The next item of business is a debate on motion S4M-11975, in the name of Jamie Hepburn, on mental health. As soon as Mr Hepburn is on his feet and ready, we can kick off.
16:09
I was nearly ready, Presiding Officer.
I welcome my first opportunity as the minister with responsibility for mental health to debate improving Scotland’s mental health. I know that members will join me in welcoming the opportunity to cover that important matter, particularly at this time of year, when minds turn to doing better and to renewing resolutions. One of my resolutions is to do all that I can to ensure that we see improved mental health in our country.
As the first minister of any Scottish Government to have mental health explicitly referred to in their ministerial title, I hope that that gives some indication of the importance that the Administration places on improving Scotland’s mental health. We shall rightly be judged on our efforts, and I hope to set out some of those in the next 10 minutes or so.
The Government is taking forward the Mental Health (Scotland) Bill to seek to refine and improve the system that we have in place to ensure that people with a mental health disorder can access effective treatment quickly and easily. I hope that that in itself gives some indication of the importance that we place on mental health. That bill will rightly be subject to debate on its own merits at another time, but I thank the Health and Sport Committee for its efforts in scrutinising it thus far, and I look forward to reading its stage 1 report in due course.
In this opening speech, I will aim to cover some key issues relating to illness, recovery and stigma. I will speak about what we have done and how we are doing; set out the progress that we are making across Scotland; and speak about what we will do next to focus on the challenges that are before us. Members may be familiar with those challenges from discussions with constituents.
Mental health is, of course, a subject that touches us all, whether we have a mental health problem, we are a carer for someone who has a mental health problem, or we have family, friends or colleagues who have had a mental health problem. Mental illness is one of the top public health challenges not just in Scotland, but across Europe as a whole, where it is estimated that mental health disorders affect more than a third of the population every year.
Despite mental illness being such a common human experience, people too often do not admit to their closeness to a mental illness. A person might be unwilling to mention a spell of illness, the time that they needed antidepressants or the time that they required therapy. They might be reluctant to mention that they take medication daily to control symptoms. We might shy away from asking a friend who has been down if they are okay and whether they want to talk. That reluctance, reticence or unwillingness can come about because we expect a bad response. That is an issue and one of the challenges that I spoke of earlier.
That is why we must continue to break down the stigma of mental ill health. Debates such as this one are key to doing just that. It is vital that the Parliament—our country’s national legislature—regularly and openly debates topics that are related to mental health.
Our partners in the third sector also have a huge role to play in tackling stigma. I am pleased that the work of organisations such as Alzheimer Scotland, Penumbra and the Scottish Association for Mental Health is being recognised. The Government recognises the importance of the third sector, and in 2013-14 we provided more than £1 million to numerous national mental health organisations.
I welcome the joint Scottish Government and Comic Relief funding for the see me campaign. As members will know, see me is Scotland’s national campaign to end mental health stigma and discrimination, and it is hosted by the Scottish Association for Mental Health. The Scottish social attitudes survey shows that the work of see me is still needed, with a greater emphasis on changing outcomes. People still experience negative attitudes if they have a mental health problem, and people self-stigmatise—they avoid events and do not want to talk about their illness.
The refounded see me programme has a framework of action to take forward over the next three years, with activity areas based around, for example, equality and human rights, the workplace, settings where people experience discrimination, lived experience participation and national campaigning.
There are other ways in which we can start to end mental health discrimination. There has been a debate on parity of mental health and physical health—I see that Mr Hume’s amendment refers to that. I welcome that debate. I want to see the same focus and approach to improving mental health services that we have to improving physical health services.
The National Health Service (Scotland) Act 1978 states that the Scottish ministers have a duty to secure improvements in the physical and mental health of the people of Scotland. It does not distinguish between the two, nor does it place a higher importance on one than on the other. Our Scottish NHS has a duty to promote the improvement of health, and that duty extends equally to physical and mental health.
For too long, mental health lacked targets. People waited for lengthy periods to receive well-recognised, evidence-based treatment. The Government is working to change that. Scotland was the first nation in the UK to introduce a target to ensure faster access to psychological therapies for people of all ages. The target for boards is that patients will get a referral to treatment for psychological therapies within 18 weeks. That is a challenging target, but we should recognise the work that boards have been doing to try to meet it.
The latest data shows that the average adjusted waiting time for psychological therapies is eight weeks and that 81 per cent of people were seen within 18 weeks. Some boards are doing better than that, but we know that others are not. That point is made in Richard Simpson’s amendment, which also mentions our shared concern about stigma. I say at this stage that we will support the Labour amendment this evening.
We have been offering boards support to tackle waiting lists. I want to see the good work being sustained, but let me be clear that I want to see all the boards meeting the target, and that is why the Government has embedded it in NHS Scotland’s local delivery plan guidance for 2015-16.
I want to say a little about recovery. People with mental health problems have been at the forefront of rethinking what is meant by recovery. As the Scottish recovery network emphasises, people can and do recover from even the most serious and long-term mental health problems. The network also stresses that recovery is a personal journey and that it is about living a meaningful and satisfying life with or without symptoms. A meaningful and satisfying life is as important for people with a mental health problem as it is for people with a physical health problem.
One of our challenges now is to address the higher mortality rate of people with a mental health disorder compared with the general population. We have produced guidance on how NHS boards can ensure that there is good work between primary and secondary care to provide good-quality physical health services to people with severe and enduring mental illness. Physical health improvement is built into the Scottish recovery indicator to ensure that practice in mental health services relates to the factors that can help recovery.
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 50 per cent since 2008, and we have introduced a waiting time target for accessing child and adolescent mental health services to help to drive improvements. In the two years between September 2012 and September 2014, the number of children and young people who were seen by CAMHS increased by more than 60 per cent. That phenomenal increase reflects more children and young people being referred to services.
It is little wonder, then, that the target has been challenging. We have been transparent in publishing the data. I say again that it is clear that some boards are doing better than others, and again I make the point that I want all the boards to meet the target. This target, too, is embedded in NHS Scotland’s local delivery plan guidance for 2015-16.
Ensuring access to mental health services for children and young people is an absolute priority for this Government. That is why we have not only increased the number of people who are employed in the area—
Will the minister take an intervention?
Do I have time, Presiding Officer?
You do not have much time.
I will take a brief intervention.
Given that only one health board in mainland Scotland has achieved the 18-week target for CAMHS, when does the minister expect that all health boards will be able to achieve it?
I made the point that I expect all health boards to achieve the target this year. That is my expectation. We set the target for a reason and we expect the health boards to achieve it.
I had begun to say that we have not only increased the number of people who are employed in the area but invested almost £17 million since 2009 to deliver faster access to child and adolescent mental health services in Scotland’s communities. That spending comes as part of increased expenditure on mental health, which went up by £31.9 million from £867.1 million in 2010-11 to £899 million in 2012-13, and we are investing an additional £15 million over the next three years to improve mental health services in particular.
