Official Report 1177KB pdf
The next item of business is a statement by Tom Arthur on youth mental health support. The minister will take questions at the end of his statement, so there should be no interventions or interruptions.
14:27
My statement concerns the lasting legacy of the youth commission on mental health services, which reported in 2019. I begin by thanking Young Scot, Scottish Action for Mental Health and the Children and Young People’s Commissioner Scotland for their recent report detailing the progress against the commission’s recommendations. The opportunity to give my statement today is therefore very timely.
The youth commission’s work remains at the heart of the Government’s approach to children and young people’s mental health and wellbeing. The commission was part of a sea change in how we think about support for children and young people’s mental health. The commission’s primary theme was that support should be available across the whole system at all levels of need, which is a principle that is at the core of our current mental health and wellbeing strategy. The strategy sets out our shared vision of a Scotland that is free from stigma and inequality, where everyone, including children and young people, fulfils their right to achieve the best mental health and wellbeing possible. I believe that that reflects the youth commission’s ambition for children and young people’s mental health.
That includes the strategies that focus on the three Ps—promote, prevent and provide. It is clear that the commission was a catalyst for so much of the change that we have seen across the system in the intervening years. I will give some examples shortly. The commission was a great example of young people directly driving meaningful improvements on the issues that matter to them. On that note, I give my heartfelt thanks to the many young people who shared their personal experiences. They demonstrated tenacity, candour and passion to improve the services that they access. Their work, and that of the many young people who followed them in sharing their views and experiences, continues to influence policy six years after the report was published. Therefore, I hope that the members of the commission are very proud of what they achieved.
We accepted the vast majority of the 103 recommendations that were made by the commission. However, as the new progress report acknowledges, the landscape has changed significantly over the past six years. The time between then and now spans two parliamentary terms. In that time, we have had a global pandemic; national health service spend on mental health has increased dramatically; and we have published two national strategic mental health documents—I could go on.
The latest report highlights the difficulty of reporting progress against previous recommendations that have themselves resulted in huge change. That is why I want to focus my statement on the commission’s lasting legacy. It is only right that we reflect on its achievements, and I would like to do so with reference to each of the commission’s five key themes.
The first theme focused on services. The recommendations directly influenced the development of the service specification for national child and adolescent mental health services, which was published in 2020 and outlined the standard of support that young people and their families are entitled to expect from the national health service. Key principles of the specification include equity of access and a needs-led and rights-based approach that is aligned with the getting it right for every child policy.
In recent years, we have invested significantly in CAMHS improvements and continue to work with health boards to closely monitor implementation of the specification. In line with the commission’s recommendations, the service specification states that CAMHS must work in partnership with children, young people and their families in all aspects of service design and delivery, including transition planning.
We have also seen considerable improvements in CAMHS waiting times. The 18-week standard has now been met for the third quarter in a row, with 91.8 per cent of children and young people starting treatment within 18 weeks of referral. Local CAMHS teams continue to respond well to demand, with one in two children and young people who are referred to CAMHS starting treatment within five weeks, compared with 12 weeks in the period before the pandemic. That is the result of sustained investment by the Scottish Government and, even more importantly, the continued hard work of our amazing CAMHS workforce.
CAMHS staffing levels have increased by 54.3 per cent in the past decade under this Government. We have also exceeded our commitment to provide funding for 320 additional staff in CAMHS by 2026, increasing case capacity by more than 10,000.
The commission’s second theme—education—called for a whole-school approach. We have ensured access to counselling services in secondary schools across the country, and continue to support local authorities with £16 million every year. We have also published a whole-school approach framework to assist in supporting children and young people’s mental health in schools.
The third theme called for more community-based approaches to support mental health. We know that not all children and young people who need support will require a specialist service such as CAMHS. That is why, since 2020, we have provided local authorities with more than £80 million to fund community-based mental health support for children and young people, including £15 million a year in baseline funding from 2025-26. Community-based supports are now available in every local authority area, and councils report that such support was accessed by nearly 80,000 people in 2024-25.
