having to wait so long for treatment. If a young person needs psychological help now, their condition is more likely to be further entrenched and more difficult to treat a whole six months later.
The situation is just as concerning for older people. Take a condition such as dementia, which is an illness that we all fear and dread. I am sure that we all know someone who is affected. The Cabinet Secretary, as I did, recently met Frank and Amanda Kopel, who have been campaigning for better care for dementia sufferers. I pay tribute to them for the loving, caring, determined and dignified way in which they have campaigned.
They and others have raised the issue of poor access to local services, and the matters that they raise get to the nub of the issue. In the current climate we see devastating cuts to local government budgets. I do not want this to be taken as political knockabout; it is a very serious issue that we must address. We see support services being cut, educational psychologist posts being lost, classroom assistants going—they are very much the front line of support—social care in crisis, drug and alcohol services being reduced, support grants to the voluntary sector slashed and respite and other care provision cut back. All those factors and more impact on people’s ability to access services and the community’s ability to help those with debilitating mental health conditions.
I ask the Parliament: when we will have a mature debate about local government and NHS finance? When are we going to face the realities, as is our duty in this Parliament, and discuss how we do or do not finance local mental health and associated support services? Where is the morality in children and families suffering and people such as Frank and Amanda Kopel being denied treatment and services, while at the same time their Parliament fails to address the fundamental problem of the way in which services are financed?
I move amendment S4M-09558.1, to insert at end:
“; further notes that the number of admissions of children to adult wards rose in 2013 by 27% to 219 after a number of years of progress, and calls on the Scottish Government to review its plans for bed capacity for children and young people with mental health problems”.
16:11
I welcome the Liberal Democrats’ decision to debate Scotland’s mental health, although it is perhaps a little premature, given that the 10 year follow-up to the Grant report of 2003 is due to be published later this year.
However, given that one in four of us will experience a mental health problem at some time in our lives, and that mental ill health now accounts for close to half of all people who are not working because of health problems, it is important that we consider what progress is being made to tackle the unmet needs of those who are affected by mental illness.
There is no doubt that significant efforts are being made to speed up diagnosis and referral of people who experience mental health problems, and to provide the appropriate services to aid their recovery. The HEAT target that has been set by the Government to have a maximum waiting time, by the end of this year, of 18 weeks from referral to accessing psychological treatment, is very welcome, but is some way from being achieved, with just 82 per cent of adults and 85 per cent of children currently being seen within 18 weeks. Those waiting times do not sound very long, but 4 and a half months is quite a long time for people to be suffering mental trauma without access to the services that they need. I therefore hope that the target times, once they are achieved, will be re-set at a more ambitious level.
SAMH has expressed concern about the health inequalities that persist in parts of Scotland and within certain communities, with access to services being affected by geography, deprivation and ethnicity. SAMH found that in the more deprived areas more than a quarter of people did not know where to seek help when they suffered from depression, anxiety or other mental health problems, and that of those who did seek help, 77 per cent went initially to their general practitioner.
That certainly ties in with what the Health and Sport Committee heard yesterday from GPs who work in deprived communities, who said that many of their patients suffer from multiple comorbidities, and that mental health issues are closely associated with the physical ill health and social problems that affect many people in those areas. Those GPs are under severe and increasing pressure in dealing with their workload, and find that they do not have adequate time to spend with their patients. In those communities there are many people from ethnic minority backgrounds, who also have cultural barriers to seeking help.
Moreover, a recent survey of GPs by SAMH showed that GPs often do not make referrals to services including psychological therapies and social prescribing, because waiting times are too long, referral criteria are unclear, or there is no access to such services in their area. The resultant delays in supporting people who experience mental health problems mean that by the time people come to treatment, their situation is likely to be more complicated and their recovery may be compromised.
Similar delays in engaging with psychiatric services are quite common in remote and rural areas, and for farmers in particular, who used to have the support of colleagues and family on the farm, but who now lead fairly isolated lives and bottle up their problems. That has led to a significant increase in suicide among farmers in recent years, which is cause for concern. However, it is encouraging that overall rates of suicide have come down, but we cannot be complacent about that.
Two commitments in the Government’s mental health strategy particularly interest me. Commitment 21 is:
“We will identify particular challenges and opportunities linked to the mental health of older people and will develop outcome measures related to older people’s mental health as part of the work to take forward the integration process.”
Commitment 22 is:
“We will work with the Royal College of GPs and other partners to increase the number of people with long term conditions with a co-morbidity of depression or anxiety who are receiving appropriate care and treatment for their mental illness.”
