Meeting of the Parliament
Meeting date: Wednesday, May 17, 2023
Agenda: Portfolio Question Time, Bus Services, Mental Health Crisis, Complaint, Business Motions, Parliamentary Bureau Motions, Decision Time, Lyme Disease
- Portfolio Question Time
- Bus Services
- Mental Health Crisis
- Business Motions
- Parliamentary Bureau Motions
- Decision Time
- Lyme Disease
Mental Health Crisis
The next item of business is a debate on motion S6M-08955, in the name of Jackie Baillie, on tackling Scotland’s mental health crisis. I invite members who wish to participate in the debate to press their request-to-speak buttons now or as soon as possible.
I advise colleagues that the debate is as tightly constrained, timewise, as the previous debate, so I encourage all members to stick to their time allocation. With that, I call Jackie Baillie, leading by example, to speak to and move the motion.
You have up to six minutes, Ms Baillie.16:01
This week is mental health awareness week. Although much progress has been made, in recent years, in how mental health is treated and regarded, so much more still needs to be done. We all know someone who has been affected by mental health difficulties, and the events of recent years, such as lockdowns, have led to a rise in the number of people experiencing mental health problems.
The need to take action to protect the mental health of the people of Scotland is self-evident but, sadly, this Government has failed to do that. Today, some 30,000 children, young people and adults in Scotland are languishing on mental health waiting lists. That is nothing short of shocking, but, although it has been exacerbated by the pandemic, that crisis did not develop overnight. Despite the Scottish National Party Government introducing a national standard, in 2014, that 90 per cent of referrals for child and adolescent mental health services should start treatment within 18 weeks, that target has not been met once.
Around a third of young people who are referred to CAMHS services wait more than 18 weeks for treatment. Statistics that Scottish Labour has obtained show that the number of mental health calls to NHS 24 has risen sevenfold since 2019 and that—horrifyingly—7,576 Scots are thought to have died by suicide in the past decade. Those are not just statistics—they are lives cut brutally and tragically short, and it is incumbent on every single one of us in the chamber to work to ensure that more lives are not avoidably lost.
What must be done to protect the mental health of our nation? We must always remember that mental health issues, like physical health issues, do not drop from the sky. They are often the product of people’s circumstances and surroundings, which is why tackling poverty, unemployment and low-paid, insecure work must be part of a holistic approach to improving mental and physical health for all of Scotland.
Without targeted action to tackle the mental health crisis, more lives will be lost. Despite promise after promise from the SNP Government, staff shortages are continuing to undermine the heroic efforts of our national health service to tackle the mental health crisis. Despite an SNP promise to recruit 1,000 additional community mental health roles, the minister has admitted, in response to me, that not one has yet been recruited—and, by the way, the budget has been slashed. That is nothing short of a catastrophic dereliction of duty on the part of the Government.
Michael Matheson, who I see has now joined us, and Maree Todd may be new in their roles but they have been in Government for a long time and they inherit the mess that was left to them by Humza Yousaf. It is vital that they acknowledge the SNP’s failings, listen to NHS workers and act now.
To start, the SNP can end the short-changing of mental health funding in Scotland. In Labour-controlled Wales—I know that SNP members are keen to cite Labour-controlled Wales—mental health funding is 11 per cent of the health budget, and in England it is 10 per cent. In Scotland, it is just below 9 per cent.
With the scale of the mental health crisis that Scotland faces, that makes absolutely no sense and may even be putting lives at risk. That is why the SNP must urgently consider increasing mental health funding to at least 11 per cent of the NHS budget, to bring it into line with Wales—and, indeed, England—and to bolster front-line services. In my area, crisis services, for example, are extremely patchy, and after 8 o’clock at night people might not be able to access a local service.
We know that calls to mental health helplines are skyrocketing and that people in crisis are being left hanging on the telephone far too often. It is time for further investment in NHS 24 to ensure that no call goes unanswered.
With 30,000 Scots, including children, languishing on NHS waiting lists, we need a new referral system and investment in front-line services to support NHS staff. We also need a dedicated mental health worker in every general practice and specialist mental health services in every health board.
To do nothing to tackle the crisis would be nothing short of a dereliction of duty and an abandonment of the people of Scotland. It is time to draw a line under the inaction and get to grips with the crisis. SNP neglect has consequences, and SNP neglect of mental health services must end.
In the name of co-operation, and for the benefit of the people of Scotland, I move the motion in my name and call on everyone in the chamber who understands the scale of the mental health crisis to support our motion at decision time.