Young people aged 16 and over can also access projects that are supported by our communities mental health and wellbeing fund for adults. We have invested £81 million in that fund since 2021, with a further £15 million committed for 2026-27 through our third sector fairer funding pilot.
Our substantial investment in community-based support brings me to the commission’s next theme: finance, policy and rights. As I mentioned earlier, NHS mental health expenditure has risen substantially in recent years, from £1.3 billion in 2022-23 to £1.49 billion in 2023-24. Despite facing the most challenging financial situation since devolution, we have doubled the direct programme budget for mental health since 2020-21, allowing us to build on the improvements that we have made in early intervention and prevention, as well as clinical support.
Again, let me be unequivocally clear: the mental health budget for 2025-26 remains at £270.5 million. Between the Scottish Government and NHS boards, we expect spending on mental health to be around £1.5 billion in 2025-26.
The commission’s report emphasised the importance of young people being at the centre of decision making and being supported to understand their rights. That principle of meaningful participation is central to the adoption of a children’s rights-based approach and is a guiding general principle of the United Nations Convention on the Rights of the Child.
Scotland is the first country in the United Kingdom, and the first nation in the world, to incorporate the UNCRC into domestic law, within the limits of devolved competence, providing legal protection for children’s rights. Further building on the legacy of the commission, we continue to ensure that the voices of children, young people and those with lived experience are central to policy development, for example through our child and family mental health joint strategic board and a youth reference group that supports our work on suicide prevention.
In its final theme, the commission rightly acknowledged the need to train the workforce to better meet the needs of children and young people. Our mental health and wellbeing workforce action plan sets out a range of actions to address key workforce issues, including training. In 2025-26, we provided NHS Education for Scotland with over £30 million to continue multidisciplinary education, training and support of workforce expansion, including for CAMHS.
Despite the substantial progress that I have set out, we are not complacent. I acknowledge that we have much more to do. That is why we are working with partners to refresh our mental health and wellbeing delivery plan. The next delivery plan is scheduled for 2026 and will contain a focused selection of strategic actions that will enable us to make significant progress towards our overall vision for health and social care reform. I want the delivery plan to show a clear and tangible contribution not only to the mental health and wellbeing strategy, but to the service renewal framework, the population health framework and the NHS Scotland operational improvement plan.
I also recognise the importance of ensuring that the Government learns from our incredibly valuable partners who are working on the ground and in communities. For example, I know that SAMH is shortly to open its nook network hub in Glasgow, which will be an integrated, community-based site that brings together stakeholders from across the city and will be open to people aged 10 and up. I very much look forward to visiting the nook hub and learning from the innovative approach that SAMH is taking.
Finally, I will touch briefly on neurodevelopmental support, following on from my statement to Parliament in June. Although I recognise that neurodivergence is not a mental health condition, I want to reaffirm that we are continuing to take action to support people with neurodevelopmental needs. Improving support for children and young people is a long-term commitment. Although we are still at the early stages of that work, we are providing funding of £500,000 this year to improve ND assessment and support for children and young people. In conjunction with the Convention of Scottish Local Authorities, we have undertaken a review of the implementation of a national neurodevelopmental specification. That will inform improvements to ensure that health boards and local authorities are delivering the specification in full. We have also established a new cross-sector neurodevelopmental task force, which met for the first time on 2 October. It will be key to taking forward the actions that are identified in the review.
I end by reminding colleagues that tomorrow is world mental health day, which makes this an ideal time to reflect on the progress that we have made and the work that we still have to do. I again give my thanks to the youth commission members and to SAMH and Young Scot. The lasting legacy that they have created continues to drive our approach to children and young people’s mental health and wellbeing.
I look forward to members’ questions.
The minister will take questions on the issues raised in his statement. I intend to allow around 20 minutes for questions, after which we will need move to the next item of business. I encourage members who wish to ask a question to press their request-to-speak buttons.
I thank the minister for early sight of his statement.