Both groups of people are increasing in number as the population of Scotland ages, and the first will certainly contribute to a rise in psychological problems associated with dementia. Given that, I ask the minister to give us an update on those two commitments.
Finally, I want to touch on a success story for children and young people in Fife who have severe mental health conditions. The Royal College of Nursing brought it to my attention just this morning, and I suspect that the minister might have been talking about the same thing in his speech. The NHS Fife child and adolescent mental health intensive therapy service, which is run as a partnership involving nurses, psychiatrists, psychologists and therapists, provides personalised community-focused care for eight-year-olds to 18-year-olds. Under the leadership of a nurse consultant, the service offers high intensity home-based support and therapy that are tailored to meet the individual needs of young people and their families and carers. It offers effective—and cost-effective—therapeutic management of young people who are suffering from severe mental health problems who, as a result, need minimal, if any, hospitalisation. The project sounds very worth while, and other health boards would do well to consider it—especially given the 27 per cent rise in the number of children who were, as Labour’s amendment points out, admitted to adult wards last year.
I am conscious that I have rambled a bit around different aspects of mental health. However, I think that the debate gives us the opportunity to look at service provision from all angles. I commend Jim Hume for leading the debate.
Many thanks. We move to open debate.
16:16
I welcome the opportunity to speak in this afternoon's debate on what is a vital issue for tens of thousands of people across Scotland. In last year’s debate on the Scottish Government’s mental health strategy, I said that the strategy was very much a work in progress, so it is helpful for Parliament to take a further look at progress since then and at what still needs to be done.
As Neil Findlay pointed out, mental health is one of the biggest public health challenges that face Scotland and Europe as a whole. Back in 2005, the World Health Organization predicted that by 2030 depression will be the second-biggest health burden, which is why successive Scottish Administrations and the Parliament have worked together to make mental health a priority, and why significant efforts are being made to deliver the commitments in the current mental health strategy.
Although faster access to appropriate care and support for people who suffer from mental ill health is a fundamental challenge, we should remember that Scotland remains the only country in the world to have introduced a waiting time target for access to psychological therapies. From this December, that target will be no longer than 18 weeks from referral to treatment, and data from last December suggest that about 81.6 per cent of people are already seen within that timescale. For specialist child and adolescent mental health services, the Government has set a 26-week target, which will reduce to 18 weeks by December. As of December last year, 82.5 per cent of the children and young people who were referred were seen within 18 weeks. Our NHS boards are making progress in meeting the target, which is, as the minister has made clear, challenging and is intended to drive improvement in the system.
We know, however, that there is still much more to do and that this is very much work in progress. The Government does not underestimate the challenge that we face. However, the targets are only part of the picture. In addition to improving access to, and the quality of, psychological services, health boards need to offer services that meet the full range of people's needs, including—if they are right for the patient—lower-intensity interventions that might prevent their ever needing higher-intensity services at all.
In our last debate on the mental health strategy, I highlighted a social prescribing project in the Stewartry that has been joint-funded by NHS Dumfries and Galloway and Dumfries and Galloway Council, and which involves the third sector and two general practices, in Castle Douglas and Dalbeattie. The results of the project, the aim of which is to reduce prescribing of anti-depressants through other forms of therapeutic provision, are being evaluated, but the fact is that we need a mixture of such provision in order to deliver the same person-centred approach to mental health care that we require in other areas of health care.
I welcome the Government’s continuing commitment to tackling the stigma that is, I am sad to say, still associated with mental illness and mental health problems, with the re-funded “see me” national programme investing, with Comic Relief, £4.5 million over three years. In that regard, SAMH, the Mental Health Foundation and many other organisations are to be commended for the support that they provide to Scots who live with mental health problems.
There has been very little time to cover such a broad and complex policy area, so in conclusion I say that the Government remains committed to providing high-quality mental health services, to improving access to those services and to improving their scope and breadth, to tackling the stigma that has dogged mental ill health for too long, and to addressing the wider issues of social policy and deprivation, which are undoubtedly important factors in the social context of mental health.
Publication later this year of the 10-years-on follow-up to the Grant report to review the state of mental health services in Scotland will be crucial in giving us the national picture from the early years to later life, in showing variations, and in identifying the gaps and challenges that persist. I look forward very much to seeing that report.
I support the minister’s amendment.
16:20
We should always begin health debates with positive stories, and it is very easy to find them because we have that wonderful organisation Patient Opinion here this week. Earlier today, I asked it for feedback from patients on mental health services. It had received many excellent stories about good services from the health service in relation to mental health. It is clear that we should learn from those stories and that everyone should seek to emulate that example.