Ensuring the prompt treatment of people is a key priority for improving Scotland’s mental health. What we know to be true of physical illness—that the sooner treatment begins, the sooner a person can recover—is invariably true of mental illness. Of course, the more we do, the more clearly we see how much more we still need to do.
I am glad that the Parliament has welcomed in 2015 with the mental health of all at its heart, and I ask all members to think about the right way forward.
I move,
That the Parliament welcomes the level of interest and commitment to improving mental health and mental health services; recognises the equal importance that the NHS places on the care and treatment of mental and physical illness; notes the Scottish Government’s recent announcement of an additional £15 million investment in mental health services, and looks forward to further progress in improving mental health and wellbeing as a fundamental and integral part of delivering person-centred, safe and effective healthcare services.
16:20
I draw members’ attention to my interests as a fellow of the Royal College of Psychiatrists, a member of the British Medical Association and a chair in psychology at the University of Stirling.
I welcome this as the first health debate of the new Cabinet. I hope that it will be one of many, because we have had a paucity of mental health debates in the past. I also welcome Jamie Hepburn to his first debate as a minister. I welcome the tone of his speech.
The unequal and false division into mind and body as separate entities occurred over a century and a half ago, and it has dogged the biological model of medicine ever since. We know that general practitioners treat most patients with mental illness and do so holistically, but they are confronted with serious difficulties in not having the time to manage complex mental and physical morbidity. That is particularly the case in deprived areas, where mental health problems are massively more prevalent. The deep-end practices have reported that as part of their view of the inverse care law—the fact that resources are applied in inverse proportion to care needs.
I welcome the appointment of the six link workers, but that is just the beginning. A much more dynamic and radical approach to primary care is needed if specialist services are not to be even further overwhelmed. Malcolm Chisholm will speak a little more about primary care later in the debate.
The 1997 mental health framework started by saying that it was written
“to assist staff in health, social work and housing agencies ... to develop a joint approach to the planning, commissioning and provision of integrated mental health services.”
It was also intended to assist the people who use those services, those who care for those people and staff in voluntary and other agencies
“to play their part as partners and stakeholders.”
That introductory message is as relevant today as it was then. However, the framework was directed mainly at the problem of severe and enduring mental illnesses. Much progress has been made in the management of psychotic illness and dementia, but less has been made on dealing with personality disorder and developmental disorders.
Much has happened since 1997. The closure of old and unsuitable hospitals has continued, and with the help of public-private partnerships—I know that the Scottish National Party does not approve of PPP, but I presume that the similar non-profit-distributing model will continue—the closure and replacement rate has intensified.
We passed the Adults with Incapacity (Scotland) Act in 2000—Mary Scanlon will remember our debates about it. The Millan commission reported in 1999, when it enunciated 10 principles, which were incorporated in the Mental Health (Care and Treatment) (Scotland) Act 2003. That was the first time in my professional and political life that a Scottish act was not simply a tartanised version of a UK act. It led the way, was hailed in Europe as a piece of far-thinking legislation and was eventually copied in England.
Further attention is now being paid to the human rights of patients with mental illness. I suggest to the minister that that might require a larger review of the interaction of the existing acts than was possible under the rather limited McManus review, whose proposals we are considering.
The minister referred to the see me anti-stigmatisation programme, which Malcolm Chisholm established when he was a minister. In its first four years, it began to transform public and—in part—media attitudes. Regrettably, as the minister said, the social attitudes survey of 2013 shows that some attitudes have not continued to improve and in some respects have gone backwards. What has been titled the refounding of the programme, which is overdue, places far too great an emphasis on very short, one-year programmes. We are beset by one-yearitis in our projects, whereas we should build on what has worked far more.
Under Labour, the 2006 follow-up strategy “Delivering for Mental Health” introduced standards and integrated care pathways for severe and enduring illness. The benefit of that was reflected in the initial 25 per cent reduction in readmissions within a year. That reduction has continued under the present Government and is very welcome.
The HEAT—health improvement, efficiency, access to services and treatment—target for reductions in suicides that Labour introduced has also been continued by the present Government and has led to a substantial reduction even if it has missed its target. It is to the Government’s credit that the rate has not increased during the recession as has happened in many countries.
The HEAT target for antidepressant prescriptions has wisely been dropped. It was in part a proxy for psychological treatments, but better quality prescribing has meant a rise in the amount and length of treatment. We commend the Government for changing that HEAT target.
The 2010 90 per cent referral-to-treatment HEAT target for psychological therapies has not been met. There has been quite good progress, although, as the minister said, that progress masks huge variation, with Lanarkshire and Glasgow performing well into the 80s, while the figure for Lothian and Forth Valley—the area into which I introduced community psychology for the first time in Scotland in 1982—is depressingly low at 40 per cent. That is why we call again for rigorous inspection and clearly agreed plans of action to match the improved reporting that is demonstrating that these matters are hugely variable.
Dementia diagnosis has improved and the standards for support have been effective, but serious problems of failure to undertake or record cognitive assessment have been noted in Health Improvement Scotland inspections of acute elderly care. Staff might feel that cognitive assessment is not a priority, but it really is—it is very important.
Progress in a number of other specific areas has been slow. Health inequalities have increased not decreased. As the minister has accepted, CAHMS is still a major challenge and I welcome the tough targets that the Government has set although, as Mary Scanlon said in her intervention, they have not been met. If we are to achieve those targets, it will be necessary to support the lower-tier services because they will reduce demand. In the last two quarters, referrals to CAMHS increased hugely and they will continue to do so unless lower-tier services are improved. For example, the recent spread of the Place2Be service from the cluster of Niddrie primary schools in Edinburgh to more deprived areas in East Lothian and Glasgow is welcome, as are home start, the positive parenting programme and family nurse partnerships, but it is not enough.
I hope that this is the first of many debates about mental health. We have not covered many areas, such as prisoners, forensic psychiatry, substance abuse and veterans. I welcome the fact that my amendment has been accepted.
I move amendment S4M-11975.2, to insert after “physical illness”:
“but notes that, while there has been progress toward the targets on child and adolescent mental health, the targets have not been met, psychological treatments waiting times remain very challenging and primary care teams are under substantial and increasing time pressure to deliver holistic care, particularly in areas of deprivation where there is a greater amount of mental illness; further notes that, after initial progress in improving public attitudes to mental illness with the See Me programme, this welcome trend has stalled and there is a need for more robust monitoring and inspection of the variation between NHS boards”.
16:27
I welcome the minister to his new portfolio. There is considerable scope to do much more to improve mental health services. Mental health is one of those issues that tend to gain cross-party support with very little party-political intervention, because it is so important. We will support the Government’s motion and the amendments in the names of Richard Simpson and Jim Hume.