The rise in poor mental health among children is one of the most concerning health issues that we face in Scotland, even in an environment in which poor health outcomes are too common. Scotland has had a significant spike in the need for CAMHS services, along with a massive jump in attention deficit hyperactivity disorder, autism and neurodivergence referrals. We even have situations in which health boards cannot disaggregate CAMHS numbers from neurodivergence numbers. That cannot be allowed to continue. How can we solve an issue if we do not understand the problem?
We also have a third sector, which we rely on heavily, that is on its knees. Many essential mental health services that it provides are in danger of disappearing, further exacerbating the pressure on our statutory services.
Last week, I was at the launch event for Voluntary Health Scotland’s manifesto, the key theme of which is prevention. We need significantly better interaction between the third sector and statutory services, with an emphasis on prevention.
It is great that councils have more money, but what assessment has the Scottish Government made of what is happening on the ground? Many leisure centres, pools and community halls have shut because of a lack of local government funding. Those spaces provide front-line support services for our kids by offering, first, inclusion and, secondly, an outlet.
The commission on mental health services made its recommendations in 2019 but, last month, the children’s commissioner said:
“evidence of progress by the Scottish Government in many areas is seriously lacking.”
What guarantee do we have that the Government will finally deliver after six years?
The children’s commissioner also highlighted that the Scottish Government had made a key commitment that at least 1 per cent of NHS funding should go towards young people’s mental health services, which has not been fulfilled. Will the minister commit to delivering that promise by the end of the parliamentary session?
I will take each of Brian Whittle’s questions in turn. He referred to the impact on the ground. As I touched on, since 2020, £860 million has been invested in community mental health services from two funding streams: one for children and young people and another for adults. As I said in my statement, the funding for children and young people has been baselined into local government funding.
Around the inception of that funding, a framework was published that set out the types of interventions that it would help to support and the vision for community mental health support. The evidence that we have seen to date—the number of organisations that have been able to secure funding and deliver projects on the ground locally, and the point that I made about around 80,000 people receiving support in the last year for which we have data—demonstrates the significant impact of that funding. Of course, we continue to engage with partners and local government to understand what further action can be taken.
On the point about progress on the commission’s recommendations, as the commission’s report acknowledged, and as I touched on in my statement, there has been a sea change over recent years—not least because of the impact of the Covid pandemic—and a second mental health and wellbeing strategy has been introduced. The actions that I have set out demonstrate that the commission’s core recommendations, which the Government accepted either outright or in principle, have strongly informed our strategic position and the actions that are being taken forward via the delivery plan.
With regard to the point on CAMHS spending, we recognise the commitments that Mr Whittle mentions and are resolved to work constructively with our partners to ensure that we can deliver on the commitment for 1 per cent of NHS funding to go to CAMHS and, indeed, on the commitment for spending on mental health services to increase to 10 per cent of the total NHS front-line budget.
I thank the minister for advance sight of his statement.
We all agree that the current system for young people who seek mental health support is broken and must be transformed. I came to the Parliament from the Bipolar Scotland conference held in Edinburgh this morning, where there was broad agreement that prevention is often ill recognised and poorly resourced, particularly because of irrational and incoherent decisions made by integration joint boards in allocating budgets.
At First Minister’s question time, the First Minister told me that the Government was on track to meet its commitment to spend 10 per cent of the national health service budget on mental health services by the end of this parliamentary session. Does the minister agree with the First Minister that that will be achieved, and is he willing to be held to account for that commitment?
The First Minister set out clearly what action the Government is pursuing and that we are on track to achieve the goal that he mentions. As I stated when responding to questions on my statement in June, I made a commitment that we would work constructively with health boards to support that delivery because, as Paul Sweeney will be aware, there is variation across health boards in the total percentage of resource that is allocated for mental health services. I again commit to working constructively with health boards to achieve it.
Mr Sweeney made a point about prevention. That is absolutely important. It is the heart of the population health framework and, indeed, a core component of our mental health and wellbeing strategy, which seeks not only to promote positive mental wellbeing but to prevent crisis and need and, where they develop, to be able to provide the required support.
