The next item of business is a debate on motion S4M-12492, in the name of Jim Hume, on mental health. I ask members who wish to speak in the debate to press their request-to-speak buttons now or as soon as possible.
Before I call Mr Hume to speak to and move the motion—if he is ready—I advise the chamber that we are now extraordinarily tight for time and I must ask members not to exceed their allocated time. Mr Hume, you have 10 minutes.
15:55
At the outset, I must underline the importance of our hard-working and dedicated front-line national health service staff, who are the backbone of the service and deserve every support from Government.
We know that for too long now many patients with mental ill health have suffered in silence. Thankfully, much progress has been made in breaking the stigma attached to mental health and individuals are now taking the brave step of telling their general practitioner that they have a problem or of talking to a friend, relative or charity. It is therefore frustrating and upsetting that when they find the courage to come forward for help they cannot then get the treatment and support that they desperately need.
We have only to think of the 795 suicides in 2013 to remind ourselves that ensuring early access to mental health services is vital. We should commend the choose life campaign’s excellent work and the huge advances that it has made in tackling suicide rates in Scotland, but we have to build on that and look at a zero-tolerance ambition to engender a cultural change and ensure that mental ill health is treated before people get to that desperate stage. Disappointingly, last week’s figures from the Information Services Division highlight once again the continued problems that face mental health services across Scotland and, although today’s debate presents a timely opportunity for the Parliament to give this important area of health and patients affected by mental health issues the prominence that they deserve, I find it worrying that the same old story of missed targets has been repeated.
The bottom line is that the Government is simply not delivering for patients suffering mental ill health, and a worrying fact is that mental health has become the Cinderella service of the NHS. To illustrate that point, I will refer to last week’s figures. With regard to child and adolescent mental health services, we know that, nationally, the new 18-week target is not being met. When the figures are broken down, we see that five health boards are still failing to meet the old 26-week target and that only half are meeting the new treatment target of 18 weeks. The figure for educational psychologists is at a dangerous low and, as far as adult psychological services are concerned, the 18-week target is once again not being met with 15.5 per cent of patients facing waits of 19 to 35 weeks and 4.4 per cent of patients waiting a staggering 35 weeks for treatment. Young and vulnerable people are repeatedly being let down by ministers.
Because of the lack of facilities and specialised wards, children and adolescents are being forced to seek treatment in England, but the harder adjustment to periods away from home often aggravates their conditions. There are currently no secure in-patient facilities for children in Scotland, and their treatment has to be planned on an ad hoc and temporary basis. There are no in-patient facilities at all for young people with mental health problems in Aberdeenshire; the closest such facilities are located more than 50 miles away in Dundee. As my colleague Alison McInnes has often pointed out, that causes young people and their parents even more distress.
The Mental Welfare Commission has identified that last year 202 children were treated in adult wards, and Kindred Scotland, which supports around 900 families with children that have additional support needs, has told me that around 60 per cent of those families have a mental health referral. These organisations are raising a red flag about the increasing need for child and adolescent mental health services to be delivered, because some families are reaching crisis point before they are able to get a diagnosis. That is leading to those families being isolated at a time when they need urgent access to staff, behavioural support services, specialist schooling and even medication, which they cannot get without CAMHS support.
We know that, without proper early support, young people run the risk of self-harm. That is reflected in the BBC figures, which show that the number of young people who have been admitted to hospital for self-harm has doubled in the past five years in some areas of Scotland.
The fact that the Government has let that concerning trend occur is a reflection of its failure to provide adequate resources and early support for mental healthcare. To do so is crucial. By focusing resources where they are most needed to encourage early intervention, we can reduce the number of youngsters who are admitted to hospital for self-harm and pull people back from the brink of suicide.
The member says that there should be more resources for mental health. Does he have any suggestion about where they would come from? Would they be from the physical health budget?
If we look at the Government’s record on the matter, we see that it has reduced its funding for the mental health research budget from £4 million in 2008-09 to just £860,000. Therefore, it is about prioritisation.
The ministers have to listen to the experts who are warning about problems in training, recruitment and retention of the mental health workforce. The Scottish children’s services coalition has told me that it considers that the red flag has been raised on an impending tipping point in respect of educational psychologists across Scotland. In 2012, the Government removed the funding for bursaries paid to each trainee, which resulted in a drop of 70 per cent in the applications for those courses. The number of children with additional support needs has more than doubled—the figure reached 140,542 children in 2014. That means that there is one educational psychologist for more than 356 children.
Sadly, that intense workload is being echoed across other fields in mental health services, including adult psychological treatment services, where a particularly worrisome rising trend seems to be developing.
Two fifths of general practitioners are not referring patients for psychological treatments because of the ballooning waiting times, or just a lack of provision. It is not just me who says that; the GPs themselves say it. I will quote the words of two GPs who responded to a Scottish Association for Mental Health survey. One said:
“Access to psychological therapies is extremely poor with long and unacceptable wait times. GPs feel under pressure not to refer people to already stretched services”.
The other said:
“We do not have adequate access to non-pharmaceutical treatment options. We have NO access to psychological therapies in our remote rural area. It makes me very angry”.
Mr Hume mentioned the SAMH survey of GPs. Does he recognise that, when he talks about 40 per cent of GPs not referring due to a lack of availability, that figure is actually 40 per cent of those who said that they had not referred? When we looked at the figures, it was actually 8 per cent of all the GPs responding—I confirmed that with SAMH when I discussed the matter with it.
The minister will have to go and get SAMH to put that on the record, as that was from its briefing. Ministers have sidelined mental health issues again.
Although the Government claims to have improved the services by hiring more people and reducing wait times for numbers of patients, last week’s ISD numbers tell another story. Only 81 per cent of patients who were referred for adult psychological therapies began their treatment within the 18-week target and only three of the 14 NHS boards reached that target. What about those patients who waited or have been waiting for more than 18 weeks and the nearly 250 patients who have waited for more than an entire year to begin their treatment? If the Government believes that there are sufficient resources, that is not reflected in the views of the professionals or the charities or, indeed, the statistics.
That is a worrying prospect, given our ageing population, who often present with complex mental health needs. Indeed, the British Psychological Society has underlined the disparity in the number of psychologists who are employed in older adult services, who are only 35 out of a workforce of approximately 726 whole-time equivalent psychologists. That places older adults at a marked disadvantage in their access to specialist psychological assessment and intervention.