That the Parliament acknowledges Mental Health Awareness Week and, in so doing, is deeply concerned by the mental health crisis in Scotland, with almost 30,000 children, young people and adults on waiting lists; notes that mental health-related calls to NHS24 were almost seven times higher in 2022 than in 2019 and that, tragically, 7,576 people have died from probable suicide in the last decade; considers that staff shortages are undermining efforts to improve care, with the Scottish Government failing to begin the recruitment of the 1,000 additional roles to support community mental health resilience; agrees that funding must be directed into frontline services and community-based services; supports the creation of a new referral system, so that no young person is rejected for treatment, the provision of a dedicated mental health worker in every GP practice and a mental health A&E department in every health board so that patients can be fast-tracked, and calls for mental health spending to be increased to at least 11% of the NHS budget.16:07
I thank Jackie Baillie for bringing this debate on mental health awareness week to the chamber. Mental health is a fundamentally important topic for all parties.
This year’s theme—anxiety—is an important one. Many of us will have had direct experience of it over the past few years. Everything that I will briefly touch on during my opening remarks comes back to one core message, which is related to the theme of this week: if you need help for your mental health, please ask for it.
Nobody is saying that we already have a perfect system. Jackie Baillie’s motion highlights some legitimate concerns that the Government shares. We hear from individuals, families and our workforce that there can be issues and frustrations with finding and receiving the right help.
We know that we need a power of additional work if we are to see the right services and support consistently in place for the people of Scotland. Our forthcoming mental health and wellbeing strategy, which we will publish in the coming weeks, will describe that work.
Does the minister recognise that the concern goes far beyond mere frustration, that access to those services is sometimes impossible and that diagnosis of the most critical conditions takes years? It is more than frustration, because there is a complete absence of any practical offer whatsoever.
I do not agree with that characterisation of the situation that we are in. I acknowledge that some children have been waiting too long for child and adolescent mental health services, but I am absolutely certain that we are seeing an improving trajectory and that we have built the right foundations to improve the situation.
Will the minister take an intervention?
Will the minister take an intervention?
I really must make some progress, because I have time for only a short opening speech.
We will publish the accompanying delivery and workforce plans after the summer recess, which will give us time to work with stakeholders and partners on the detail of implementation.
Improving mental health goes even wider than the Labour motion suggests. Among other things, it requires us to address wider social factors—as Jackie Baillie acknowledged in her opening speech—to challenge stigma and to promote good mental wellbeing for everyone.
I agree that doing more of the same will not deliver the transformative change that we need. That will be a key principle of the strategy, and I am sure that we have cross-party agreement on that. Notwithstanding that, my amendment to the motion seeks to restore some balance to the debate. Yes, there are issues, but we are also seeing real progress, and it is important that that is recognised.
Audit Scotland will publish its report on adult mental health services next month. Is the minister confident that the report will be positive for the Government?
Minister, I can give you a bit of time back.
Thank you very much, Deputy Presiding Officer.
As always with Audit Scotland reports, I am confident that the Government will read with interest and take on board the comments that are made.
We have seen historic increases in spending. It is a fact that the Scottish Government’s core mental health budget has more than doubled since 2020-21. There has been extraordinary work, some of it behind the scenes, by boards to clear long waits. In the past quarter alone, the number of children who were waiting for more than 52 weeks for child and adolescent mental health services decreased by 42 per cent, and the number who were waiting for more than 18 weeks decreased by 32 per cent. That unseen work has set the conditions for the most sustained, positive changes in CAMHS waiting lists for more than half a decade, and the number of children who started treatment from CAMHS in the most recent quarter is comfortably the highest figure on record.
As I mentioned, our focus cannot be just on specialist services. Over the past two years, we have invested £30 million to establish community-based mental health and wellbeing services for children, young people and their families. More than 45,000 people accessed those services between July and December last year, which reduced inappropriate referrals to specialist services. We have also invested £36 million in our communities mental health and wellbeing fund for adults over the past two years, and a further £15 million has been announced for 2023-24.
I will touch briefly on one specific part of the original motion, which Jackie Baillie raised in her opening speech. The motion refers to an increase in NHS 24 call volumes. Yes, calls are consistently up, but that is for a range of reasons. We have moved the mental health hub to a 24/7 service. More people know that the service exists, because we have signposted to it, as well as to a range of other supports, through our “Mind to Mind” website. It is not just about the volume of the calls but about how we respond to the calls.? We have backed NHS 24 with more than £9 million of funding since 2021 to ensure a quality service for everyone. I gently say that we should all take care to avoid using language that could stigmatise those who ask for help.
Are there areas where we need to make more progress more quickly? Yes—absolutely. We have exceeded our commitment to fund more than 800 additional mental health workers, many of whom are working in primary care and community settings, but we know that we need to further enhance the support that is available in primary care. We have had to make difficult decisions on the basis of our current financial situation, but that does not mean that that area is not still a priority.
More generally, we have signalled that, by the end of this parliamentary session, 10 per cent of NHS expenditure should be on mental health and 1 per cent should be on CAMHS.
Will the minister take an intervention?
The minister is concluding.
Minister, you need to wind up.
In my closing minutes, we know that boards face—
No, you are concluding, minister.