I am pleased to be starting 2015 with a debate on mental health. In the short time that is available to me, I hope that I can cover some concerns about the mental health strategy. It started in 2012, and all the commitments are to be achieved by the end of this year. Conservatives want progress in improving mental health and wellbeing, so the debate is an opportunity to review the Government’s report card.
As Richard Simpson said, apart from debates on dementia, the SNP has held two debates specifically on mental health since 2007. One was held in September 2011 and the other was in January 2013—the Scottish Parliament information centre has confirmed that. I would have thought that mental health justified an annual update and debate, although I appreciate that the Health and Sport Committee is looking at the Mental Health (Scotland) Bill.
Those of us who were on the Health and Community Care Committee in 2003 had high hopes that the Mental Health (Care and Treatment) (Scotland) Act 2003 would make a huge difference to service users. Today is our opportunity to look at that.
I read in its briefing that Penumbra, along with the University of Abertay Dundee, has developed a personal outcomes approach with an internationally recognised tool called the individual recovery outcomes counter. The tool allows self-assessment of mental health and wellbeing to track improvements. For so long we have said that we have given £10,000, £10 million or £20 million then sat back and thought, “That’s fine—we’ve thrown the money in there,” but we have never measured the outcomes. I put on record how much I welcome the development of a tool to do just that.
Given that this is the minister’s first mental health debate, I draw his attention to progress on some of the commitments in the Government’s strategy, although I appreciate that the strategy lasts until the end of the year. I will pick out a few of those commitments.
Commitment 1 is that
“a 10 year on follow up to the Sandra Grant Report ... will be published in 2014.”
However, we have heard nothing. Commitment 6 is to
“a Scotland-wide approach to improving mental health through new technology ... with NHS 24.”
To date, we have heard nothing.
Commitment 12, which all three Opposition parties mentioned in their amendments, is to reduce the number of children being treated in adult psychiatric wards. We spoke about that issue in 2003 but, according to the Mental Welfare Commission for Scotland’s most recent annual report, the number of children treated in adult wards rose to 202 in 2013 from 177 in the previous year. Again, there has been no progress.
Commitment 26 is to an audit of the in-patient estate. In July 2014, it was confirmed that there are fewer beds, but no reasons or changing reasons were given for why people were in hospital and there was no significant consideration of a future strategy or action.
There has been nothing on commitment 30, which Richard Simpson mentioned, on women with borderline personality disorder in prison. On commitment 33, which is
“to develop appropriate specialist capability in respect of developmental disorders”—
Richard Simpson raised that in 2003—there has, again, been nothing. I appreciate that the strategy is due for completion later this year, but many targets have already been missed and there is a huge amount of work to do this year to meet the commitments.
As if that was not poor enough, the commitment to 18 weeks from referral to treatment for 90 per cent of psychological therapies patients was met by four out of 14 health boards. More than 14,000 people throughout the country are still waiting to be seen. That is not good enough. There has been plenty of time to plan for resources. The lack of alternative psychological therapies probably explains why so many people are on antidepressants. I will pick that up when I sum up.
I move amendment S4M-11975.3, to leave out from “looks forward” to “in improving” and insert:
“calls on the Scottish Government to ensure that additional investment is used effectively to increase NHS mental health bed numbers, including having sufficient adolescent beds to end the practice of children and young people being placed inappropriately in adult psychiatric wards, and staffing across all disciplines, including psychology, in order to meet existing waiting time targets and to bring forward improvements in”.
16:33
I congratulate Jamie Hepburn on his first Government motion and welcome him to his new post—I am pleased that mental health is included in his title. We will be happy to work with him constructively.
It is fitting that mental health is the topic of one of the first debates of the new year because, as this year will see the end of the current mental health strategy for Scotland, we have a golden opportunity to change the way in which mental health is viewed and treated. We need to have a meaningful new strategy in place a year from now.
For too long, mental health has not been spoken about. In treatment terms, it has been the Cinderella service in the national health service. The Royal College of Nursing briefing stated that
“mental health is often the poor relation to physical health when it comes to priority and funding within the NHS.”
I welcome the fact that we have HEAT targets for mental health services in Scotland, although they do not go far enough.
I want the Scottish Government to follow the UK Government’s lead by clearly laying it out in legislation that mental and physical ill health have equal recognition. I do not think that that is what Jamie Hepburn described when he talked about wanting to improve services. Of course services should be improved, but that does not mean that mental and physical health services will be equal.
On parity, the UK Government’s Health and Social Care Act 2012 provides that
“The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement ... in the physical and mental health of the people of England”.
Section 1 of the National Health Service (Scotland) Act 1978 provides that it shall continue to be the duty of the Scottish ministers
“to promote in Scotland a comprehensive and integrated health service designed to secure ... improvement in the physical and mental health of the people of Scotland”.
That is not such a big difference, is it?
There is a difference, because south of the border the Government has provided in legislation that there is parity.
The Government motion makes no great reference to the pressure on NHS services. I have expressed concern about that in the Parliament on many occasions. A consensus is emerging that the issue needs to be addressed now, which is to be welcomed, as is the investment. However, that is not enough. The Scottish Government needs to acknowledge the weaknesses in the system if the situation is to improve.
One in four people will suffer mental ill health at some point in their life. Some 10 per cent of children and young people in Scotland have mental health problems that are so significant as to have an impact on their daily lives. If people do not receive proper support and treatment, the impact of mental ill health can be devastating—it can affect education, work, home life and relationships.
For every individual, getting the right treatment and support quickly is essential. However, it is clear that people in Scotland are not getting the services that they need and deserve. NHS boards are failing to meet targets that the Scottish Government set. For example, 90 per cent of young people who need treatment should be seen within 26 weeks but, in six of Scotland’s 14 health board areas, that is not happening. There has been a 12 per cent increase in the number of children and young people who are waiting more than six months for treatment.
SAMH said in its briefing for the debate that it will be impossible to meet the 18-week target for psychological therapies. The most recent figures show that only four out of 14 health boards meet the 90 per cent target and that more than 14,000 people are waiting to be seen across the country.
SAMH reported that two fifths of GPs say that they have not referred anyone for psychological therapies recently, because waiting times are too long. Therefore, the current level of referrals does not reflect need. Even so, people are waiting too long and targets are being missed.
The Scottish Government’s pledge of £15 million over three years for improvements in mental health services at primary care level is welcome, but the funding is not enough to secure the transformation that we need. The issue is not just waiting times but the environment in which we treat vulnerable young people. The guidelines make it clear that young people should be treated in adult psychiatric units only in exceptional cases, but the Mental Welfare Commission for Scotland found that last year 202 young people were treated in adult wards—the number was up from 177 in the previous year.