Just last year, we were promised a report by the then Minister for Public Health that would follow up with a 10-year review of the Grant report of 2003 by the end of 2014. I look forward to the new minister addressing that issue.
When the mental health strategy was published in 2012, the Government said:
“Improving mental health and treating mental illness are two of our major challenges.”
However, we know that the mental health research budget has been cut from £4 million in 2008-09 to £860,000 this year. That is about Government priorities. The warm words do not stack up against the fact of such a drastic cut. I hope that the minister will update Parliament on what shape any new strategy will take beyond 2015.
Surely one of the biggest health inequalities in the NHS is the treatment of mental ill health. There is an obvious lack of parity between what the system deems acceptable for someone with a physical health complaint and what it deems acceptable for someone with a psychological health complaint. We would not allow someone with a broken bone to wait for months to be seen and treated, so why does the Scottish Government allow people with mental ill health to wait for more than six months or, in some cases, more than a year for treatment? I hope that ministers will agree that that situation needs to be addressed by putting mental health on the same footing as physical health. I urge the Scottish Government to follow the United Kingdom Government’s lead and lay out clearly in legislation that mental and physical ill health are recognised equally.
I move,
That the Parliament notes that one in four people will experience a mental health problem during their lifetime; considers that providing appropriate treatment and support is critical to improving people’s wellbeing; notes the recent worrying figures that show that targets for child and adolescent mental health services and for adult patients referred for psychological therapies continue to be missed; notes that children and adolescent self-harm has doubled in some parts of Scotland; notes that 795 people died by suicide in 2013 in Scotland and calls on the Scottish Government to report to the Parliament on progress on its 36 commitments in the Mental Health Strategy for Scotland 2012-15, to ensure that parity is enshrined in law for the treatment of mental and physical ill-health, to commit to a zero suicide ambition and to adequately resource mental health services, and expresses its support for Scotland’s dedicated and committed NHS staff working in this critical area of health.
Thank you for your brevity. I now call Jamie Hepburn. Minister, you have up to seven minutes.
16:05
I will try to respond to some of the points that Mr Hume and others raised in my closing speech, but at the outset I emphasise that I very much welcome the opportunity of a further debate on Scotland’s mental health. I believe that this is the third parliamentary debate that we have had on mental health in this calendar year. In the first debate, which I secured immediately after the Parliament returned from the Christmas recess, there was a clear consensus that we should debate the subject more often. I am very glad that we seem to be doing so. It is vital that the Scottish Parliament engages in bringing the issue to the fore.
While trying to capture the essence of the motion, my amendment also tries to place matters in a better context. I believe that Dr Simpson’s amendment also does that, to an extent. If the Government’s amendment is not agreed to, we will support Dr Simpson’s amendment.
Mental ill health is an issue that touches us all, whether we have a mental health problem, are a carer for someone who has a mental health problem or have family, friends or colleagues who have had a mental health problem. It is estimated that mental health disorders affect more than a third of the population every year. It is therefore vital that we continue to break down the stigma around mental ill health.
The see me campaign, which is hosted by the Scottish Association for Mental Health, is Scotland’s national campaign to end mental ill health stigma and discrimination. We have made enormous progress in tackling that stigma, but the Scottish social attitudes survey that was published late last year showed that the work of the see me campaign is still needed, as people still experience negative attitudes because of their mental health problems. People often self-stigmatise—they avoid events and do not want to talk about their illness. The refounded see me campaign has planned activities around, for example, equality and human rights, the workplace and settings where people experience discrimination, emphasising the role that we all—employers, communities, friends, the media and others—have in ending the stigma of mental ill health.
I know that Mr Hume referred to this in his opening speech, but I set out in my amendment that we should thank and support not only our NHS staff who work in mental health but those in the third sector who work in that area. The see me campaign is a great example of that work.
There are other ways in which we can start to end mental ill health discrimination. There has been debate around parity between mental health and physical health. Mr Hume raised that point again in his speech, and I know that it is of particular interest to him and that he has raised it in the chamber on a number of occasions.
As I have set out previously, the National Health Service (Scotland) Act 1978 already states that Scottish ministers have a duty to secure
“improvement in the physical and mental health of the people of Scotland”.
However, it does not distinguish between the two areas, nor does it place a higher importance on one over the other. Our Scottish NHS has a duty to promote the improvement of health—a duty that extends equally to the areas of physical and mental health.
Will the minister give way?
I am sure that Mr Hume will want to acknowledge that duty.
The minister is correct that the 1978 act, which applies to Scotland, refers to
“improvement in the physical and mental health of the people of Scotland”,
but the Health and Social Care Act 2012, which applies to England, refers to improvement
“in the prevention, diagnosis and treatment of physical and mental illness.”
It highlights those things separately.
Of course. I expected that Mr Hume would raise that point, and I am aware that that is what section 1 of the Health and Social Care Act 2012 says. Presiding Officer, let me read out for you and members in the chamber what section 1 of the National Health Service (Scotland) Act 1978 says:
“It shall continue to be the duty of the Secretary of State”—
it is now the duty of Scottish ministers—
“to promote in Scotland a comprehensive and integrated health service designed to secure—
(a) improvement in the physical and mental health of the people of Scotland, and,
(b) the prevention, diagnosis and treatment of illness”.
I say to Mr Hume that that covers both physical and mental illness. I am more than happy to discuss the matter with him, and if he believes or perceives that some form of legislative vehicle would be apposite, I am happy to consider the matter. However, it is fundamentally important that we recognise that there is already parity in legislation between mental and physical health.
I hope that the fact that my portfolio also includes sport and health improvement signals an understanding of how supporting the mind supports the body and how supporting the body supports the mind. I fundamentally believe that improved access to physical activity can make an important difference to a person’s sense of mental wellbeing, and I am determined to bring the influence of sport to bear on improving Scotland’s mental health.
However, I am also clear that we must improve access to mental health services, because some of us will experience mental health problems just as some of us will become physically unwell. That is why we have developed access targets for psychological therapies and child and adolescent mental health services.
We should recognise that Scotland was the first nation in the UK to introduce a target to ensure faster access to psychological therapies for all ages. The target for boards is for patients to start treatment for psychological therapies within 18 weeks of referral. That is a challenging target and we should recognise the work that boards have been undertaking to try to meet it. The latest data shows that the average adjusted waiting time for psychological therapies is eight weeks and that 81.4 per cent of people were seen within 18 weeks.