We know that boards face a range of pressures but, equally, spending needs to ensure parity between mental and physical health.
Our workforce across services, communities—
No, minister—you must conclude and move your amendment.
Okay. In the spirit of realistic but ambitious improvement, I move amendment S6M-08955.3, to leave out from first “and” to end and insert:
“; understands that many people are struggling with their mental health and wellbeing, so welcomes this debate as an important opportunity to talk openly about issues such as anxiety; recognises the cumulative impact that the COVID-19 pandemic, the conflict in Ukraine, Brexit and the cost of living crisis have had on the mental wellbeing of children, young people and adults across the country; welcomes the fact that mental health spending has doubled in cash terms from £651 million in 2006-07 to £1.3 billion in 2021-22, and that, as a result of that investment, Child and Adolescent Mental Health Services (CAMHS) and psychological therapies staffing has more than doubled; acknowledges that the Scottish Government has exceeded its commitment to fund over 800 additional mental health workers in settings such as A&E departments, GP practices, police custody suites and prisons; notes the aims to increase mental health staffing further, but recognises that supporting wider community resilience is as important as enhancing NHS capacity; welcomes, therefore, the fact that, between July and December 2022, more than 45,000 children, young people and their family members across Scotland accessed community-based mental health support; acknowledges the benefit of the 3,300 grants provided to grassroots community organisations through the Communities Mental Health and Wellbeing Fund for adults in the past two years, with a further £15 million of investment confirmed for 2023-24; notes that, since its launch in 2017, the Distress Brief Intervention programme has provided support to over 40,000 people; recognises that every death lost to suicide is an enormous tragedy, which leaves devastating and long-lasting impacts on families, friends and communities; supports the aims of the work being driven forward by a wide range of partners as a result of the Scottish Government and COSLA’s Suicide Prevention Strategy and Action Plan, published in 2022, and believes that these efforts will be enhanced by the publication in June 2023 of a new Mental Health and Wellbeing Strategy, which will focus on further action required to support mental health and wellbeing.”
Thank you, minister. There really is very little time in hand, so members will have to stick to their allocated speaking times.
I call Sue Webber to speak to and move amendment S6M-08955.1 for up to four minutes.16:14
This week is mental health awareness week, and this year’s official theme is anxiety. More than half of Scots who were surveyed said that anxiety interferes in their daily lives, and, although it is natural to be anxious, for some people those feelings might not go away. They might get worse or not have a particular cause and become a problem, especially if people do not know what the feelings are or why they are happening. Everyone’s experience of anxiety is different, and not everyone who has anxiety will experience the same symptoms.
Anxiety can become debilitating and affect a person’s performance at work and their personal life. In 2008, that happened to me. There was not one cause but several challenges that I faced—physical pain from an injury, pressure at work and the death of a close friend. I needed time off work. I was lucky—I received support from my employer through their employee assistance programme and, after six weeks, I was on a phased return to work. As I said, I was fortunate. The counselling was arranged quickly and the sessions happened in regular succession.
On the SNP’s watch, Scots across the country are waiting far too long for mental health treatment. CAMHS is the main route to assessment and treatment for children and young people seeking help with their mental health, but we should remember that the SNP has never met its CAMHS target and adult waiting times are still nowhere near good enough. In 2022, almost 9,000 children were refused mental health treatment. Between January and June this year, 4,640 referrals to CAMHS were rejected. Long delays in accessing treatment can lead to more entrenched difficulties by the time a child or young person is able to access a service. Failing to solve the CAMHS crisis today will lead to poor mental health outcomes for future generations, further compounding the issue.
However, it is not just CAMHS that is in crisis under the SNP. The SNP Government froze the mental health budget for 2023-24. Just this weekend, the outgoing Children and Young People’s Commissioner Scotland, Bruce Adamson, said that Nicola Sturgeon had failed to address the issue of children’s mental health. The First Minister, Humza Yousaf, pledged to recruit an additional 1,000 mental health specialists when he was the cabinet secretary for health, but that has been delayed. There is a shortage of mental health beds across Scotland, and there are 190 CAMHS vacancies in Scotland.
Let us not forget that our existing staff are absolutely critical to delivering these services and they are clearly working at the extreme end of their professional capacity, so we must be hyper-aware of their mental wellbeing. Knowing healthcare professionals as I do, I am well aware of how low down the priority list they put their own health and wellbeing. That is evident in the data that was presented in the press over the weekend. Between 2018 and 2022, almost 75,000 NHS staff members missed work due to anxiety, stress, depression or other mental health issues.
As the largest staffing group in the NHS mental health workforce, nursing staff play a key role in the delivery of services. However, current levels of staff absence due to anxiety, depression and other mental health-related illnesses are extremely worrying. Nursing staff across NHS Scotland are telling us that staff shortages are impacting on their ability to provide safe care for patients and on both their own and their colleagues’ wellbeing.