Because Scotland has no specialist secure healthcare services for young people, young people are placed in specialist units in England, which makes it difficult for them to retain links with their families and local services. That approach is also expensive, of course.
All mental health services need to be the best that they can be. They need to be evidence led and responsive to local demand. Individuals should receive the care that they need in the setting that is most appropriate for them, no matter where they live.
I move amendment S4M-11975.1, to leave out from “welcomes” to end and insert:
“notes that, since 2009, there have been 883 fewer staffed mental health beds and that Scotland’s hospitals have lost 64 specialist mental health nurses; further notes that targets for mental health treatment times are being missed; is concerned that hundreds of young people face waits of over six months to begin child and adolescent mental health service treatment and that treatment is being carried out in adult wards, which are unsuitable for children’s needs; believes the number of mental health officers (MHO) to be inadequate as highlighted by the 5% fall in MHO consents for emergency detention in hospital; recognises that nine out of 10 people who experience mental health problems have experienced stigma and discrimination; believes that there is a real opportunity to change the way that mental health is seen and treated in 2015 with a revised mental health strategy, and calls on the Scottish Government to act now and follow the lead of the UK Government and set out in legislation that mental health and physical health deserve equal recognition.”
16:38
I welcome the minister to his new post. I sincerely hope that he and I can have a dialogue about mental health.
There is a stigma around mental ill health. It is unfortunate, but the stigma exists and we need to recognise that. The question is how we move forward. Legislation in itself cannot solve the problem, which is about attitudes—including one’s attitude to oneself. If someone has a physical illness, they can go to the doctor and talk about it, but if they have a mental illness or are not feeling too good, they sometimes shy away from doing that. I do not know how we will get over that, but we need to continue to have dialogue about the issue. I certainly look forward to further debate.
When I worked in the third sector before coming to the Parliament, I recognised that people with sensory loss go through a period of adjustment. That adjustment means that their wellbeing—their mental health—is impaired, because they lose the ability to do things that they have always been able to do. However, that adjustment is short term for many and, once they realise that they can take a can-do approach, life becomes better. For the majority of people, coming to terms with their condition is the way forward. As Penumbra said, peer support can be an asset to someone in moving forward. I have seen that in many aspects of the work that I did in my previous existence in the social work and care sector.
I commend the Government on its approach. Mary Scanlon mentioned the mental health strategy. The Government recognised that we need to improve mental health services for people, undertook an extensive consultation process and came up with key findings. The Government did not shy away from the problem; it recognised that the problem is complex and that it needs to be resolved. It cannot be resolved just by putting money into it; it needs to be resolved in an effective and appropriate way, which sometimes means using the appropriate specialist. Dr Simpson mentioned the family nurse partnerships, for instance, which can be an excellent way of coming to terms with some of the problems that exist in our communities.
I am sure that the minister is aware of my personal circumstances. I know that child and adolescent mental health services are lacking in some areas and, sometimes, the initial intervention is essential to try to offset the problems that some of our young people have. Not every child or adolescent will have their mental health improved through CAMHS and the appropriate psychological services, because some conditions might be extreme. However, we need to ensure that someone is listening at the outset. If a referral comes from a GP and a young person is referred on, we need to do our best to ensure that they are seen by the most appropriate specialist in the healthcare sector.
I would like to see improvements in managed clinical networks for specific conditions. I would certainly like something such as that to happen in relation to eating disorders, to try to prevent deaths in our communities of young people with such disorders. I am sure that the minister and I will discuss that in the future. I again commend the Government for the work that it is doing and its recognition that more needs to be done.
16:43
I also welcome Jamie Hepburn to his job, in particular to his role as the minister for mental health, a role that I know he will give his full attention to.
I welcome the strategies that previous Governments and the present Government have put forward to tackle mental health issues, in particular the see me campaign that Dr Simpson mentioned. It was launched in 2002 to tackle the stigma of mental health, and I think that it has been a huge success. I look forward to more such strategies; the campaign has raised awareness of mental health issues and has been welcomed by communities—certainly it has been welcomed in the community in Glasgow that I represent.
The mental health strategy that was published in 2012, with its seven key themes and its four key change areas, is an important piece of work. I know that Mary Scanlon mentioned it. I am particularly keen on two of the key change areas that are mentioned. The first is
“Rethinking how we respond to common mental health problems”
and the second is
“Community, inpatient and crisis mental health services”.
The community services part is particularly interesting to me.
I raised those two areas because when we work in the community, we see how mental health services are delivered in the community. I wonder whether, if changes in those areas were applied properly, they would be able to enhance the services that are there at the moment.
I want to pick up on two issues. First, action in the two key change areas that I mentioned might have enabled one local service in my constituency—the Charlie Reid centre on Elmbank Street—to stay open, and might even have enhanced its service provision. Unfortunately, the centre, which was much loved by users and staff alike, closed its doors in May 2014 after 21 years of service in Glasgow. When I used to visit, there were so many different things going on that it was a sheer joy to be there, and it was clear that people got a lot out of the centre. The reason for its closure was the withdrawal of core funding by Glasgow City Council and its reliance on personal funds and direct payments.
If changes are applied in those two key areas, other such centres may be able to stay open. There is no doubt that the closure of the Charlie Reid centre will have a knock on-effect on the Glasgow Association for Mental Health, as my colleague John Mason will discuss in his speech.
The second issue that I want to raise concerns the isolation of older people. Isolation can lead to depression, which can have a devastating impact on people’s lives. Once again, I look to the two key change areas that I highlighted, in particular services for local communities.
I wonder whether local authorities have been involved in developing the new strategy. Many of the community-led initiatives in my area are closing down or not being used because funding has been withdrawn by local authorities. For example, Glasgow City Council has withdrawn money from elderly people in my area who go to daycare centres, which are a lifeline for many of them. Some people have been charged £15 a day to go to those centres.
I know that it is Jamie Hepburn’s first outing as the minister with responsibility for this portfolio, but perhaps in summing up he could address the issues that I have raised with regard to local authorities being involved, or more involved, in the development of the strategy that will—as members have mentioned—be published at the end of the year.
16:47
I welcome the minister to his post, and I also welcome the many developments that have taken place in mental health since 1999. There has been a great deal of continuity in this area between one Administration and the next. However, it is right in debates such as this one that we highlight the problems that exist, particularly when those problems have been brought to us by constituents.
I have two examples that I want to discuss today. The first concerns a woman who came to see me quite recently. She was anxious and met the criteria for referral for psychological therapy—as was confirmed recently by an NHS helpline—and yet her GP did not refer her. I wonder how common that is.
The SAMH briefing for this debate states that
“two-fifths of GPs ... had not referred anyone for psychological therapies ... because waiting times are too long.”