Some boards are doing better than others. We are offering boards support to tackle waiting lists, and progress has been made. I recognise, though, that that progress is not significant enough. I expect all boards to meet the target, and that is why we have embedded it in NHS Scotland’s local delivery plan guidance for 2015-16.
I turn to CAMHS.
You are in your final 40 seconds.
The mental health of our children and young people has been a focus of our efforts to improve Scotland’s mental health. We have increased the specialist child and adolescent mental health services workforce by almost 24 per cent since 2009, and the latest data shows that more people are being seen within 18 weeks, with an average waiting time of seven weeks. That is an improvement, but it is still not good enough. Last week, I was in contact with those health boards that did not meet the target in the latest figures, and I have been assured that we will continue to see progress.
You must close, please.
Again, I am determined that we meet that target.
Ensuring the prompt treatment of people who are experiencing mental health problems is a key priority for improving Scotland’s mental health. I am glad that we have this third opportunity in 2015 to debate mental health and I look forward to keeping a strong focus on the area and to responding to points that are raised in the debate.
I move amendment S4M-12492.2, to leave out from “notes the recent” to end and insert:
“further notes the progress made in improving access to child and adolescent mental health services, with a 57% increase in the number of children and young people starting treatment, but is concerned that the waiting times standards are still to be achieved consistently across Scotland; welcomes the reduction in stigma and the increase in young people who now feel more confident about seeking help for self-harm; commits to supporting further efforts to meet the targets for referral to child and adult mental health services and psychological therapies; believes that every suicide represents a tragedy; notes the 11 commitments in the Suicide Prevention Strategy 2013-16 to continue the downward trend, which has seen a 19% reduction in suicides in Scotland over 10 years; recognises that there must be, and that legislation already reflects, no distinction of importance between physical and mental health; expects the Scottish Government to ensure transparent reporting of progress in meeting the challenges of improving people’s mental health, including on the Mental Health Strategy for Scotland 2012-15, and expresses its support for Scotland’s dedicated and committed NHS staff and those in the third sector working in this critical area.”
16:13
I refer members to my declaration of interests. I am pleased to be opening the debate on behalf of Scottish Labour. If members will forgive me, I propose to concentrate entirely on child and adolescent services.
In 2006, the Liberal Democrat and Labour coalition laid out some challenges that were facing CAMHS. They included building the workforce and ensuring that the number of under-18s being admitted to non-specialist units was halved by 2009. Building a workforce takes time, and it is to the credit of both that Administration and the Scottish National Party Administration that, up to 2011, the staffing numbers increased, particularly in psychology and for nursing staff. However, since 2009, the number of full-time equivalent consultants has gone down, vacancies have gone up and the number of family therapists has reduced by a third. Moreover, 28 per cent of all the staff are on temporary contracts. It cannot be good for a service to have that level of temporary contracts.
The 2006 Labour Government’s CAMHS framework stated clearly that adequate—I stress that word—staffing required a minimum of 15 per 100,000 population. Today, eight years on, seven boards do not have that staffing level. Among the worst is my board, NHS Forth Valley, where the figure is 8.3.
NHS Forth Valley is also one of the worst-performing boards for waiting times. On closer inspection, we find that its referral figures uniquely exclude tier 2 provision—that is, it reports referral times only for tiers 3 and 4. Anyone who is referred to tier 2 must wait six months for an assessment—and that is not the median wait or the longest wait. Why is that board not being placed under special measures for CAMHS in the same way as the Royal Alexandra hospital and, now, the Western infirmary have been for accident and emergency services? Is that equality between physical and mental health?
The member raises the fair point that there are vacancies in CAMHS. I recommend that he include that as part of the challenge. I discussed the matter with each of the health boards last week, and he will accept that the health boards are trying to fill those vacancies.
Yes, I accept that. However, in 2009, when the Mental Welfare Commission welcomed the fact that the target had been reached, halving the number of admissions to non-specialist units, it emphasised that the progress had to be maintained. Labour had planned new and refurbished in-patient specialist beds to take the number up to 57. Unfortunately, in an answer to a parliamentary question in October, the SNP confirmed that only 42 beds are currently commissioned, with six more to be opened. That is still only 48 beds, and the result is that the number of admissions to non-specialist units reported by the MWC has risen by 40 per cent, from 141 in 2012 to 202 in December. My question to the minister is this: what target has he set for progress on reducing such admissions, either by providing more beds or by having more of the innovative intensive community services such as we have in Fife?
I always praise the Government when it does something right, and the introduction in 2010 of the UK’s first health improvement, efficiency and governance, access and treatment targets for waiting times, of 26 weeks by March 2013 and 18 weeks by December 2014, was welcome. However, last year we saw an increase, from 20 to 226, in the number of patients waiting for more than 52 weeks, and the 26-week target—not the 18-week target—has still not been met by five health boards. The SNP also promised last year that the 10-year follow-up to the 2003 Scottish needs assessment programme report would be published in 2014. When will it be published? It has not yet been published.
I will finish on a concern that, I believe, the Government must investigate. The latest ISD Scotland figures are no longer developmental but are now credible. In the past year, out of 26,800 referrals, 5,100 were “rejected”. When I asked the ISD about that, it said that they were “deemed inappropriate”. One in five referrals was rejected. Once again, and for the first time since the waiting list scandal in NHS Lothian, we see a massive variation in the number of rejections. In one board, the figure was 5.6 per cent; in one of the island boards, it was 0 per cent, but perhaps that is not relevant; and there were clusters in which the figure was between 11 and 13 per cent, which may be more relevant. However, in two boards, more than 27 per cent of referrals were rejected. There are clear guidelines on their websites about what patients are referred for, yet more than one in four patient referrals are being rejected. The cabinet secretary must investigate that extraordinary variation and, more important, what then happens to those rejected children.
You must close.
I welcome the £15 million of support for the mental health programme, but if mental health services had received the same share as they received in 2009, they would currently be £75 million better off every year. They are being short changed.