However, it is always our duty to highlight problems, as well. Psychological therapies are a good example in that context. There has been some general progress on waiting times, but we know that there are problems. That is captured in the motion by the figure of 13,986 people waiting, but it is crystallised for me by two constituency examples that I have heard of this month, which involve people who have had problems that relate to that area of the service. An adult woman with anxiety was desperate to get psychological therapy of some kind, but all she was offered was medication, which she would not take because she knew that it would have adverse side effects on her. The other example involves a parent of a teenage daughter who has profound anxiety and self-harms. It took several years for her to be accepted as a patient by specialist services. Now that she has been accepted as suitable, she has a further wait for treatment.
For me, that raises three questions about psychological therapies. The first is on the waiting time issue. Things have certainly got a lot better, but is the waiting time for assessment or treatment? They may not always be the same thing.
The second question is this: What are the criteria for acceptance by specialist services? There must be fear of a trade-off between the eligibility criteria and the waiting time. I do not know whether that happens, but it is clear that one way of coping with waiting time pressures would be to take only people who are more seriously ill. The forthcoming SAMH research, which Jim Hume referred to, is related to that. We are told by SAMH that GPs are uncertain about the assessment criteria.
Thirdly, what is the range of available psychological services? At a meeting of the cross-party group on mental health about a year ago, we dealt with psychological therapies, and Donnie Lyons pointed out that the Mental Welfare Commission for Scotland was concerned that psychological treatment in the NHS may extend only to cognitive behavioural therapy—not that there is anything wrong with that—and that patients may not get a real choice of therapies. That was reinforced by a letter that I received from the minister a couple of weeks ago that said that only five child psychotherapy trainees started in October. Do we have a sufficient range of psychological therapies?
I have mentioned Donnie Lyons, so it is appropriate to pay tribute to all his work as director of the Mental Welfare Commission for Scotland, from which he retired two days ago. As I am talking about people who retired two days ago, I should also pay tribute to Sir Harry Burns, who is the most outstanding chief medical officer we have ever had. He is, of course, relevant to this debate, because one of his many passions was prevention of mental ill health through development of early years services. That is a very important dimension of Scottish Government policy in which there has been a lot of good work—in particular, targeted work on the early years.
You are in your final minute.
We should also remember that we need services that are available for all young people. In that regard, the Place2Be project is really good, because it is available to all children in primary schools where it applies—for example, in Forthview primary school in my constituency. I hope that that work can be generally extended.
The second half of my speech will disappear—obviously, I was going to praise the Labour amendment. It worries me that although the Mental Health (Care and Treatment) (Scotland) Act 2003 placed a duty on health boards to provide sufficient services and accommodation for young people up to the age of 18, that still has not been achieved. I was going to talk about many other concerns about the revision of the act that came up in the cross-party group on mental health last Wednesday, but that will have to wait for another day, because my time is up.
16:24
As my niece is a psychologist for NHS Borders, I know that mental health is a major issue, but I was not aware of the magnitude of the problem. As Neil Findlay pointed out, more than a third of Europeans will be affected by mental illness this year, and depression is the leading chronic condition in Europe. I was astounded when I found out that the World Health Organization predicts that depression will be the second-biggest health burden by 2030—second only to HIV/AIDS.
Depression is perhaps the problem that I have seen most closely in my family. My father suffered from a degenerative illness in later life and ended up with depression in a big way. That is one example of how people can move into being depressives, but there are many others. At the Health and Sport Committee last week, Lexi Parfitt of SAMH said:
“We know from decades of research about the complex interaction between poverty and mental health, and we know that poverty is both a cause and a symptom of poor mental health. ... If a person is mentally unwell, it can be quite difficult for them to deal with bills and so on, which makes them more vulnerable. For example, bipolar is characterised by extreme highs followed by extreme lows. When people are in their high period, it is not uncommon for them to give money away and spend money left, right and centre, which leaves them quite vulnerable.”—[Official Report, Health and Sport Committee, 25 March 2014; c 5117.]
Taken with all the experiences through life, that vulnerability can be overwhelming to someone who is suffering with mental health difficulties. If we add the difficulties of making claims in a complex welfare system, the sense of being overwhelmed can prevail.
It is perhaps only now that I really appreciate the “Mental Health Strategy for Scotland: 2012-2015”. It is essential that a system is in place for family and carer support, because without it the pressures of living and working with a sufferer can be extremely damaging. I am proud that Scotland is the only country to have introduced a waiting time target for access to psychological therapies. I understand that there are problems, however.