After 16 years in government, the SNP seems to be out of ideas when it comes to tackling mental health. We must look after our existing workforce and help them to keep well so that they can look after the wellness of our population. We need a fresh approach that incorporates modern, efficient, and local solutions into healthcare.
Ms Webber, you must conclude.
I thought that I had five minutes.
I move amendment S6M-08955.1, to insert at end:
“; raises the issue of increased levels of mental illness among NHS staff, with almost 75,000 staff members being absent due to anxiety, stress, depression or other mental illness between 2018 and 2022; notes that the outgoing Children and Young People’s Commissioner said that the former First Minister, Nicola Sturgeon, had failed children on a number of issues, including mental health, and reminds the Scottish Government that failing to solve the Child and Adolescent Mental Health Services (CAMHS) crisis today will lead to poor mental health outcomes for future generations, further compounding the issue.”
Apologies—I know that there is a lot of interest and a willingness to engage in the debate, but these short debates do not allow for that and I need to protect the time for business later this afternoon.
I call Alex Cole-Hamilton—you have up to four minutes.16:18
Thank you, Presiding Officer. I will be brief. I am grateful for the opportunity to speak in the debate and I thank Jackie Baillie for bringing it to the chamber.
I must say that it is the cruellest irony that the minister in charge of the portfolio entreats people with mental ill health issues to come forward, only for them to join the longest queue in the national health service. The frustration that they, their families and the doctors and nurses around them feel is a mark of shame.
As we mark this mental health awareness week, it is important to acknowledge the scale of the challenge that I have just identified. Of course, it has been added to by the pandemic, which was a time of extraordinary trauma. However, a lot of that trauma already existed and was already not being addressed. The toll that that has taken has increased stress, depression, anxiety and—yes—waiting lists yet further.
We have heard about the focus of this year’s mental health awareness week, which is anxiety. We know that 58 per cent of adults in Scotland have in the past two weeks experienced anxiety that interfered with their daily lives. We are a nation on edge. When mental health symptoms are left untreated they can all too often become chronic and can lead to acute mental and physical health issues.
People need support and treatment, but they are just not getting it, with almost 30,000 Scots currently languishing on waiting lists for mental health treatments. As we have heard, in 2014, the SNP Government set a new national standard that 90 per cent of people who were referred to psychological therapy would start their treatment within 19 weeks. The target was set just as Nicola Sturgeon became First Minister of Scotland. It is a dreadful indictment of her time in office that that standard has never been met—not once in the nine years that she sat in Bute house. Two of the three worst years were recorded while Humza Yousaf was Cabinet Secretary for Health and Social Care.
Mental health nursing staff play a key role in delivery of services. It is troubling that we are facing such a significant staff shortage, with more than 700 vacant posts. There is also a shortfall in nursing students. It is no wonder that services are struggling to meet demand.
It is unsurprising that the strain that staff are under is affecting their wellbeing. More than 70 per cent of members of the Royal College of Nursing have reported working more than their contracted hours at least once a week, while 60 per cent said that they were under far too much pressure at work. The NHS is buckling. Those figures should provide a wake-up call to the Administration. It is completely and utterly disappointing that the SNP-Green Government has cut the mental health budget in real terms by a staggering £50 million since last November. That is outrageous.
In 2021, Parliament voted, through agreement to a motion in my name, to declare a mental health crisis. Only two years on, the situation is even worse. The Government is not only sticking its head in the sand, but is actively making the situation worse through cuts to mental health services. As with so many other issues, it is abundantly clear that this continuity Government is living up to its name, with its abject failure to improve things for the people whom we are sent here to serve. It lacks the will, the determination and the imagination that are necessary in order to turn the situation around.
Humza Yousaf’s NHS recovery plan committed to clearing waiting lists in CAMHS and psychological therapies by March 2023, but it is now May, and we are nowhere. The First Minister and his Government are nowhere. People are stuck on waiting lists and are crying out for something to change. They need new hope now, more than ever.
The Scottish Liberal Democrats in Government would replace and increase funding for mental health services. We would reduce waiting times and roll out mental health professionals to work alongside GPs, police officers and in accident and emergency departments. We would establish a single point of contact for those who are on CAMHS waiting lists so that our young people will no longer be forced to tell their stories over and over again. We have to act, and we have to act now.16:22
On 12 May 2022, I raised the plight of my constituent, Ryan Caswell, at First Minister’s question time. At that point, Ryan had been a delayed discharge patient who was resident in the Carseview centre, the mental health unit in Dundee, for two years and three months. Ryan has complex care needs, including autism spectrum disorder and learning disabilities. Carseview is a deeply inappropriate setting for him. The First Minister described my constituent’s case as “unacceptable” and said that she would look into it. However, 370 days have passed and Ryan remains an in-patient at Carseview. In the words of Ryan’s mother Irene:
“It has been 3 years, 3 months and 16 days. We are still waiting for the care and treatment to start. We have no idea how this will pan out, but Ryan cannot remain at risk where he is.”