I move amendment S4M-12492.3, to leave out from “notes the recent” to “missed” and insert:
“while welcoming the HEAT waiting time targets for child and adolescent mental health services (CAMHS), notes that both the 26-week targets for 90% of referrals for March 2013 and the 18-week target for December 2014 were not met for Scotland overall and not met by a number of NHS boards; calls on the Scottish Government to publish the 10-year follow-up to the 2003 Scottish Needs Assessment Programme report, which was promised for 2014; further calls on the Scottish Government to carry out an independent review of the referrals rejected by CAHMS and explain the substantial variation in these rejections; invites the Scottish Government to report to the Parliament on resumption of progress in eliminating the admission of children and adolescents to non-specialist settings, and notes that the target for adult patients referred for psychological therapies continues to be missed;”
16:18
I hope that it is a good sign for the many people who are waiting for help to cope with mental health challenges that this is the second parliamentary debate on mental health this year, with a stage 1 debate on the Mental Health (Scotland) Bill to follow next week. It is right that the Parliament should focus on mental health, because one in four of us will have to deal with a mental illness at some time in our lives and mental health is just as important as physical health. Indeed, our physical wellbeing is influenced significantly by our mental and psychological welfare.
The appointment of a minister with specific responsibility for mental health is, I hope, an indicator that the Scottish Government is taking the matter seriously. I welcome the tone of the Government’s amendment, which acknowledges that physical and mental health are equally important and accepts that, although progress is being made, there remain significant challenges, particularly in the provision of psychological services for children and adolescents. Moreover, it is widely acknowledged that there is a lack of provision generally, especially in deprived areas and for people with long-term conditions such as dementia, diabetes and heart problems.
With many of the commitments in the mental health strategy to 2015 as yet unmet, there is clearly no room for complacency, and increasing efforts are needed urgently to meet the needs of the many people who require help. In the short time allocated to me, I will focus on just two of the strategy’s commitments, which SAMH highlighted in its briefing for the debate.
There has been, quite rightly, a lot of comment in recent weeks on the failure to achieve commitment 13, which is to provide access to psychological therapies within 18 weeks of referral by the end of December last year, with the benchmark of success being that the target should be met in 90 per cent of cases.
In reality, only five health boards met the target. More than 16,000 people are still on the waiting list, of whom 3.9 per cent have waited for between 36 and 52 weeks and 1.5 per cent have waited for more than a year. That is not good enough. Of particular worry, SAMH has told us—although the minister disagrees—that 40 per cent of the GPs whom they contacted said that they have not even referred people recently for psychological therapies because of the long waiting times. Therefore, we have no idea of the real unmet need.
The Government faces a major challenge if the 18-week target is to be delivered before the end of this year. Beyond that, SAMH is quite right to recommend that talking therapies should be included in the 12-week target in order to put mental health on a par with physical health.
Linked to that is the failure to achieve commitment 15 in the mental health strategy, which is to increase local knowledge of social prescribing opportunities. It is well known how beneficial simple activities such as walking, gardening, art classes and just being able to talk over problems with one’s peers can be in coping with mental stress and depression. If the 90 per cent of GPs who told SAMH that they wanted more information on such activities locally had that information, the benefits in terms of early intervention and reduction in prescription drugs would, I am sure, be significant.
The placing of trained mental health link workers in GP surgeries in areas of extreme deprivation, where mental health issues are common, is a promising pilot scheme. Those workers can intervene early and signpost patients to community services and the support that comes from social activities. Now that the pilot has been extended to 2018, I hope that, in time, other GP practices will benefit from the approach, particularly as health and social integration develops and evolves across Scotland.
I agree. We hold out great hope for the pilot. I presume that the member would agree that we must thoroughly assess the efficacy of the programme before we roll it out further.
I absolutely agree. It is a worthwhile pilot.
Increasing social prescribing should not be too difficult to achieve, because many communities have the activities in place that would benefit people with mental health issues. However, improved access to psychological services will require more investment not only in trained psychologists, but in nurses who are trained in cognitive behavioural therapy and who, under good supervision and governance, can help to achieve the Government’s HEAT target on access to psychological therapies. With the commitment to caring for people in the community and avoiding the need for hospitalisation whenever possible, such investment, right across the country, is surely the way to go.
Such a short debate gives us little time to deal with the many challenges that stand in the way of achieving mental wellbeing for people who need help—from children and young adults who are dealing with depression, bereavement, bullying and the many other stresses that can become overwhelming, to the increasing number of older people with chronic ailments or who face the traumas of dementia.
Much work remains to be done, but at least that is now recognised. I hope that the mental health strategy’s next phase will focus on what remains to be achieved, with realistic targets that are aimed at putting mental and physical health on an equal footing and helping the hard-working staff in the field to get the results that they desire and which patients deserve.
We will support the motion and the Labour and Scottish Government amendments.
16:23
I, too, start my speech on this important debate by recognising and paying tribute to the outstanding work done in this area by hard-working health professionals across the country.
As we all know, mental illness is one of the major public health challenges in Scotland. Although much has been achieved, there is much work to be done as we constantly strive to improve the services offered in this field. I hope to illustrate some of the challenges faced by those working in this area and also some of the work being done to overcome those very challenges.
Jim Hume’s motion notes that one in four people will experience a mental health problem during their lifetime. I think that we know that, no matter what the statistics tell us, the reality is that many more than one in four of our population will suffer from a mental health illness at some time in their life. We can also say with some certainty that the level of demand on the health service to provide help to those who are suffering from a mental health illness is likely only to grow.
Much of that increase in demand is being driven by the hardships of modern life and, in particular, by financial challenges and poverty. I do not want to get into the impact that the UK Government’s welfare reforms and the rise in the use of food banks is having on people’s mental health and their families, but we cannot simply ignore those matters.
Our job is to debate in a responsible way what we can do to improve services for those who have a mental health illness and have decided to seek professional help. We face a growing challenge, because although we have a budget that is still rising significantly it is not able to keep pace with the sheer scale of the increasing demand. We see that challenge across the health sector in its widest sense. Frankly, we simply cannot continue to throw resources at it, because we all know how limited our capacity to do so will become as a result of further public expenditure cuts.
As Richard Simpson mentioned, it is clear that in the Forth Valley NHS Board area child and adolescent mental health services and psychological therapy services are under significant pressure. The statistics do not make comfortable reading, but that only serves to emphasise the scale of the challenge that we face.