There is focus on increasing support for self management and self-help approaches, and there is work being done on the anti-stigma and anti-discrimination agendas, focusing on the rights of people with mental illnesses and developing the outcomes approach to include personal, social and clinical outcomes.
I was surprised that some issues to do with GPs’ surgeries were also raised last week, because I had not thought about them before. Many sufferers of mental health conditions find going to the doctor’s surgery difficult. As well as the problem of arranging the appointment with the receptionist, which can be overwhelming, people have to deal with doctors who do not know them, so they may feel that they are being passed around. All the pressures add up and can engulf people who suffer from mental health issues.
I am running out of time. I end by paying tribute to those who work within the see me campaign and SAMH’s campaigns. Each and every one of us should fight the stigma of mental health difficulties. I am sure that the £4.3 million that came from the Scottish Government and Comic Relief will be well used and appreciated, but we can all do more to bring the issue into the mainstream and to get people talking about it. We should not be scared to talk about it. People should hear the idea that they are not unusual if they are sufferers, and the more help that we can give people, the better.
16:28
I thank Jim Hume and his Liberal Democrat colleagues for bringing this debate to the chamber. Although there is some contention among the parties on what response is appropriate from the Scottish Government, there is something approaching unanimity across the Parliament in recognising the importance of mental health as a public health issue. That has not always been the case.
I want to look in particular at the importance of poverty and its impact on mental health. Deprivation can be both a cause and an effect of poor mental health. That should be reason enough for us all to worry, but inflation has outstripped wage rises for every month bar one over the past four years, and the average household has seen a drop in income of between £1,200 and £1,600, which has created the new phenomenon of widespread in-work poverty. Child poverty, which we pledged as a country to abolish, is instead set to rise again, and if we can expect an increase in mental health issues to match those increased levels of poverty, it is even more worrying that the welfare systems that we should be able to rely on in times of need are now in danger of making things worse.
The welfare state that was established to give us peace of mind in times of economic difficulty is now being used to make judgments about those of us who might at some point need some support and—which is worse—is becoming a system that actively discriminates against people who suffer from poor mental health.
At the Welfare Reform Committee earlier this week, Inclusion Scotland was just one of the organisations that presented powerful evidence on the impact of sanctions on some of our most vulnerable citizens. It highlighted that Department for Work and Pensions figures that were released in February 2012 showed that about 45 per cent of employment support allowance sanctions are given to people with mental health conditions, learning difficulties or behavioural conditions such as autism, even though they make up only about 30 per cent of ESA recipients.
The Jimmy Reid Foundation produced a paper just last month entitled “In Place of Anxiety—Social Security for the Common Weal”, which describes how welfare systems are being calibrated to create an environment of fear and insecurity—evils that can take just as much of a physical and psychological toll on people as poverty itself.
The University of Glasgow’s paper “General Practitioners at the Deep End” is based on a survey of doctors working in the 100 most deprived general practice areas in Scotland, who were asked how austerity measures are affecting them. Their central concern was to highlight the number of patients with deteriorating mental health, and they identified a problem at two ends of the mental health spectrum: on the one hand, there is an increasing amount of in-work stress and pressure of job insecurity, and on the other hand, there are people who have been assessed as being fit to work but who are suffering from chronic mental health issues.
SAMH intends to publish next week an even more detailed report on mental health that is based on a survey of its clients and staff that reveals their everyday experience of the subject. I know that the Scottish Government and the Parliament’s Welfare Reform Committee will greet that with interest.
The evidence that has been given to Parliament makes it clear that claimants and observers alike regard the welfare reforms as punitive and unfair actions that strip people of their respect and dignity, and that instead of improving our wellbeing, are contributing to poorer mental health. I certainly do not hold the Scottish Government responsible for those developments, and I believe that we are usually united against the Conservatives on welfare reform. However, we also have to ensure that in introducing mitigation measures we do not implicitly or inadvertently repeat the same judgments—for example, it is clear that claimants of crisis loans from the Scottish welfare fund are more likely to receive vouchers than cash. There is an implicit judgment there that, at best, we do not trust people with cash and, at worst, we assume that all claimants are potential fraudsters.
Mental health is not just an issue for our health services to cope with; it is a set of attitudes, a prejudice or a stigma that we all have to overcome individually and as a society. We have to be careful that we do not make things worse through our public policies and our social and economic policies.
16:32
I am glad to have been given the opportunity to talk about mental health issues here today. A number of members have looked at some of the positives that have happened in that regard in the past number of years, and long may that situation continue.