It quotes one GP who says:
“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”.
I am very concerned by that research and by my constituent’s experience. Although four health boards out of 14 met the 18-week target for access to psychological therapies, the situation may well be worse because there is unmet need as a result of non-referral. There is definitely a big challenge in that respect.
Of course, other factors may be involved. I am a great fan of GPs, including Dr Simpson, and I am a special fan of my own GP. However, we must be realistic and accept that some GPs are probably not as knowledgeable about mental health as they should be. Some members have said that there should be more on mental health as part of GPs’ training, and I note that the recent shape of training review group report, “Securing the future of excellent patient care”, recommends an expansion of GP training, presumably post degree, to include more mental health placements. The briefing from the Royal College of Psychiatrists for today’s debate states that it supports the recommendation.
The SAMH research on GPs is also interesting. Its briefing states that
“90%”
of GPs
“said they wanted more information on local social prescribing opportunities”
and that almost 50 per cent were
“not aware of ... SIGN guidelines on non-pharmaceutical treatments for depression.”
There is, realistically, room for some work in that area.
If members want to find out more about the issue, they should come to the SAMH reception next Thursday, which I am sponsoring and which is on mental health and primary care, so the timing is excellent.
There are many good examples of mental health care and primary care in the community more generally. Richard Simpson referred to the link workers in the deep end practices—let us see a bit more of that. There are great nursing projects, which I will be highlighting in my members’ business debate tomorrow, and many of them have a mental health focus. There are also community projects, which I am sure members have in their constituencies. For example, in my constituency there is the Pilton Community Health Project, which runs its women supporting women project as well as providing counselling services and doing other work, a lot of which is to do with mental health.
My second example is an even more distressing one, because it involves a woman whose son committed suicide when, she feels, there was no help or services available for him. The woman, Laura Nolan, has set up the Joshua Nolan foundation and has done amazing work in the past year to raise money for counselling for those who cannot get services through the NHS. Of course, that should not be necessary, but we should pay tribute to her for all the work that she has done. She is now starting to work on awareness of mental health issues in schools, which is part of the very important public mental health agenda, which includes the work of the see me campaign. We have to work on that as well.
You need to bring your remarks to a close.
I had a lot more to say about young people and mental health, but I am being told to stop, so I shall.
Thank you.
16:51
We last debated mental health on 28 October, when we discussed a motion that Linda Fabiani lodged. It is good that we are returning to the subject today in Government time.
I will start by focusing on GAMH, the Glasgow Association for Mental Health, which is a charity that is based in my constituency. As members might know, Glasgow City Council is planning to cut the GAMH budget pretty severely, by 40 per cent or £880,000. Of course, all budgets are under pressure and everyone expects budgets to fall a few per cent each year, but that proposal is much more severe and represents a real shift of resources away from that section of mental health provision. If we are serious about preventative expenditure and trying to tackle problems before they escalate, I am puzzled by the thinking behind those Glasgow cuts.
The Evening Times of 30 December carried the story of Jennie Robertson, who was the victim of sexual abuse as a youngster and who has been through various treatment regimes, including prescribed drugs and electroconvulsive therapy. However, the one thing that helped her most was input from GAMH. I have had some connection with GAMH, including almost exactly a year ago, when it launched a book of writings by folk with mental health issues. The launch, which was in Dennistoun in my constituency, was a really impressive and moving event at which the main speaker was Liz Lochhead, who spoke in a personal way about her experiences.
It strikes me that one thing that people with mental health issues need is time, including time spent being listened to so that someone really understands their problems, time to form friendships and trust people, time to take part in physical activities or hobbies, which can be a real help, and time to reflect on and perhaps write of their experiences. That is exactly the kind of thing that GAMH and, I am sure, other organisations do. Giving people a few pills might be quicker and cheaper, but I am increasingly certain that it is not always the answer.
I raised the question of GAMH with Glasgow City Council, and I have to say that I was somewhat unhappy with a number of points in its reply of 2 December. For example, the council said:
“A citizen’s engagement with Social Work should only ever be, in the main, transitory in nature.”
Surely, as with physical disability or illness, some conditions in the mental health realm are long term. I understand that the decision to cut funding has been called in by committee, and I very much hope that the decision will be reconsidered. If the Government can make any representations to the council on behalf of some very vulnerable folk, that would be much appreciated.
I have a few other points to make in relation to mental health more generally. The first is about the continuing challenge of stigma, which has been mentioned. We had a negative reaction from some folk—admittedly it was a minority—in a community in my constituency when there was a proposal to build a care home for people with mental health issues. We need to continue working to counteract such stigma.
My second point is on the link between poverty and poor mental health. Audit Scotland figures show that GP consultations for depression and anxiety ranged from 28 per 1,000 in the least deprived areas to 62 per 1,000 in more deprived areas. Similarly, the rate of suicide is three times higher in the most deprived areas.
Finally, although we should talk about the shortcomings and the things that we want to be improved, we need to keep things in perspective. During recess, I read a report about Cambodia, where the Government has stated that it will not examine mental health issues because it has to deal with many other issues, such as malaria.
You need to bring your remarks to a close.
At the weekend, I spoke to a Canadian who has worked all over the world and is currently working in Mozambique. He said that one thing that we must not forget is how superb the NHS is, by world standards.
16:55
Of course, this is a big subject. I know that Mary Scanlon feels that it is not given enough time, but it is a subject that affects so many people that we could literally talk about it constantly. For that reason, we have to hone down our contributions, as everyone who has spoken today has done.
I am particularly interested in the aspects of the Government motion that talk about mental health and wellbeing, because wellbeing is an important word to use about someone’s health, whether physical or mental. I am also interested in the mental health innovation fund and would like to hear more about that. I have read that it is about identifying new ways of treating people in the early stages. It ties in with primary care services, too. Malcolm Chisholm referred to the SAMH briefing and I think that Richard Simpson also spoke about primary care services, which are important for early identification and understanding. They are also important in taking away some of the stigma around mental ill health. I remember reading a piece of research that said that some people felt that even their GP was stigmatising them when they went along to seek help. A big awareness-raising exercise needs to go on, as well.
The Government’s mental health strategy ties in with the NHS Scotland quality strategy about making healthcare person-centred, safe and effective. That is particularly relevant for mental health issues. Healthcare must be person-centred; it must suit each person. There should be a joined-up approach not only in the health portfolio but across all portfolios and every aspect of life. That is what leads to an overall sense of wellbeing. Too often, we separate things and put them into different categories. Sometimes, the pooling of health budgets, transport budgets and arts and culture budgets can create a sense of wellbeing. I see that regularly in my constituency.