The debate is not about statistics and numbers on a page; it is about the quality of life of individuals and their families, and what health boards, the Government and we as a Parliament can do to make improvements. No Government or health service sets out to create such conditions. They are usually the result of a range of complex circumstances that cannot easily be resolved—but resolve them we must.
To help me to understand the specific challenges that Forth Valley NHS Board faces, I asked the board to let me know what action it is taking to resolve them. It informed me that it is facing significant workforce challenges in both CAMHS and psychological therapy services. It told me that it is committing an additional £0.5 million a year on a recurring basis to that area, that recruitment is now under way for two nurses and two consultants, and that further staffing changes are being made for CAMHS.
In the area of psychological services, the board intends to recruit a new head of service and to fill five additional posts in the near future, as well as introducing additional clinics. That will depend on what the recruitment market can provide; the board faces a significant challenge in that regard. In addition, it intends to implement a number of waiting time initiatives to help improve the efficiency and productivity of its mental health services. I sincerely hope that the actions that the board is taking will have the desired impact and will lead to significant improvement.
Those with a mental health illness who rely on our health service deserve a debate that is focused on how improvement plans can help deliver change for the better. I recognise the tone of Jim Hume’s motion and Richard Simpson’s amendment, but I think that the minister’s amendment is better in capturing a sense of where we are and the context, so I will be supporting it at decision time.
16:28
Like other members, I am full of praise and admiration for those who work in mental health services.
As far as the Government’s actions are concerned, I acknowledge the continuity of policy, in general terms, between the current Administration and the previous one, and the progress that has been made in several areas, but it is right in debates such as today’s that we highlight the problems that exist. I hear of those problems in my capacity as a constituency MSP, but people also draw my attention to various issues because I am co-convener of the cross-party group on mental health.
Therefore, I am bound to be concerned about the figures for referral for child and adolescent mental health services that came out last week. Only 54 per cent of young people in Lothian who are referred are accepted within 18 weeks, and only 63 per cent are accepted within 26 weeks, which is not much higher, so it is clear that there are big issues. That is the case not just in Lothian; I pay tribute to the Scottish children’s services coalition, which said:
“We are at a crisis point and high level strategic management is required in order to get a grip on the situation.”
The question of unmet need has come up. Richard Simpson talked about the referrals that are rejected. We cannot assume that, in those health board areas in which 27 per cent of referrals are rejected, there is not a need for a service for those people. We have not heard that GPs are not referring young people because of the number of young people who are waiting for CAMHS, but we should remember the quote that Jim Hume read out and the evidence of SAMH on adult services. We can argue about the percentages, but the fact of the matter is that SAMH quoted a GP who said:
“GPs feel under pressure not to refer people to already stretched services”.
That is a very striking comment on the situation.
We are also concerned, as Richard Simpson emphasised, about children and adolescents in non-specialist settings. That issue was legislated for in the Mental Health (Care and Treatment) (Scotland) Act 2003, and perhaps we can revisit it when we return to the Mental Health (Scotland) Bill next week, as progress seems to have stalled.
The preventative agenda is clearly important, involving early intervention and projects such as Place2Be, which operates in Forthview primary school in my constituency, as well as educational psychologists, which we debated recently. The issue that I highlighted at health questions is also relevant, because the mental health problems of women around the time of birth are clearly a massive problem for them and for their children. I paid tribute at question time to the specialist perinatal community team in Lothian, but we know that many areas of Scotland lack perinatal mental health services, which are important for young people as well.
We debated eating disorders last week. Again, that is a massive mental health issue for young people. Since last week’s debate, I have had a consultation with a mother who told me that her daughter got quite a good CAMH service for eating disorders but that as soon as she turned 18 her case fell off the cliff—I am currently taking up with NHS Lothian what is available for her now that she is designated as an adult.
Clearly, the wider preventative agendas are important. The choose life and see me campaigns have been mentioned, and I was pleased to be associated with those great campaigns when they started, but more needs to be done there too. In the previous mental health debate, I paid tribute to Laura Nolan from Edinburgh, who was nominated as one of the Evening Times women of the year, and the work that she is doing to help those at risk of suicide by providing services for them and by spreading awareness of mental health in schools.
This should be a collaborative exercise. Mental health is an issue for everyone, and I hope that we will all follow the great example of Laura Nolan and do our bit, as well as urging the Government to fulfil its responsibilities.
16:32
I very much welcome the return to mental health as a subject for debate. There is a lot of agreement across the chamber that we need to put more emphasis on mental health, but we may not be entirely clear about how to do that. Stigma has been mentioned in previous debates and again today. It is partly a question of the time that it takes for attitudes to change, but that does not mean that we should not keep talking about it and so help to change those attitudes.
As I have mentioned before, a new care home was built in my constituency and everyone was quite happy about it until it transpired that the residents would have mental health issues. That provoked quite a reaction from part of the local community. I have been to visit, and they would be delighted if either the First Minister or Mr Hepburn was able to visit or open the home.
I am interested in some of the words and phrases that appear in the Lib Dem motion. First, there is mention of the “targets”, which we are all familiar with. Just this morning at the Finance Committee, we were discussing preventative spending and the need to shift resources in that direction. Targets are not necessarily in contradiction to preventative spend, but there is a certain danger with targets that they focus on what is easily measured in the short term. Although, in this case, the targets focus on psychological therapies, which we can accept are preventative, it is worth noting that targets can sometimes take our eye off the long-term goals.
Secondly, the motion uses the phrase:
“adequately resource mental health services”.
What does that actually mean? Does it mean reducing the resources for physical health? There could be an argument for that, but we should be open about it if the plan is to reduce the number of hospitals for physical health and to cut down availability of accident and emergency services. One could argue for that, but it should be spelled out.
Thirdly, there is the phrase:
“parity is enshrined in law”.
What does that mean? Does it mean equal amounts of money spent on mental and physical health? Does it mean an equal number of in-patient beds for mental health and physical health? I understand that that used to be the case in the 1970s, when I used to visit patients in Lennox castle, Gartloch and elsewhere, and surely it is not desirable that we go back to that situation. It is much better to have more help in the community.
Will the member give way?
Very quickly.
There has been some discussion about the two different acts—the 1978 act, which covers Scotland, and the 2012 act. To make it clear, I point out that the 1978 act, with which the minister seems to be content, talks about
“improvement in the physical and mental health of the people of Scotland”,
whereas the Health and Social Care Act 2012—
I am sorry, but Jim Hume is taking far too long.