However, like Mr Macintosh, I think that a number of major issues are holding Scotland back from being able to improve its mental health. I think that the key to that is welfare reform. As Mr Macintosh has, I have heard at the Welfare Reform Committee many stories that are horrid, to say the least. Iain Duncan Smith has said that he is on a “historic mission”—as William Wilberforce was in his campaign to end the slave trade—to help people “break free”. I would not describe the welfare reform policies in that way. The welfare reforms are stripping people with mental health issues of their independence and dignity and, often, of their hope.
Donald McKenzie from Support in Mind Scotland said at the Welfare Reform Committee:
“The impact of ESA has been devastating on the mental health of claimants, who have been stressed and often traumatised by the process. They have been made to feel like frauds for suffering poor mental health, and have been disbelieved by the Atos staff carrying out the assessments. I believe that many medical examiners have little experience of mental health issues, do not take into account any additional evidence from other mental health professionals, and do not seek supportive evidence from GPs and so on. Our service users are baffled and angry that they are subjected to this distressing and stressful process when they are clearly unfit to work. The process itself causes deterioration in mental health and leads to further depression and anxiety.”
Later in his evidence, that gentleman said:
“My job should be about helping people to feel better about themselves in order to improve their mental health, but in reality most of my work is on benefits, in which I have to talk people down and dig into the dark corners to get information. A person who has made a recent suicide attempt will get 15 points and will get their ESA.”—[Official Report, Welfare Reform Committee, 18 February 2014; c 1247, 1270.]
That is a sad indictment of the Tory-Liberal welfare reforms. If Mr Hume is truly serious about improving Scotland’s mental health, he will have to look closely at his Westminster Government’s welfare reforms, which are having a major effect on people’s lives.
Inclusion Scotland has an informative news section on its website. One story, about a woman in her early 50s, states:
“The Mental Welfare Commission for Scotland said the woman ... took her own life less than a month after an Atos assessor gave her zero points in a work capability assessment and docked her weekly benefits by nearly 30%.
The MWC said it could find no other reason why the woman, named only as Miss DE, would kill herself at her home on New Year’s Eve 2011.
She had no history of suicidal behaviour, was hoping to return to work and was about to get married.
After an exhaustive investigation, including interviews with all the mental health professionals involved in her treatment, her GP, friends and local welfare rights team and the Atos and Department of Work and Pensions (DWP) staff involved in her case, the commission concluded the assessment was to blame.”
If we want to improve mental health in this country, we must stop those unfair work capability assessments.
We move to the closing speeches.
16:37
I thank Jim Hume for the way in which he opened this short debate, which turned out to be two debates for the price of one. I will concentrate on the motion and the amendments in the name of Mr Matheson and Dr Simpson, which are much more consistent with the longer narrative that the Parliament has had in dealing with mental health issues than the more pejorative argument that has been made, which I leave to find its place in another and more appropriate debate.
One of the great strengths of the Scottish Parliament has been the leisure of time over the past 15 years for an issue such as mental health to be properly explored and discussed. That has led to an appreciation from all parties in the Parliament of what needs to be done and support for a strategy to take that forward. At the heart of that has been an understanding that the need for public perception to change must underpin a successful mental health strategy. Public perception has been slow to change, but there are now suggestions that it is changing. I think that people now understand the way in which mental health issues underpin many other issues that we have spent time debating, such as alcohol and drug addiction, eating disorders and obesity, and crime.
We tend to talk about the preventative agenda in the sense of preventing cancers or other diseases, but I think that we recognise that, if that agenda is to be as comprehensively appreciated and applied as it should be, it has a role in the delivery of a successful mental health strategy. As the minister said, if we are to have a comprehensive health response, we should see no division between physical and mental health. The Scottish Conservatives continue to believe that there is a small role in that for forgetting the silos and having a universal GP-attached health visiting service for families with children in the early years. I do not mean that that is the ultimate solution, but it would be the beginnings of the kind of comprehensive preventative strategy that, with everything else that has been discussed, would make a contribution.
Neil Findlay said that mental health issues are some of the most prevalent conditions of our time, but I wonder whether the situation is so different now, or whether it is just that populations across Europe now understand that what they previously dismissed or denigrated are very real health conditions, and we are successfully diagnosing many more people’s mental health problems. Hopefully, through that initial diagnosis, we will have an effective strategy and treatment will be successful.
The consultation on the forthcoming mental health bill is now at an end. In the Public Petitions Committee, we have heard from people involved in the process and people who suffer from mental health problems about their strong and passionate views on electro-convulsive therapy. It occurred to me that it is very important, as we move forward with a mental health bill, that we do not look as if we are talking down to people who are suffering from mental health issues and instead involve them, and the see me campaign and SAMH, in the comprehensive work that the bill seeks to develop.