No end in sight, no solution offered, no hope given: Ryan has become another example of what the children’s commissioner rightly identified as a young person who has been “absolutely failed” by Nicola Sturgeon. She, and her health secretary Humza Yousaf, did nothing. It has been another year of suffering and pain for Ryan and of anxiety and distress for his parents Irene and Paul, whose lives are drifting on, so much less than they should and could be.
The reality of mental health care in Tayside is worlds away from the description that the minister provided in her opening speech and the amendment that she lodged. In the past five years, 345 lives have been lost to suicide in Tayside. It was relentless campaigning from bereaved and desperate local people that resulted in the Strang report of 2020, which was heavy with urgent recommendations.
The update report of 2021 by Dr Strang has been described to me as
“the worst report in Scottish public life”,
because responsible local bodies comprehensively misrepresented what was happening. That debacle resulted in the appointment of the independent oversight and assurance group, which reported at the start of this year. We have had report after report after report—endless paper—but scant change for those who need it.
In the absence of any ministerial action, I led a members’ business debate on 8 February this year, during which the then Minister for Mental Wellbeing and Social Care promised an improvement plan for NHS Tayside mental health services by the end of March. That plan is now the latest on the groaning shelves of Ninewells hospital.
There has so far been no response from the Government to that report. Has the minister read it and, crucially, what will she do to ensure that the latest targets that it sets out are finally delivered? Will she accept accountability, given that it was commissioned by the Government after Labour pressure, or will Ryan’s plight once again fall foul of the incompetence of this Government?
The chronic issues with mental health services in NHS Tayside have been described to me by the most senior clinicians in Scotland as
“the canary in the coal mine”
of overstretched mental health services across the country.
Every member should be concerned about the situation that is faced by the people of Dundee and Tayside. The minister said that if someone needs help, they should ask. The people of Dundee have been asking for years. Will she actually do something about it?16:26
I remind members that I am a registered mental health nurse, with current Nursing and Midwifery Council registration.
Having been a mental health nurse for more than 30 years, I firmly believe that mental health is one of the most important public health issues that is faced by Scotland today. We know that the pandemic had a significant impact on people’s mental health and wellbeing, with necessary restrictions exacerbating some people’s existing mental health problems. On top of that, the cost of living crisis is having a further detrimental impact on people. Poverty in childhood and among adults can cause poor mental health through social stresses, stigma and trauma.
The debate taking place in mental health awareness week affords us all the opportunity to restate our shared commitment to improving the mental health and wellbeing of the nation.
Compared with when I started out in my career as a mental health nurse, people are now speaking far more openly about their mental health challenges and greater numbers of people are, ultimately, seeking help.
Of course, the challenge lies in ensuring that people can access mental health support where and when they need it. I believe that we have taken great strides in that regard, and I will acknowledge two particular examples. Only last month, Scottish Government investment, through the recovery and renewal fund, supported the creation of a new CAMHS outpatient facility at Udston hospital in Hamilton, which serves NHS Lanarkshire. The new facility will support children and young people from my constituency to access high-quality mental health care.
In looking at mental health support for children and young people, one of the policies that I am most proud of having driven when I was Minister for Mental Health was on ensuring that every secondary school has access to counselling services. Counselling can help children and young people to explore, understand and overcome issues in their lives—whether they are due to exam stress, trauma or bereavement—and to improve their resilience. The benefit of the service is that it meets the needs of the individual at an early stage and complements the range of approaches that are already available in schools to support the mental, emotional, social and physical wellbeing of children and young people.
From my constituency casework, I know that although services might be available to individuals, some people are experiencing unacceptable waits for mental health treatment.
We also continue to hear of the tragedy of people dying by suicide. Although the number of such deaths has fallen in recent years, the Scottish Government must continue to use every lever at its disposal to drive it down further.
The Scottish Government is investing and is taking action to help to ensure that people can access a range of types of help to match their needs, and at the earliest stage possible. Direct investment in mental health services has more than doubled since 2020-21, and the published budget for mental health services will increase by 139 per cent over this session of Parliament. The Scottish Government is continuing to seek further improvements and to invest in growing the workforce.
CAMHS staffing has more than doubled under this Government to a current all-time high. Indeed, in NHS Lanarkshire, which serves my constituency, there has been an increase of more than 400 per cent in CAMHS staffing since September 2006.
As a result of those actions and continued investment, we are now seeing evidence of significant and sustained progress in many areas across Scotland, including continuing record levels of activity and some of the most positive changes in waiting lists that we have seen for more than half a decade.
The Scottish Government is committed to improving mental health, whether that is through the creation and reform of services or through investment in the workforce. We will continue to take actions to ensure that the people of Scotland have access to the mental health care and support that they need in order that they can navigate the challenges that they face.16:30
Poor mental health is a serious public health challenge. Most of all, it can be very frightening and isolating for those who experience it.