I agree. Please continue, Mr Mason.
I agreed to take a short intervention, but I am sorry about that.
I am also intrigued by the term “zero suicide ambition”. I agree with that ambition and I welcome the reduction in recent years, but I suspect that zero suicides is incredibly difficult to achieve.
I also wonder how that fits in with the concept of assisted suicide. That shows up one of the problems with assisted suicide, which is that there is often a link with mental health issues. The Parliament’s actions can be symbolic and, if we say that assisted suicide is acceptable, we also make a strong statement that, when someone faces problems in life, suicide is a valid way out. I do not think that we want to send out that message.
16:35
As Jim Hume’s motion rightly acknowledges, mental health issues are universal. Few families will be untouched by the need for professional help at some stage in their lives.
Mental health is clearly a major public health challenge, and mental disorders are more common in socioeconomically deprived areas and regions. Indeed, we have only to look at Greece in the past few years to understand the impact of austerity on the mental health of that society. In its briefing, Inclusion Scotland suggests that there is significant evidence that people with mental health conditions have been disproportionately hit by sanctions from jobseekers allowance and employment support allowance.
Public perception also remains vital. In the past, people who were unfortunate enough to suffer from mental illness were too often stigmatised and excluded by society. With the sterling work of the see me campaign, which was launched in 2002 and internationally recognised as an example of best practice, we have moved a long way. Today, there is more openness, and celebrities such as Stephen Fry talk openly about bipolar disorder.
Of course, mental disorders are not uniform: women are more likely to suffer from depression than men, and the association between poor mental health and disability is clear. However, suicide is disproportionately male. It particularly affects young men and, in Scotland, we have high rates of suicide compared with the European average. The reasons for that high rate are clearly complex. Self-esteem, family breakdown, relationship difficulties and drug use in particular all play a part, as do economic factors. Indeed, some academics and researchers call it “the Scottish effect”.
The suicide rate in 2012 was among the lowest for 25 years, although it increased the next year. It will be interesting to see whether, in 2014, a downward trend was established again. We know for sure that suicide rates are strongly related to deprivation. Nevertheless, we need to encourage individuals not to suffer in isolation. At least speaking openly to a friend or family member is becoming a less feared encounter as a result of a better understanding and awareness of the importance of mental health. Initiatives such as the see me campaign, the choose life campaign and the Scottish recovery network are important.
Among competing financial pressures, the Government recognises the need to invest in mental health. The figures on psychological therapies for some boards are disappointing but we should not forget that the shortage of cognitive behavioural therapists is itself an issue. There is clearly a demand that cannot be met with the stroke of a pen, which is why it is important that other approaches, such as the use of online technology, be explored.
The nature of our society means that the demand for services for children and young people is not slowing down. It is disappointing that half the health boards are not achieving their targets, but I am encouraged that those boards have action plans in place to address that issue and I have no doubt that they will recognise the need to respond to concerns.
Let us also not forget that improvements in general health by changing people’s diets, encouraging physical activity, reducing smoking, tackling levels of drug and alcohol dependency, and raising awareness of the threats from new psychoactive substances all play a part.
16:39
I thank members for some excellent speeches and a tone that befits the topic.
I remind some of the newer members that six years ago Audit Scotland produced a report called “Overview of mental health services”. At that time, 142 children had been referred to adult wards. The Scottish National Party made a commitment then, but instead of 142, we now have 202. I am sorry to have to say that everything that was recommended in that report has been raised as a problem again today, so I hope that our new minister will take time to read it, because there is a fair bit of déjà vu.
Will Mary Scanlon give way?
No. I have less than four minutes and the minister will have a chance to sum up.
I will start with psychological services, because 16,000 people are on the waiting list. If the Government is serious about inequalities, it should start with mental health, given that 43 per cent of people on benefits have a mental health issue.
On psychological therapies, the minister would do well to read Scottish intercollegiate guidelines network guideline 114—“Non-pharmaceutical management of depression in adults”. It was published in January 2010 and was due to be considered for review two years ago, but that did not happen, either. Paragraph 9.1 of the guideline describes the provision of psychological therapies, which I think every member has mentioned, as
“patchy, idiosyncratic and largely uncoordinated”.
That was five years ago. The Scottish Government has had five years to address the
“patchy, idiosyncratic and largely uncoordinated”
services and it has failed absolutely. The guidelines also stated five years ago that
“NHS Education for Scotland is working in partnership with the Scottish Government, NHS Boards and other service providers to increase the capacity within the current NHS workforce to deliver psychological therapies”.
Where is that increased capacity? Every member from every party in the chamber has mentioned the lack of workforce planning and the lack of capacity in the workforce. Now we have a situation, five years later, where local doctors do not even bother referring patients because there is nothing to refer them to. That is certainly a good way of managing a hidden waiting list: no referral, no waiting list.
It is also appalling that there is no general SIGN guideline on depression; there are only non-pharmaceutical guidelines for therapies that do not exist. With one in three patients presenting at GPs for problems relating to stress, anxiety or depression, Scotland does not even have a SIGN guideline for GPs.
As other members have done, I pay tribute to SAMH, Penumbra and the many others that help people with mental health issues. However, the SNP always likes to compare us with England. In England, the National Institute for Health and Care Excellence does have recommendations for treatment of depression, including mindfulness-based cognitive therapy, which is a NICE-approved treatment that is based on sound research and has been in place since 2004. We are still waiting for a guideline. MBCT is proven to cut relapse rates in half for people who experience more than two episodes of depression, and has the strongest evidence base. John Mason should understand that the reduction in costs for antidepressants would more than pay for that therapy and the benefit would be not only to the patient but, as Bruce Crawford mentioned, to the family. I welcome the fact that Bruce Crawford mentioned the family. The benefit for the patient and the family would be far greater than that from a daily dose of pills.
I googled the “Scottish Medicines Consortium” and “depression” for the SMC equivalent of the NICE guidelines. I found a list of drugs, but no psychological therapies. We should not be surprised by the situation; the guidelines are simply not in place, because there is no commitment from this Government.
16:43
I, like others in the debate, pay tribute to the hard-working staff who provide services in hospitals and in our communities with very limited resources. Malcolm Chisholm was right to say that we have to draw attention to the problems of those services or we would be remiss in our duty.