I endorse—particularly as the issue came before the Public Petitions Committee—Neil Findlay’s comments about Amanda and Frank Kopel and their campaign for support for people with Alzheimer’s under the age of 65, which is currently not available in the health service. There is an opportunity for all parties to consider their response to that appeal before manifestos are produced in 2016. The Scottish Conservatives are certainly listening.
It has been a short and slightly more controversial debate than might have been anticipated, but I think that, at heart, the chamber understands—and all parties understand—the collective need for a response from this Parliament to take forward a successful agenda on mental health.
16:41
I draw members’ attention to my entry in the register of interests, as I am a fellow of the Royal College of Psychiatrists, honorary professor of psychology at the University of Stirling and a member of SAMH.
I agree with Jackson Carlaw that this has been a useful debate. Before I address it, I will just say that the judgment from the Scottish Information Commissioner on further transparency in relation to NHS Lanarkshire’s mental health services is welcome, as is the minister’s commitment on better data, because transparency on data is vital.
I want to concentrate my comments on child and adolescent mental health services. We all acknowledge the challenge facing all our services, and the Government, in achieving our shared aspiration of good, accessible CAMH services. The Government’s target of 26 weeks and a further reduction to 18 weeks is very welcome. However, the difficulty of achieving that will be quite significant, particularly in relation to psychological services. A number of members have referred to that, and Jim Hume’s fairly forensic analysis was an important contribution.
Jim Hume, Neil Findlay and Nanette Milne reminded us that health inequalities in the mental health field are stark and sometimes unrecognised. As Ken Macintosh and Kevin Stewart said, that is likely to increase in the current economic climate and in response to welfare reform. The issue of mental health is not properly dealt with and not well recognised under welfare reform.
In our amendment, we were referring to tier 4 services. As was mentioned by Nanette Milne and indeed the minister, service redesign is very important in preventing admission—that is welcome in Fife and the Borders and the examples given—but the increase in admissions of children to adult wards, which reverses the previous trend, is a worry. The Government needs to review the cuts in the previously agreed bed capacity for child and adolescent services, because we have not got that quite right.
My colleague Neil Findlay showed the reduction and proposed further reduction in educational psychologist posts and other services in the local authorities against the background of underprovision in clinical psychology.
Much has been said today about psychological therapies. Does Dr Simpson share my concern that psychological therapies do not necessarily address the needs of every person with a mental illness and that, in many cases, they actually need a psychiatrist?
I will come on to that. Early identification of mental health problems is vital, so we really need to look at the tier 1 and 2 services, which are considerably less expensive than the tier 3 and 4 services to which the member was referring.
I join Malcolm Chisholm in praising the Place2Be project in Edinburgh, which involves 10 schools now and has been followed by Glasgow and East Lothian. I commend to the minister the development of such counselling services in schools, as they take the weight off child and adolescent mental health services.
Another programme is the one that is run by the Foundation for Positive Mental Health. Dr Alastair Dobbin, an Edinburgh GP, has trained hundreds of general practitioners in the promotion of wellbeing, which is also important, as are the services in Aileen McLeod’s constituency that she referred to.
The Scottish Parliament and the Government face challenges across the NHS and the social care sector. However, mental health remains one of the greatest, and we must unite as a Parliament to try to develop all the services to improve the welfare of those who have mental health problems.
16:45
This has been a useful debate. I want to draw it together in a consensual fashion, because our mental health debates have largely had a consensus around them.
I am sure that members will recognise that, when we published the mental health strategy in 2012, it was in order to build on the good work that had already been done on the back of the earlier strategy and to continue to make that progress and increase the pace where possible. There was also a strong consensus among stakeholders that that was the right approach to take, and that we needed to build on the previous commitments and continue that progress.
Some members have asked about what progress has been made. The Scottish Government website keeps up-to-date information on the 36 commitments that were set out in the strategy. Seven commitments have been completed; 23 commitments are well under way; and four commitments are scheduled for work in 2014-15. A considerable amount of work has already been done as part of the implementation of the mental health strategy.
Jim Hume and others have mentioned the Grant report, which was extremely useful 10 years ago in providing us with an insight into the situation in our mental health services at a national level. The work that we are presently undertaking, which has already been commissioned, will enable us to get another report, 10 years on, to see exactly what progress has been made since 2003, and also to see where the challenges remain, which will enable us to focus in on them much more effectively. To complement that, later this year we will undertake a one-day census of the in-patient estate. That follows on from the successful pilot that we ran in NHS Greater Glasgow and Clyde last year. Along with the 10-year update report, it will give us a fantastic level of data on and insight into the state of our mental health services across the country, which will enable us to identify where we need to make further progress, and how we can focus in on those areas.