I have spoken many times about Theatre Nemo, which does wonderful stuff in the arts, but today I want to mention another organisation, which ties into the issue of new towns. The centres of new towns are different from those of other towns. In new towns such as Cumbernauld, Glenrothes and East Kilbride, the shopping centre is the town centre. Therefore, I want to talk about the shopmobility scheme, which supplies disability carts, bikes, trolleys and so on in town centres. However, it is not just about shops; it is about enabling people to feel that they are part of their community because they can move around their own town centre, where they will find not only shops but libraries, cafes and other places where they can meet people. People who live in new towns do not just walk out of the door and go along to local shops; they have to go to their town centre.
I would like there to be a lot more joined-up thinking across portfolios and I ask Mr Hepburn, in his new role, to think about reaching out beyond his portfolio and seeing where the mental health innovation fund can be used and augmented by other aspects of Government so that we can promote that sense of wellbeing that comes not from being referred to a service by a GP but from feeling that one’s life is useful.
16:59
I, too, welcome the minister to his new post. He should take in good spirit the robust exchanges that we have heard from a number of members, which should ensure that we learn from the challenges that we face. The minister should take on board the fact that some of the measures in the current mental health strategy that need to be met have not been met, and there is no doubt that the Government should include in future parliamentary business the opportunity for us to revisit the debate that we have had today so that we can take the issues forward.
I hope that, in his closing remarks, the minister will show humility in recognising that some of the challenges that the Government faces have not been met and that he will tell us how he intends to address that at an early stage. I appreciate how complex the area is, but we must recognise that the patient experience is not always as positive as it should be. Whatever measures could be put in place to improve the situation would be welcomed.
Like other members, I recognise the dedication of the staff who treat people who have mental health conditions. Those staff are to be commended for their good work. Over the years, I have dealt with many members of staff who have shown absolute dedication in what is a complex area, in facing challenges in terms of resources and in the bureaucracy in the system. Nevertheless, we should recognise that there are cases of mistreatment or misdiagnosis, and that those who are treated by health professionals do not always get the treatment that they should get. People find themselves in the bureaucratic process of making complaints because they are concerned that their condition has not been dealt with as well as it could have been.
I want to raise the particular case—it is similar to the case that Malcolm Chisholm raised—of a constituent who visited me just last month. She suffers from a bipolar condition and contacted me to say that she had a prescription from the NHS centre for integrative care at the homoeopathic facility in Glasgow. She had been a nurse for over 30 years, but had had to give up work in order to get treatment to get better and to get back to the job. Her new treatment has been working well and she is beginning to return to the state that she was in previously.
However, in a situation that is similar to that which Malcolm Chisholm described, her GP refused to give her the repeat prescription that she requested. Because of that, her condition has deteriorated. I find that to be unacceptable. It could be that, as in the case that Malcolm Chisholm described, my constituent’s GP has not been able to refer her to services because they are not available.
To me, that is a clear case of a patient experience that has gone wrong unacceptably. My constituent’s condition has now deteriorated, and she is currently going through the bureaucracy of pursuing an official complaint. I ask the minister, in his new role, to ensure that he takes on board such real-life patient experiences so that we can take action.
I ask members to support the Government motion and the amendments that have been lodged.
17:03
I welcome the minister to his new role and welcome the tone that he struck in opening the debate. Broadly speaking, it has been a constructive debate.
I will touch on a number of key areas, the first of which is stigma, which has been mentioned by several members. I note the rather stark figures that are contained in the briefing that has been provided to us by the Health and Social Care Alliance Scotland. A quarter of people surveyed had experienced a mental health problem at some time, but almost half the people who were surveyed said that
“if they were experiencing mental health problems they ‘wouldn’t want people knowing about it’”.
The briefing goes on to say that one in six people said that
“they would find it difficult to talk to someone with a mental health problem”
and that
“Only 82% of people said that they thought people with mental health problems should have the same rights as anyone else.”
That is troubling for anyone to read.
When we talk about one in four people being affected by a mental health problem, let us not beat about the bush. That means that 30-odd members of this Parliament could be affected by a mental health condition at some stage in their life.
Most of us will have somebody in our networks of family and friends who is experiencing, has experienced or will experience mental ill-health, so it is our responsibility to respond to that not just as parliamentarians and politicians, but as people who have loved ones who are likely to be affected. Linda Fabiani made the point that it is not the responsibility only of the health service or even, necessarily, of social care services, but of everyone to ensure good mental health.
It is worth noting that the length of time for treatment for a mental condition will vary from person to person because each individual, by their nature, will experience mental health conditions in different ways. I do not think that we need new legislation on this—the minister highlighted that it is already in legislation—but it is important that mental health receives priority treatment. I believe that that is down to attitude as much as it is to any form of legislation.
If a person breaks his or her leg, we can roughly gauge the time that will be needed before they can have the cast taken off and before they will be able to walk again. However, for a mental health condition it is less easy to predict exactly at what point the individual will no longer require treatment. That bears remembering when we are talking about the kinds of treatment that are being offered.
In terms of negative influences, it is worth noting that briefings that we have received refer to the impact of welfare reform on mental health—certainly those from Inclusion Scotland and the mental health alliance do so—in particular for people who already suffer from significant mental health conditions, but also on people who find their anxiety and stress increasing, which has an impact on their mental health. That impact is being documented by a range of organisations across Scotland. We must accept that external factors impact on the ability of an individual to enjoy good mental health and to recover from a situation that has caused their mental health to deteriorate.
Finally, I want to touch on something positive from a local perspective. I noted in The Press and Journal in October that the Care Inspectorate gave a fantastic rating of “excellent” to the service that is provided by VSA at its facility in Westerton Crescent in Aberdeen, which switched in February 2014 from being a care home to being a housing support service for individuals who have mental health conditions. A lot of positive work is going on there, and I hope to visit the facility soon. It is worth recognising the strong role that the voluntary sector plays in ensuring that people with mental health conditions get the best support, as required.
We move to wind-up speeches. Jim Hume has four minutes.
17:07
As I said in my opening speech, I welcome the consensus that is emerging for action on mental ill-health today. The debate has also highlighted some of the concerns around treatment and service availability. I am glad that the minister wants all boards to meet their HEAT targets within a year, but of course that might be difficult to do, with the loss of beds and the cuts to the numbers of experienced and specialist staff. We must recognise some of the weaknesses as well as the ambitions. If we do not, we will fail to make progress, which we cannot afford and none of us wants.
I was a wee bit disappointed in the Conservative and Labour amendments because they perhaps do not go far enough. They accept that there is parity between physical and mental health ill health, which I do not think is the case. The RCN says that it is not the case and the evidence is that GPs are not referring people to talking therapies because they know about the pressure on services.
Will Jim Hume take an intervention?
I have only three minutes left, so I am sorry, minister.
I am glad that Richard Simpson mentioned human rights because I am concerned that guardianships are being used more and more for people who have learning disorders, but I will leave that for another day.