More than 200 young people have waited for more than a year to access mental health services. That is unacceptable. Young people are having their life chances damaged due to a lack of services at a really important time when they need to make decisions. Malcolm Chisholm also quoted the Scottish Children’s Services Coalition. The SCSC went on to say:
“Families usually experience months of waiting even before a referral to CAMHS. The consequent delay in diagnosis and appropriate support can result in crisis and the need for costly extra resources.”
That delay is not a cost-saving measure; it ends up costing more, because people’s conditions deteriorate and they need more intervention than they would have needed if they had been seen more timeously.
Specialist services are few and far between. Jim Hume talked about people from Aberdeen needing to go to Dundee. People from the Highlands and Islands also have to go to Dundee, which for many people is a huge distance to travel, especially people from low-income families who cannot visit often. It must have a real impact on young people’s mental health to be separated from family and friends for so long.
I reiterate Dr Richard Simpson’s point about referral rejections and the need to investigate why the number of rejections is so high in some areas. What is happening to those who have been rejected? What support are they receiving, and where are they receiving it? Has any cognisance been taken of their outcomes? What is happening to them in the long term? Are they receiving appropriate support when they require it? I would welcome the minister’s comments on those questions.
The minister, John Mason and a number of other members talked about the stigma that is associated with mental health issues and how that can impact on provision of services in the community. The minister mentioned self-stigmatisation as a result of people being unwilling to speak out, but I add a note of caution to that. It is very difficult for people to speak out because of the stigma, especially when they are at their most vulnerable. It would, in normal circumstances, take a very brave person to speak out and share their experience. If they face a backlash, the situation becomes even more difficult for them, especially if they are currently experiencing mental ill health.
A number of members spoke about physical activity. I agree with that approach: we need to do an awful lot more to show how physical activity of any kind—things like gardening as well as marathon running and the like—can help people’s mental health. I have read of people who were able to come off medication because they had an exercise regime that helped them to do so.
Those approaches are recognised, but they are not often offered as credible options. We need, rather than simply focusing on drugs, to consider prescribing access to leisure centres, sporting facilities and the like in order to get people more active if physical activity is proved to help them.
A number of members mentioned self-harm and that incidence of it has doubled. A young person spoke to me very recently about her self-harming and the fact that she needed to go to A and E to be stitched. It is clear that we need to train staff in A and E to deal with people who self-harm; she was refused anaesthetic while her arm was being stitched because she was told that she had done the damage to herself without anaesthetic in the first place. We need to deal with those issues and ensure that people are trained to help those who are in such situations.
You must close.
We need to hear about the review of SNAP, and I look forward to the minister telling us when that will be available, and when we will have an investigation into rejected referrals.
16:47
I welcome the fact that we have had the debate. I agree with Mary Scanlon that the tone of the debate has, by and large, been very good. It is more important than it might be for most other debates that in this debate, given the subject matter, we strike the right tone.
Bruce Crawford said that the debate is not about statistics but about people’s quality of life. I very much agree with that perspective. That will always be my starting point. Delivery of person-focused health care will be a priority for this Government.
Bruce Crawford also mentioned the challenges in relation to CAMHS for NHS Forth Valley in his constituency. I know that he had hoped to raise that issue at question time earlier today, but unfortunately time ran out before we reached his question. I hope that he will be reassured that I have contacted NHS Forth Valley and the other six boards in which the CAMHS referral target has not been reached.
Nanette Milne and Rhoda Grant raised the issue of social prescribing, of which I recognise the importance. Work is under way through NHS Health Scotland to promote awareness of and access to social prescribing, and I will be happy to report back to Parliament on that later.
John Mason invited me to come and visit a care home in his constituency. I would be happy to do so. There was an exchange between Jim Hume and John Mason regarding parity between physical and mental health; I will touch briefly on that issue. I am happy to discuss it further, but I need to emphasise a point in response to Mr Hume’s suggestion that there is a fundamental difference between what we have here in Scotland and what exists in England. He mentioned that the National Health Service (Scotland) Act 1978 sets out that we have a duty to promote a
“service designed to secure ... the prevention, diagnosis and treatment of illness”.
However, before that, illness is defined in relation to “physical and mental health”. It is already there. I am not quite sure what the issue is, but I am happy to discuss the matter further with Mr Hume.
The 1978 act mentions “illness”, but the Health and Social Care Act 2012, which is from south of the border, actually specifies mental illness. It talks about
“the prevention, diagnosis and treatment of physical and mental illness.”
I literally have that in front of me and I can read it. However, although the 1978 act is not in the same order, it talks about improving
“the physical and mental health of the people of Scotland”.
That is how illness is defined.
On the prescribing issue that Mary Scanlon raised, I make the point that prescribing is, of course, a clinical decision. I refer Ms Scanlon and others to the comments of John Gillies, who is a past chair of the Royal College of General Practitioners, who said:
“As the stigma attached to mental health has declined, more patients raise problems such as depression with their GPs. There is good evidence that GPs assess and treat depression appropriately.”
That includes prescribing of medicines.
Jim Hume also raised the issue of research funding. It is not the case that there has been a reduction in mental health research funding for NHS boards. There are various sources of funding. Of course, funding relies on bids being made.
Malcolm Chisholm referred to a GP who feels under pressure not to refer patients to specialist services. I say clearly that that is not my expectation. If GPs believe that they should refer a person to specialist services, they should do that. I have to say that the figures do not suggest that there is a problem with the number of referrals; there has been a 60 per cent increase in referrals to CAMHS in the past two years.
The problem is that the percentage has not risen. The rejections have gone on for years, despite the fact that the guidance is there.
I was about to touch on rejected referrals because, as Dr Simpson knows—or as he should know, as his colleague Patricia Ferguson raised the issue with me in Parliament—referral might be rejected for a number of reasons, such as the person not meeting the criteria for access to CAMHS. However, where a child does not meet the criteria, we expect the service to signpost the child to the most appropriate service. I recognise the importance of the issue and I undertake to look at it further, particularly in relation to regional variation. I will be happy to report back to Parliament on that.
Many other areas were touched on in the debate, although I probably do not have time to touch on them. Jim Hume mentioned the report on the Sandra Grant review. Work is under way to assess that further. Good progress is being made, and we hope to report back soon.
I welcome the debate and look forward to returning to the subject. I hope that members can acknowledge that progress has been made, just as I accept that further progress still has to be made.