The reality is that Scottish mental health services simply are not meeting existing levels of demand. Thousands of children and adults are on waiting lists, and thousands more are being rejected for mental health treatment after their initial referral. Furthermore, on the SNP’s watch, 1.5 million working days have been lost in the NHS due to mental illness since 2018.
There is a mental health crisis in Scotland. After 16 years at the helm, the SNP Government—along with its Green partners—must take full responsibility for the mismanagement of our mental health services.
Over the past year, I have been supporting a constituent in the north-east and her family whose horrendous story brings into sharp relief why the system must change.
After receiving successful treatment in a central belt mother and baby unit for postpartum psychosis, my constituent was sectioned in the Carseview centre in Tayside, where mental health services were so poor that they were subject to an independent inquiry by Dr David Strang.
The transition from perinatal mental health services to general adult services was abrupt and distressing. My constituent was separated from her children and her support system. She was very, very scared. She described the experience as being
“like living a nightmare; the whole experience just didn’t seem real.”
My constituent’s sister has been advocating on her behalf and has lodged a petition with the Scottish Parliament to improve maternal mental health services.
The Scottish Government must do better for women as they navigate motherhood. It is shocking that the mental health strategy mentions “women” only four times—and one of those is in a footnote. The strategy is gender blind, even though women are twice as likely to be diagnosed with anxiety as men.
The Scottish Conservatives believe that we need modern, efficient and local solutions for mental health care. For communities across Scotland and in the north-east, we want to see local delivery. I have raised the closure of the Mulberry unit for acute mental health care at Stracathro hospital numerous times with the Scottish Government. The unit closed because of insufficient staffing, which is a problem that we keep seeing in healthcare delivery in the north-east. Distressed and vulnerable patients in Angus now must travel many miles for mental health treatment. How can that be right?
I urge the Scottish Government to stop the platitudes and recycled policy pledges. It must get a grip on a crisis that is affecting thousands of people now and that will haunt thousands in the future if they do not get the care and treatment that they need.16:34
Scotland’s mental health crisis has reached breaking point. Currently, more than 30,000 people are on a waiting list for mental health support; mental health-related calls to NHS 24 are seven times higher now than in 2019; and, in the past two years, more than 4,000 patients have waited over a year before they have even been allocated their first appointment. That is unacceptable.
Covid-19 and the cost of living crisis have placed mental health at the forefront of the political agenda, as they have caused the Scottish population to experience amplified feelings of anxiety. The theme of this year’s mental health awareness week is anxiety. Children and young people studying at universities and colleges can often feel overwhelmed by stress and anxiety.
Research by the Mental Health Foundation last year found that 64 per cent of college students in Scotland had low mental wellbeing and 55 per cent had hidden their mental health problems due to shame. However, students in Scotland are not able to access the help and support that they desperately need. If young people cannot rely on the NHS for it, they must have alternative routes for seeking counselling and advice on mental health issues.
Universities and colleges are places where young people can seek help and advice. Counselling services at universities and colleges provide students with extra support at a time in their lives when stress and anxiety can seriously impact their mental health. Counsellors at our universities do a tremendous and essential job by supporting staff and students to find solutions to their problems, yet many are now facing uncertainty about their jobs and the future of counselling services at universities and colleges, because funding from the Scottish Government will end in July. Up to 80 counselling jobs in higher and further education across Scotland are set to be cut if additional funding is not allocated.
University or college can be a stressful and challenging environment for many young adults, and the Covid pandemic has only exacerbated that. Counsellors at universities and colleges do vital work to reduce stress and anxiety and improve mental health. Their work massively reduces the pressure on NHS services at a time when the NHS is already outsourcing children’s mental health services to reduce waiting times.
The Scottish Government must allocate continued funding now to save the 80 counselling jobs across Scottish universities and colleges. That vital service must continue to be available to all students who need that little bit of extra support. During this mental health awareness week, the Scottish Government should make a commitment to students across Scotland that support at university and college will continue to be there for those who need it.16:38
I know simply from my casework about the pressure on mental health services. It is a pressure that, in my 24 years as an MSP, I have not seen before. Although I wish that referrals could be accelerated, I recognise that the volume of referrals has risen. Several factors are causing unforeseen pressure on services. One is Covid. Another is the cost of living and inflation in energy and food bills, with inflation on the price of food reaching almost 19 per cent. Another is that people are more likely—and this is a good thing—to identify that they have a mental health problem. Both the Labour motion and the Tory amendment would have more credibility if they even referenced those factors.
I will start with the devastating fallout from Covid. On the situation in Midlothian South, Tweeddale and Lauderdale, I received the following response from the chief executive of NHS Borders:
“Regrettably, the Community Mental Health Team were experiencing pressure from the Covid-19 backlog and the demand for the Neurodevelopmental Disorder assessments. As a result, NHS Borders are implementing the existing secondary care referral criteria. Therefore, only patients assessed as meeting level 4 (complex) will progress for assessment by the CMHT. This is in line with the National Autism Implementation Team recommendations”.