Just about every member who has spoken referred to psychological therapies. A key part of introducing the HEAT standard was to drive up improvement in the service. It was a stretch target. I know that the system is not perfect, but the target was introduced to drive further improvement in the system. The latest data shows that the average wait for access to psychological therapies is nine weeks. I recognise that there are variations in different parts of the country. The work that we are undertaking with the Information Services Division around the data that we receive from boards is being done to ensure that we can apply further pressure to those boards where there has been insufficient progress, to drive further progress in accessing psychological therapies.
Malcolm Chisholm mentioned the 18-week target. That is for treatment, rather than referral—it is for the period from referral to treatment. Also mentioned was the range of psychological therapies that are available—there are more therapies than just CBT. A couple of years ago, we published the treatment matrix, which contains a range of evidence-based treatments and psychological therapies that can be provided through NHS Scotland. I am conscious that some people would like different kinds of counselling to be included in the treatment matrix, but we have taken forward the matrix on the basis of clear, clinical evidence that a treatment can provide a better outcome for individuals.
A couple of members may be interested to know that, for access to psychological therapies, the waiting time in the Borders, Dumfries and Galloway and Highland is six weeks and in Fife it is 10 weeks. Those are improvements on what happened previously.
A number of members, including Neil Findlay and Richard Simpson, referred to improving access to CAMHS. Richard Simpson was on the Health and Sport Committee with me in a previous parliamentary session, when we considered CAMH services. It was clear that they had been chronically underfunded since the beginning. Investment had just not been made in CAMH services, but a significant level of funding has been introduced over recent years, which has allowed an increase in the level of service that can be provided to speed up access.
Will the minister give way?
Do I have time, Presiding Officer?
Not much, but on you go.
I support a great deal of what the minister said, but I say gently that, at some point, we have to have a serious discussion about the funding of local government and community services that provide support to people with a range of health problems, particularly mental health problems.
The Labour Party is free to propose a debate on that issue if it wishes and we can respond to such points. However, there has been a significant improvement in CAMH services. For example, in the Borders, 99 per cent of CAMH patients are seen within 18 weeks, with the average wait being three weeks. In Dumfries and Galloway, 100 per cent are seen within 18 weeks, with the average wait being seven weeks. When I was on the Health and Sport Committee, we did not even have that type of data. We had no idea how long it was taking for people to access those services. It is extremely important that we recognise the level of improvement that has already been achieved in those services, but it is also important that we build on it in the years to come.
As I said, the debate has been useful. Members can be assured that mental health will remain a clinical priority for the Scottish Government. In doing that, we will be able to continue to build on the improvements that have been made in recent years.
16:51
I am delighted that we have had the debate and I am proud of the fact that Scottish Liberal Democrats have enabled it to happen. It has certainly been all too brief but, nonetheless, it has provided an opportunity to reflect on an issue that, despite the various debates that we have had, often still struggles to gain the attention that it deserves.
The conclusion that I draw is that it is now time for mental health to enjoy parity of esteem in legislation with physical health. The minister argued entirely justifiably that progress has been made and that measures are in place to go further on targets, data and service improvement. Nevertheless, that still falls short of putting mental health on an equal legislative footing with physical health, and we need to go further.
As Jackson Carlaw said, it has been a good debate. It has rightly and helpfully drawn on the personal experiences of a number of members. Nanette Milne reminded us of the practice in Fife that is delivering real benefits to children and adolescents. Aileen McLeod talked of an initiative in the south of Scotland that is reducing patient dependence on medicines. Malcolm Chisholm was building up to give us a raft of good examples of excellent practice. We need to bear that in mind as we advance the debate about where we want improvements to be made.
That personal approach should surprise no one. One in four of us will suffer poor mental health at some point in our lives, while three quarters of us know someone with a mental health problem. I am among that 75 per cent. A couple of years ago, I attended the funeral of a good friend—a former colleague and flatmate—who tragically took his own life after a long battle with depression.
I first met Andy in the House of Commons, where we started working around the same time following university. It was immediately clear that he was a class act. He was a passionate advocate for the causes that he cared about, notably the environment—and that was at a time when environmental issues were still dismissed as the obsession of a loony fringe. Andy combined that passion with a real political insight, a wicked sense of humour and a generosity of spirit that made him brilliant company and a privilege to know. However, there was always a sense that he was keeping something back—aspects of his life that he was reluctant to share.