Will the minister say a bit more about the steps that the Scottish Government is taking to deliver improvements across waiting lists for youth mental health services?
We are taking a number of actions. As I touched on in my statement, there has been significant investment in resource over the past decade. There has been a rise in CAMHS staffing in excess of 54 per cent as well as significant increases in our mental health budgets. That is reflected in the CAMHS performance statistics, with the national target being exceeded for the third consecutive quarter and the median wait for people to begin treatment after referral being five weeks.
Glasgow families have been left deeply concerned by the closure of the Notre Dame children’s centre earlier this year. That service supported some of the city’s most vulnerable young people. How can the minister claim real progress when trusted community-based services such as that centre are closing their doors due to funding pressures? It leaves children without the help that they desperately need.
I recognise the importance of the issue that Annie Wells has raised. Other members will have concerns with regard to locally made decisions that are taken under the existing statutory frameworks. The Government is committed to ensuring that we engage constructively with partners. This year, we have allocated record funding for our health boards and local government. As I touched on earlier, over the past five years, we have provided £160 million for community-based mental health services.
The transition from child to adult mental health services can be a worrying time for both young people and their parents or carers. What assessment has been made of the support that is required for those who are transitioning from youth mental health services to adult mental health services?
The question of transitions is extremely important. Providing transitionary support was one of the recommendations in the commission’s original report. That report followed the 2018 publication of the transition care plan guidance that informs our CAMHS approach. There is flexibility, in that when a young person reaches 18 years of age it does not necessarily mean that they move immediately to adult mental health services. The point for such a move can vary between the ages of 18 and 25 in response to the specific needs of the individual or young person. That flexibility is included within the national standard. It is for local partners to ensure that that is being delivered.
I thank the minister for advance sight of his statement. It will be disappointing to young people with ADHD across Glasgow and their parents that he mentioned issues that relate to ADHD only at the end of his statement and, even then, in very broad terms.
A constituent in Glasgow has struggled to be assessed for ADHD for almost two decades. Her assessment was first requested in 2008, when she was a young child, and she has spent the intervening years being passed from pillar to post. She is not alone. Current waiting times mean that people who are assessed this week are likely to have waited more than three years to be assessed, leading to a lifetime of uncertainty with untold consequences. What is the minister going to do to urgently ensure that there is a timely pathway for support and diagnosis for young people with ADHD?
I recognise the primacy and importance of that issue. That is why I set out the actions that the Government is undertaking in a substantive statement to the Parliament prior to summer recess, in which the substance of my remarks focused on responding to the youth commission report. However, I felt that it was important to provide a further update to the Parliament on the work that we are doing on support, assistance and assessment for neurodevelopmental conditions.
We recognise that, to use the words of the Royal College of Psychiatrists in Scotland, we are contending with an
“unprecedented increase in the number of people”
who are coming forward, which was “unforeseen”. Scotland is not alone or unique in facing this challenge; it is shared by our colleagues elsewhere in the UK and in many other countries.
To reiterate my points, we have a national specification that sets out the standards and expectations for partnership working at the local level, and we recognise that there have been implementation challenges—hence the review of implementation and the establishment of a cross-sector task force. I would be more than happy to keep Pam Duncan-Glancy up to date on that work. We have a forthcoming cross-party summit to discuss those matters further.
I remind the Parliament that I am employed as a bank nurse by NHS Greater Glasgow and Clyde.
Having adequate staffing levels is key to ensuring the provision of high-quality services. Will the minister provide an update on current CAMHS staffing levels and on the Scottish Government’s work to invest in our mental health workforce?
As I touched on earlier, there has been significant investment. Staffing has increased by more than 54.3 per cent to 1,510.9 whole-time-equivalent posts. We have exceeded our commitment to provide funding for 320 additional staff in CAMHS by 2026, which has increased capacity for cases by more than 10,000. We have also provided NHS Education for Scotland with more than £30 million in 2025-26 to continue multidisciplinary education and training and to support workforce expansion.