The Mental Health Foundation has said:
“National and localised ‘lockdowns’ ... removed the social connections and day to day support that significantly contribute to positive mental health and happiness.”
I move on to inequality. Of course, that takes me on to inflation, which is currently over 10 per cent generally, with food price inflation still running at over 19 per cent—those are Office for National Statistics figures. Added to that is the cost of heating and credit cards, never mind mortgages. The Tories’ cost of living crisis means that the poorest and most vulnerable in our society are more likely to experience poorer mental and physical wellbeing, lower life satisfaction and feelings of loneliness. That is supported by new research by the Joseph Rowntree Foundation, which states:
“More than a quarter of adults in Scotland have accessed the NHS due to the impact of the cost-of-living crisis on their mental or physical health.”
That is further confirmed by the findings of See Me Scotland, which in February found that 59 per cent of people in Scotland say that the cost of living crisis is impacting on their mental health. A poll carried out for the Royal College of Psychiatrists in Scotland found that 52 per cent of Scots are concerned about the impact of rising prices on their mental health. There was no mention of that from any of the Conservative speakers in the debate.
The impact of the pandemic was bad enough, especially for those who were already vulnerable, but it has been compounded by the highest inflation rates in generations. What is welcome, but challenging, is the gradual erosion of the stigmatisation of mental health issues. More people are therefore coming forward for assessment in the first instance, which is excellent. However, it is no wonder that, in that context, demands are high and pressures are unparalleled. The Opposition parties should at the very least acknowledge that and, in the case of the Tories, they should admit a modicum of responsibility, given the cost of living crisis.16:42
I will focus my remarks on two issues. One is something that I believe we should do more of to protect mental wellbeing and the other is a measure that I hope that we can explore to prevent suicide in young people.
In highlighting the issue of improving and protecting young people’s mental wellbeing, I first acknowledge that there will always be people who need support from in-patient or out-patient mental health services. However, I believe that there are strategies that we could adopt to ensure that we improve and protect mental wellbeing.
I recently visited Larbert high school in my region and met a number of the wonderful school nurses who support children in primary and secondary schools across Falkirk. They told me about all the projects that they deliver on how to recognise and deal with emotions and stress and how to recognise when something that people are feeling has become a wider mental health issue. The nurses run sessions for first years, who might feel anxious about coming to high school for the first time, and for pupils in secondaries 4, 5 and 6, for whom exam time can be a particularly pressured time.
The nurses teach young people how to find things that bring them relief and comfort, and that they can speak about issues with their peers or with the nurses and find a resolution. The nurses have also been working with young people who have found the transition back to in-person schooling after the pandemic tough.
In primary schools, it is about giving children the tools to be able to put a name to what they are feeling and describe what made them feel that way. It is about being able to communicate how they need help and what would help them to feel better—or what made them feel happy, if that is what they are experiencing. The nurses are a hugely passionate team. They are dedicated to improving the lives of the children in those schools, whom they definitely treat like their own bairns.
I certainly did not have anything close to that at school, and I believe that, through building resilience and healthy coping strategies, as well as changing attitudes towards speaking about mental health, the programmes that those school nurses are running could help young people as they transition to adulthood.
For young people who need CAMHS referrals, we need to ensure that they get the help in the way that they need it. Talking therapies and social prescribing might suit young people better, and we need to ensure that those who are in crisis get the support that they need. I currently have a concern about how we support children and young people who have suicidal intent or suicidal ideation. Rightly, young people should be able to say who has access to their information, who it is shared with and whether parents or guardians should be told when someone could come to harm.
A constituent shared with me the story of her 16-year-old son, Scott Martin, who was treated under CAMHS. Scott had been experiencing suicidal thoughts during an acutely bad period of mental health. His parents were not told of the severity of his mental health symptoms, and he tragically completed suicide. At the start of this parliamentary session, I met his mum, who spoke with so much love about her son, but she regretted that the thoughts that her son was having were not shared with her so that she could have supported him. I encourage everyone to have a look at the Scott Martin Foundation page if they can.
We need to address that issue and find a balance between protecting young people’s confidentiality and ensuring that someone who loves and supports the person, whether they live at home or not, knows the severity of their condition. It should not be about breaching confidences; it should be about how we ensure that young people are safe.
While we seek to improve mental wellbeing, we must be aware that there will always be people who will need mental health support. We need to ensure that the sector has the workforce that it needs, that services are accessible and that we have the correct treatment and support mix for everyone.