It emerged only later that he suffered serious and utterly debilitating bouts of depression. During those times, he would retreat completely from the world, cutting himself off from family, friends and anyone else who might have been able to help. I am not sure what any of us could have done for Andy in the latter stages, but I cannot escape the feeling that, had he been able to open up earlier about the mental health problems that he was clearly suffering, it might have been possible to support him better and enable him to cope with the condition that, eventually, killed him at a wastefully young age. In the early 1990s, the stigma that surrounds mental health was more oppressive than it is today. It is not hard to see why opening up about a mental health problem was the last thing that a young bloke from Yorkshire who was intent on proving himself in the big city would want to do.
We have come a long way in the past two decades and more. Like Colin Keir and others, I record my admiration for the work that those involved in the see me campaign have done in recent years and I welcome the refounding of that initiative for the next three years. However, I firmly believe—I think that it has been acknowledged across the chamber—that we have not come far enough.
As Jim Hume and Nanette Milne reminded us, mental illness remains the dominant health problem for people of working age. It continues to damage careers, relationships and lives. The financial costs—let alone the human costs—are colossal.
Like others, I record again my support for the Scottish Government’s mental health strategy, which has been a welcome and important step forward. Among other things, it recognises that it is critical to provide effective treatment in a timely fashion. Such treatment can safeguard the individual’s welfare in the first instance and, without offering any guarantees, it increases the chances of a person enjoying good mental health subsequently.
That is why the waiting time target to which the minister’s amendment refers is particularly welcome. However, as Jim Hume said, after encouraging early signs of progress towards meeting the target, recent figures suggest that we are moving in the wrong direction in some cases.
There are regional variations between health boards, which open up the prospect of a postcode lottery—Malcolm Chisholm gave us an illustration of that from his constituency. Additional experts have been recruited, but there is evidence of variations in the per capita ratio of psychologists in different parts of the country. That concerns the only element of the Government’s amendment with which we perhaps have a problem. I have no doubt that the situation partly reflects increased public awareness, which is very welcome. However, I presume that a rise in referrals was expected when targets were set and resources were allocated.
Variability is also a feature of the conclusions from SAMH’s know where to go campaign. It found that people who live in remote and rural areas, people from black and ethnic minority communities and people who live in deprived areas face additional barriers to accessing information, help and support. Multiple health and social problems, reduced expectations and lower health literacy have all been found by SAMH to contribute to poorer outcomes in more deprived areas. Ken Macintosh, Neil Findlay and others reasonably made that point.
As Jackson Carlaw suggested, the only discordant note was in Kevin Stewart’s speech. That speech would have carried more weight if the white paper contained evidence about where the additional resources would come from or about a different approach being mapped out for welfare reform.
Rural areas suffer from specific problems. Orkney minds and Orkney Blide Trust do phenomenal work in the islands that I represent, but a culture of self-reliance and stoicism can work against efforts to get people with health issues, including poor mental health, to engage early with medical professionals. Even when the wider community is a source of support, that can almost make things more difficult and increase the fear of stigma for not just the individual but their wider family. SAMH makes similar points about ethnic minority communities. In both instances, the result is delays in people seeking help for mental health problems. That matters because, as SAMH explains,
“The later individuals engage with health services, the more complex their treatment and recovery”
will be.
As I said, we very much support the Government’s strategy on waiting time targets and on the data to inform future decisions. The 10-year follow-up to the Grant report is welcome and I hope that it will address some of the concerns that Richard Simpson raised about children spending time on adult wards, whether through the provision of additional beds or through a service redesign. That issue needs to be addressed.
Despite the Government’s strategy and the efforts of see me and other excellent initiatives in recent years, it is clear that mental ill health is still taboo for too many people. As Nick Clegg pointed out when launching a UK Government action plan on mental health recently, the treatment of those who suffer from mental ill health is
“outdated; stuck in the dark ages; full of stigma and stereotypes.”
He is right.
One speaker at the see me event in Parliament that Fiona McLeod hosted recently defined stigma as making someone go from feeling whole and usual to feeling tainted and deficient. That is simply not right. It is also one of the strongest reasons why putting mental health and physical health on an equal footing in law makes sense. Discrimination that we would not see against those who have a physical disability or condition is still all too common against those who have a mental health problem.
The issue is not whose strategy is best but how one can learn from others in the interests of meeting the needs of those who suffer poor mental health. In all parties across the chamber, there is an appetite for the issue to be discussed more openly, taken more seriously and addressed more effectively. Mental ill health is not a second-class condition. Ultimately, there is no good health without good mental health. I support the motion in Jim Hume’s name.
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