However, not having quality services in suitable surroundings compromises individuals’ recovery, which in turn compromises their health and their future. In addition, we rely on the expert knowledge of mental health officers for the most serious cases. It is therefore hugely worrying that there is an inadequate number of mental health officers for the demand, and that because of that there has been a 5 per cent fall across Scotland in mental health officer consent for emergency detention in hospital. People should not be detained without that consent unless to do otherwise is totally impractical, but 42 per cent of detentions had no mental health officer consent. We therefore back the calls by the Mental Welfare Commission for Scotland for an urgent recruitment and training strategy for mental health officers, and we thank the commission for highlighting that need.
Campaigns such as see me, which many members have mentioned, have gone some way towards addressing the stigma that is attached to mental health, but it still exists—nine out of 10 people who suffer from mental ill health have experienced discrimination. That is unacceptable, so we must do more.
We look forward to the issuing of a revised mental health strategy this year. I hope that the minister will listen carefully to what has been said during the debate and to what those who are involved daily in mental health services have raised as issues in their meetings and briefings with us. We cannot make progress unless we deal with the concerns and the failings.
I reiterate the Scottish Liberal Democrats’ call for it to be set out in law that mental ill health and physical ill health deserve equal recognition. I believe that that will help to ensure that improvements in treatment are made for people who have mental ill health, and to address stigma where it exists. I was a bit surprised that, despite making a thorough critique of the lack of progress on the mental health strategy, Mary Scanlon supports the Government’s motion, which I believe does not go far enough.
Today’s debate is a welcome step, but it is a small step. We must keep working to improve the situation, and I am happy to do so in a consensual manner. I offer my whole-hearted support for, and thanks to, those who work in the NHS, local authorities and the third sector to provide mental health treatment. We know that, without them, individuals would be lost and the picture as a whole would be a lot darker. Those individuals are calling for real action now: we must listen to that call and act on it.
17:11
I begin by addressing a couple of the points that Jim Hume made. We support the Government’s motion because of the level of interest that the Government has shown in mental health and its level of commitment to tackling the issue. I rightly went through the commitments that were made in the mental health strategy. Although those commitments have not been achieved, I look forward to their being achieved; I was simply reminding the minister of what we seek. Nevertheless, I welcome the progress that has been made in improving mental health, and I look forward to further progress being made. It is not a huge motion, but I do not think that we are in a position to be churlish. We have a new minister—the debate is Jamie Hepburn’s first outing as minister—and I think that much more work can be done.
Jim Hume called for parity in the treatment of mental ill health with the treatment of physical ill health. I refer him to a statement that Earl Howe made at Westminster on 19 December that set out various new waiting targets. However, I want to use my time to talk about what is being done here, rather than about what the Westminster Government is doing, because it is a very short debate. If I have not covered everything that Jim Hume expected me to cover, that is not because I am not committed to improving mental health; it is due simply to a shortage of time.
Although the debate has been short, it has been an important one. I thought that Linda Fabiani made very good points on the joined-up approach and I liked what John Mason said about the use of alternatives to antidepressants, which takes me on to my next point. As others have said, 40 per cent of the GPs who took part in the Scottish Association for Mental Health’s survey said that they had not referred anyone for psychological therapies recently because waiting times were too long. We therefore have a huge hidden waiting list and enormous unmet need, because treatments and therapies that are appropriate for people’s conditions are being ruled out as a result of long waiting times. As Malcolm Chisholm said, although one in three GP appointments relates to mental health, 85 per cent of the GPs who took part in the survey told SAMH that there are gaps in service provision and 90 per cent of them wanted more information on local social prescribing opportunities. If the GPs do not know about social prescribing, the patient cannot possibly be referred to the service. There is certainly work to be done on that.
On criminal justice, commitment 32 in the mental health strategy includes an undertaking to increase effective use of community payback orders, which were introduced in 2010 to help to prevent people from going to prison when what they actually need is mental health treatment and support. We all supported that, yet only 74 out of the 10,000 community payback orders that were issued in 2011-12 included a mental health requirement, so we need to do an awful lot more on that front.
On access to CAMHS, only half of health boards achieved the 26-week waiting time target and only five of 14 health boards achieve the 18-week target. The only mainland board that is achieving the target is NHS Dumfries and Galloway. It is concerning that the target is met only 54 per cent of the time in NHS Grampian and only 50 per cent of the time in NHS Tayside.
You need to wind up, Ms Scanlon.
Just as worrying is the increase in referrals to CAMHS. The focus on recruitment of psychologists and psychiatrists is an issue, given that last year there were eight vacancies for learning disabilities posts and none was filled.
There is more to do.
17:15
I, too, welcome the new minister to his post. I am new to my post in the health brief as well. I hope that we can put mental health right at the centre of our health agenda, that mental health will be the minister’s personal passion and that he will drive the issue forward. I think that everyone across the chamber would agree that it is one of the biggest health challenges facing Scotland.
The problem is not specific to Scotland. I did quite a lot of reading over Christmas, comparing our health record with that of Finland, which is seeing an increase in mental health problems, too. On the challenges ahead, we need to look internationally and to be bold and ambitious in our approach. I hope that the minister will rise to the occasion.
There is so much that we need to look at on the mental health agenda, and it is disappointing that, since 2007, the Scottish Government has taken the opportunity to use its own debating time only twice to debate mental health. I hope that, working with the minister, we can turn that around. I will make a personal pledge to the minister: if, every time we return from recess, he wants to debate mental health in detail and to look at different aspects of how our services and communities are coping with and trying to prevent mental health issues, Labour would whole-heartedly welcome that and would meet that challenge. I also make the pledge that I will work hand in hand with him on initiatives to make sure that we put the prevention of mental health issues right at the centre of our health agenda.
I will touch specifically on educational psychology, which is an aspect of prevention that I do not think has been covered in the debate. In its briefing for today’s debate, the Scottish children’s services coalition asks the Scottish Government urgently to address issues around funding for training educational psychologists.
I would be surprised if members across the chamber have not had experience of families coming to their surgeries to ask about the waiting lists for their children to be seen and assessed in school by an educational psychologist. The waiting lists are long. If we are truly to take a preventative approach, we must look seriously at that situation.
Funding for the training of educational psychologists is an issue. In 2012, the bursaries were withdrawn, and the postgraduate course is not funded. I have had people at my surgery who have been looking to put their immense talents into educational psychology but who have not been able to afford to do so. When Michael Russell was the Cabinet Secretary for Education and Lifelong Learning, I asked him if he could redress the situation and provide funding to pay the fees of students who would be dedicating their skills to the health service on not great salaries—educational psychologists earn roughly £30,000 a year. As I say, I would be happy to work hand in hand with the minister if he would address that issue as a priority.