16:53
It is 12 months since the Scottish Liberal Democrats last used our debating time to focus on mental health. I am proud of that consistency and of the commitment across Parliament to keep mental health towards the top of the political agenda. As expected, the debate has been constructive. I thank all those who have participated and empathise with those who did not have the time to fully develop their arguments.
Although I do not support the Government’s amendment, I welcome the tone that the minister adopted in his opening remarks and acknowledge the progress that has been made. The mental health strategy is good and I welcome the HEAT targets for treatment of people who suffer mental ill health. The fact remains, however, that, as a number of members have pointed out, progress on meeting those has been patchy and in some cases we appear to be moving in the wrong direction. The effect of that, particularly in relation to child and adolescent mental health services, is a genuine concern, as Dr Simpson and Malcolm Chisholm pointed out.
Will Liam McArthur give way on that point?
I am afraid that I will struggle to give way. I am sorry.
As my colleague Jim Hume highlighted in opening the debate, only half of health boards are meeting the new 18-week target for treatment, and five are failing to meet the old 26-week target. Meanwhile, the availability of educational psychologists is below what is needed and, again, adult psychological services are falling short of the targets that have been set.
In practice, that means that interventions for those who need help—that might involve putting in place support, identifying coping strategies or whatever—are delayed, potentially with serious consequences. As SAMH warns,
“the later individuals engage with health services, the more complex their treatment and recovery will be”.
Let me be clear: this is not a criticism of the people who are on the front line in our healthcare and third sectors. Without the contribution that they make, which invariably goes above and beyond anything that we have a right to expect—as Jim Hume and the minister emphasised—the situation for people who have poor mental health would be profoundly worse. That is why the Scottish Liberal Democrats prioritised mental health in our recent budget negotiations with ministers and why in 2013 we called for additional support to boost underresourced psychological therapies.
It is little wonder that pressures exist, given the number of people who are affected. The range of conditions may be wide, and some people move in and out of ill health, but it is not a niche. As Nanette Milne pointed out, the latest social attitudes survey confirms that one person in 4 has personal experience of mental ill health in their life.
The impact, though, stretches far wider. In this and previous debates, members have spoken passionately from direct personal experience, either of themselves, a family member or a close friend. I can think of few other debates in this chamber in which similar insight and empathy have been brought to bear. That impact is one—although only one—of the reasons why we must elevate the importance that we attach to tackling poor mental health and encouraging good mental health. Scottish Liberal Democrats firmly believe it is now time for Scotland to follow the lead that has been taken south of the border, and to legislate to afford equal treatment to mental and physical health. Progress has been made here and measures are in place to go further, but they fall short of putting mental health on an equal footing with physical health, which matters. As the head of the Orkney Blide Trust, Frazer Campbell, explained to me recently:
“too often mental health services are way down the list in terms of budget allocation and other resources (for example, hospital space and room design etc).”
That is why Frazer wants to see equality in service provision.
In passing, I briefly record my gratitude to those who helped raise about £12,500 for the Blide Trust at the “Strictly Come Dancing” show last Friday night—particularly the dozen souls who risked life, limb and reputation on the dance floor. As well as raising money, I hope that the event brought the work of the Blide Trust, and the needs of people in Orkney who suffer poor mental health, to a wider audience. The issues of stigma and a reluctance to seek help are known to be more prevalent in smaller communities, especially rural ones.
Whatever other steps we take, I agree with Rod Campbell that we in this country need to be more open and honest about mental health. However, if mental health is something that people find hard to talk about openly, it is as nothing compared to the taboo surrounding suicide. Obviously not everyone with a mental health issue considers taking their own life, but the numbers who do and who succeed remain high, despite a reducing trend in recent years. In 2013, 795 people died by suicide in Scotland. Male suicides run at three times the rate for females, and according to the Samaritans suicide is now the leading cause of death of under-35s in Scotland. That last statistic is truly shocking. That people who have most of their life ahead of them and who have so much still to experience and to contribute conclude that they cannot bear to continue living is truly appalling and demands recognition of depression for what it really is.
When I spoke in the last debate on mental health, I talked about Andy Harrison, who was a friend, work colleague and flatmate from my days working in Westminster. Andy took his own life four years ago after a long battle with depression. To this day, I find it hard to accept or understand such a tragic loss of talent, vitality and decency. Andy’s wicked sense of humour and generosity of spirit, which made him such a privilege to know, masked a deep-rooted despair that ultimately killed him.
Since then, I have learned of others who have found themselves wrestling with many of the same demons as Andy. In my Orkney constituency, there has been a spate of suicides over the past six months or so. Although apparently those deaths are not out of keeping with statistical averages, nevertheless in a community of the size and character of Orkney they have touched people profoundly. I learned recently that someone whom I was at school with took their own life last year—I can still remember the shock at being told.
Even though we know that each suicide involves an individual, with their own personality and their own circumstances, and that their suicide represents that person’s own tragedy, we are guilty of seeing the statistic rather than the person. In truth, very often, even those who are closest to them do not realise the full extent of the risk until it is too late. Again, that is why we must create the conditions whereby issues of mental health, including depression, can be talked about without fear of stigma and judgment.
I firmly believe that one way of helping to achieve that is through setting an ambition of zero suicides. To John Mason I say that that is not the same as setting a target, nor is it inconsistent with the objectives underlying the Assisted Suicide (Scotland) Bill. It is about setting an aspiration and changing the mindset about how people with mental health issues are cared for. Evidence from elsewhere shows that it can have dramatic and positive effects. Mersey Care NHS Trust, in Liverpool, has a programme involving improved training for staff who work with parents, patients and families to develop a personalised safety plan. It also has a dedicated safe from suicide team that provides advice, support and monitoring, and works closely with partners including the Samaritans. In Detroit, which is signed up to such a commitment, the area that is covered by the programme has reported no suicides in more than two years.
Again, this is not a criticism of existing schemes, such as choose life, but a plea to go further—to aspire to something even more ambitious. If we fall short in that ambition, let us at least get closer than we currently are.
As I said in closing the debate last year, this is an issue that needs to be discussed openly, taken seriously and addressed effectively. It is not a second-class condition, and ultimately there is no good health without good mental health. One year on, it is truer now than ever. I urge colleagues across the chamber to support the motion.
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