Will the minister clarify how children and young people from marginalised or rural backgrounds are being included in the youth reference groups and strategic boards that are shaping mental health policy?
My clear expectation and intent is that our work in policy development should reflect the whole range of Scotland’s population, including those in different geographies, and should include consideration of issues that pertain to rurality. I am happy to follow that up in writing to provide Ariane Burgess with more specific detail.
If neurodevelopmental assessment waiting times were absorbed into CAMHS waiting times, the Government would miss every single one of its targets. The Scottish Parliament information centre tells us that more than 42,000 children are waiting for an assessment. The average waiting time is 76 weeks, which is a year and a half. Some people are waiting four, five or even six years for an assessment. That is outrageous, atrocious and, frankly, shameful. When will we achieve parity and consistency of access across all local authorities and all health boards, so that every child in Scotland, no matter where they live, has access to diagnosis and the treatment and support that they rightly deserve?
The first point that I will make is that a neurodevelopmental condition is not a mental health condition, so to suggest that those seeking a neurodevelopmental assessment should be in CAMHS is completely incorrect. Child and adolescent mental health services are there, but we are talking about acute specialist services for acute mental illness. If a person is assessed as having a neurodevelopmental condition, that does not make them mentally unwell. That is an important point to make. If someone with a neurodevelopmental condition has a comorbid mental health condition, CAMHS might be the appropriate pathway. However, it is important to make that distinction when we are discussing this matter.
Secondly, if Jamie Greene has not had the opportunity to consider the paper that the Royal College of Psychiatrists in Scotland published last week, I strongly recommend reading it. In discussing a diagnosis-led response and the mental health system, it makes the point that no mental health system in the world could respond to the unprecedented and unforeseen increase in the number of people seeking assessment and diagnosis. The paper recognises that we need a whole-system, whole-society approach, which is what we are absolutely committed to delivering.
With regard to children and young people, which the substance of my statement was concerned with, I have already set out the work that we are doing through the national specification and the cross-sector task force that has been established. I look forward to engaging with Jamie Greene at the cross-party summit.
What steps are being taken to ensure equality of access to services across different health board areas, so that young people can benefit from high-quality services irrespective of where they live in the country?
That is a really important point, and I recognise that there is still variation. The national specification was published some five years ago, and we have seen strong progress among the overwhelming majority of health boards. Where there are still challenges, the Government and officials work closely with health boards to address them. I give the commitment to members that that is what we will continue to do.
The statement indicates that there has been considerable improvement in CAMHS waiting times. However, some children are waiting as long as three years to access mental health support through the NHS, which is clearly unacceptable. What guarantees can the Scottish Government give that today’s announcement will result in waiting times being cut, or will we continue to leave our children behind?
Long waiting times are not acceptable. In my statement and in response to questions from other members, I have highlighted the strong performance that we have seen in CAMHS—the 90 per cent target has now been exceeded for three consecutive quarters, and the median waiting time between referral and start of treatment is down to five weeks, compared with 12 weeks before the pandemic. That reflects not only significant investment from the Government but the fantastic work that has been undertaken on the ground by CAMHS staff. We recognise that there is variation in the system, and we are committed to working with health boards to support them to ensure that there is equity of access across all of Scotland.
For many young people, the most appropriate forms of support are provided in community settings. Will the minister say more about the Scottish Government’s work to support community mental health services?
Rona Mackay makes an important point. Community-based services are often the most appropriate and impactful way to help people who require support with their mental health, and they are often the most effective and impactful way of supporting people who are seeking neurodevelopmental support.
As I touched on previously, the Scottish Government has provided in the region of £160 million of funding over the past five years to support community mental health services for children and young people and for adults. Young people who are aged 16 or over are also able to access adult services.
That concludes the statement on youth mental health support. Before we move to the next item of business, there will be a brief pause to allow members on the front benches to change over.