I turn to some of the contributions that have been made.
Mary Scanlon made an excellent speech. She talked about the Government’s report card on the matter, highlighted the paucity of debates and called for an annual update. I hope that she will back my call for us to look seriously at mental health more regularly than annually.
Mary Scanlon also talked about the importance of measuring mental health outcomes and raised a point that I know the minister will have taken note of: the increase in the past year in the number of children who are treated in adult psychiatric wards. I hope that that is one of the points requiring urgent action that the minister will take away from the debate.
Jim Hume and Malcolm Chisholm spoke about organisations and GPs not making referrals because the waiting lists are so long. I would like to hear an early indication from the minister of what can be done about that mass of unmet need in respect of non-referrals. That is an issue that is particularly close to my heart. I have visited organisations in Dundee that provide opportunities for young people to come together—young people who have been affected by the issue, and friends of young people in our communities who have taken their own lives. I hope that, throughout his time in government, the minister will commit to focusing very strictly on prevention and on seeing what we can do about mental health issues in Scotland.
I turn to the motion and the amendments.
You have 30 seconds.
Yes, Presiding Officer.
We will support the Government’s motion. There is much in the Conservative and Liberal amendments that we support, but I understand that, even if our amendment is agreed to—the minister has indicated the Government’s support for the Labour amendment—the Conservative and Liberal amendments would delete it. Therefore, although we agree with the content of the Conservative and Liberal amendments, we will not be able to support them. I hope that that strikes a note of consensus.
17:21
Jenny Marra said that she hopes that mental health will be my passion. I hope that she and other members will recognise that, as the first debate that I have brought to the chamber is on mental health, that gives at least some indication of the priority that I place on ensuring that we tackle mental health disorders and improve Scotland’s mental health.
The debate has been useful. Paul Martin felt that it had been “robust” and Mark McDonald felt that it had been “constructive”. At first glance, those concepts might seem to be mutually exclusive, but both comments are true, and the debate has benefited accordingly.
I know that Richard Simpson, Jenny Marra and Mary Scanlon feel that we should debate the subject more regularly, given that the process has been constructive. I am certainly happy to look at bringing it back on a more regular basis.
A lot has been said in the debate, and it is unlikely that I will be able to respond to every point. If a member has raised any particular issue that I am unable to respond or refer to, they should feel free to contact me directly.
I start by referring to Mary Scanlon’s opening speech. She raised concerns about the mental health strategy. I am happy to provide an update on some of the issues that she referred to.
Will the minister take an intervention?
I have not even got to updating Mary Scanlon yet, but I will take an intervention—absolutely.
The minister may want to address issues raised by other members, because I have submitted eight or nine written questions on the strategy that relate to most of the issues that I raised. I look forward to seeing the replies.
For the benefit of other members, I will still mention the issues anyway.
On commitment 1 in the mental health strategy and the Sandra Grant report, the report in question will be published later this year.
Mary Scanlon was concerned that technology has not featured as part of the mental health strategy. I can inform her and other members that NHS 24 is project managing a technology-based process whose acronym is Mastermind. I will not go through the full title, but essentially it is to do with telehealth. NHS 24 is piloting the process in four health board regions: Shetland, Grampian, Lanarkshire and Fife. Therefore, technology is featuring as part of the process.
Commitment 26 was to audit the in-patient estate. The audit took place in October 2014 and the findings will be published later this year.
Commitment 30 was on women in the criminal justice system with borderline personality disorder. I recognise that that is an important area. Work is on-going to improve mental health services to address those challenges, building on the work that is under way at HMP Cornton Vale to test the effectiveness of training prison staff in a mentalisation approach to working with women with borderline personality disorder and, indeed, women who have experienced trauma.
Dennis Robertson raised an issue that I know is very close to him and his family: eating disorders. If he has specific suggestions as to how we can focus our efforts better in that area, I am always willing to discuss the issue with him.
Sandra White and John Mason raised a variety of local issues in relation to the Charlie Reid centre, GAMH and the closure of day centres, which is something that I know my colleague Bob Doris has campaigned on—
One moment, minister. There is far too much talking among members coming into the chamber. I am sure that you are all pleased to see your colleagues, but could we save the happy new years and handshakes for outside?
Ultimately, those local changes are matters for the local authority, but I appreciate that the removal or reduction of services can impact on service users. I suppose it reminds us that decision makers have to carefully think through any decisions that they make.
Linda Fabiani spoke of the unique nature of new towns. She will understand that I readily recognise that, too—as indeed you will, Presiding Officer. She mentioned the idea of cross-portfolio working to deliver services better in the community, particularly in relation to where people are in their community. That is always a good thing to do, and where we can do it in this area, we will.
I turn to the amendments. I recognise the points that Mary Scanlon makes in her amendment. In particular, I pick up on what she says about young people being placed inappropriately in adult wards, which Jenny Marra also mentioned. I accept that that should not happen and I am disappointed to see that the number of young people being admitted to adult wards has increased. We expect it to be reduced.
Does the minister agree that we need to look at the transition period, when young people are moved from children’s services into adult services? That period could be extended so that, if appropriate, young people could stay within CAMHS rather than moving on to adult services.
That is the flipside of the point that I was about to make. In the circumstances that we are talking about, most of the admissions are of young people aged 16 or 17, and in certain cases an adult facility might be clinically judged to be a more appropriate setting. Nevertheless, I expect almost all children and young people who are admitted to adult wards to be discharged quickly and transferred to CAMHS settings.
I point out that we are increasing bed numbers in the north of Scotland for children and adolescents—the new unit will be ready later this year.
However, I cannot accept the Tory amendment because the quality of mental health services is not measured in nationally set numbers of beds or staff. Although, as I have alluded to, those are both important parts of a well-functioning system, it is the quality of clinical outcomes and social and personal outcomes that matters.
I do not accept Mr Hume’s amendment. I agree that we need to ensure that mental and physical health have equal recognition. I was somewhat perplexed when Mr Hume’s response to me was that the difference between Scotland and England is that that recognition has been put in legislation in England, given that I had already said to him that section 1 of the National Health Service (Scotland) Act 1978 essentially makes the same commitment here in Scotland. To be clear, I say to him that the 1978 act is legislation.
I think that we would take the Liberal Democrats’ concerns about parity rather more seriously if they had not, in March 2014, overseen a funding decision made by NHS England that imposed a proportionately greater funding cut—20 per cent greater—for mental health services than for acute hospitals, which was of course widely criticised by mental health organisations.
Jim Hume rose—
The minister is in his last 15 seconds.
I therefore cannot accept the Lib Dem amendment. I am happy to accept the Labour amendment, which is constructive.
This has been a useful debate. I look forward to bringing mental health back to the chamber as it is an important issue for us continually to debate.
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