I encourage everyone who is listening and feels that this debate has resonated with them to reach out for support. For anyone who needs it, the helpline number for Samaritans is 116 123, and the charity’s Twitter account is staffed 24 hours a day. We all need support from time to time. If you need that help, please do not struggle alone.16:46
I absolutely agree with Labour’s decision to bring this matter to the chamber today. The unique problems that are faced by people who live outside Scotland’s major cities, in smaller towns, villages and rural communities, are often overlooked in such debates.
Today, at an event in the Parliament, I spoke to a mother who told me that it took two and a half years for her son to be diagnosed with autism. Her son is now 10 and is waiting for occupational health support. He cannot read or write. That young man is being left behind. He is being excluded from his right to education because of a lack of support caused by 16 years of an SNP Government that has failed generations of people with mental health problems. The Government has failed to deliver on the promises that were made in the NHS recovery plan to reduce waiting times and to begin the recruitment of 1,000 mental health staff, which was promised in the 2021-22 programme for government. In addition, the mental health budget has been frozen, as we have heard.
On top of the mental health challenges that people in Scotland face today, remoteness, isolation and small town stigma can exacerbate problems for people who live in rural areas. Yesterday, at a countryside day that was attended by 1,200 primary 5 pupils, I spoke to many of the volunteers and rural workers. They told me about the daily challenges that they face, including stigma, rising input costs for farmers, safety concerns and the uncertain policy landscape. They spend long times not seeing anybody and can suffer from social isolation, but they are also subjected to abuse for simply doing their job in managing our land. Those pressures have had a serious detrimental impact on their mental health.
In the United Kingdom, four in five farmers under 40 cite poor mental health as the biggest problem that they face. We have a plan to tackle that by creating a network of trained mental health advisers across Scotland’s rural communities. As we discussed in my members’ business debate six days ago, those advisers would be recruited from the community—from local rugby clubs, from people such as vets and feed merchants who go down to the farm gate and from local shopkeepers. People who live in small towns, villages and more remote areas would be comfortable in engaging with those individuals, and they would be able to identify the signs of poor mental health. They would be able to check in, to provide mental health first aid during moments of distress and to encourage people to learn how to identify the signs of poor mental health and how to engage with the available resources. They would also be able to refer people, when appropriate, to more formal care, such as the RSABI counselling service or the NHS, which would ensure that the right care was received.
We need to take action. The Scottish Conservatives have a solution, and I hope that the minister and the cabinet secretary will engage with us on that. The Cabinet Secretary for Rural Affairs, Land Reform and Islands attended a roundtable with me last week to debate those proposals with stakeholders, and her willingness was refreshing. We also want to replicate some of the fantastic work that the third sector and groups such as Farmstrong have done.
I understand that the individual policies will not be a silver bullet, but we are putting forward ideas that can make a difference. We want to work with the Government to see those plans come to fruition; to help people who struggle with their mental health; and to drive CAMHS waiting times down—which would mean that the mother who spoke to me today could get help to engage her 10-year-old son in full-time education so that her family could function properly once again.16:50
I, too, welcome the opportunity to debate the issue of mental health during this mental health awareness week which, this year, focuses on anxiety.
All Governments are facing multiple and wide-ranging challenges in their efforts to ensure good mental health and wellbeing. Those challenges are cross-cutting, complex and everyone’s business—a public health issue that we will grapple with for some time.
The Scottish Government’s mental health strategy sets out the action that is required to prevent, and respond to, poor mental health, including increasing the mental health workforce in A and E settings, GP practices, police custody settings and prisons.
Not in our wildest dreams did we predict the significant mental health impact of the Covid-19 pandemic, any reference to which is disappointingly absent from the Labour motion and the Tory and Liberal Democrat amendments.
Furthermore, although they include a range of challenges and points, the motion and those amendments, in my view, lack context and focus to one degree or another—the proverbial Lego pieces thrown in the air. They make no reference to the cost of living crisis, the impact of Brexit Britain, the limited fiscal levers and many other highly relevant factors that significantly compromise mental health.
We know the linkages that exist between poverty, poor mental health, offending and other vulnerability factors. I want to focus on those individuals who are in poor mental health and come into contact with the police. We have been grappling with that issue for many years; it normally involves individuals who are distressed and often intoxicated, who contact the police seeking help. The Criminal Justice Committee has been considering that issue, too.
According to Police Scotland, demand in relation to mental health increases between the hours of 7 pm and 3 am, when services are often no longer available. Mental health incidents routinely take up around 8 hours, and a recent evaluation estimated the cost to policing at £14.6 million per annum, with each visit to A and E estimated to cost the NHS around £5,000.
Section 297 of the Mental Health (Care and Treatment) (Scotland) Act 2003 makes provision for officers to “remove” a person who is suspected of having “a mental disorder”
“to a place of safety”
when they are found “in a public place”.
However, most people are in a private place—their home—and officers are not trained to recognise mental disorder, neither should they be. That piece of legislation does not work; it leaves officers to use their initiative with limited or no practical options available to them—in effect, making the system work.
The Scottish Government is committed to ensuring that the mental health strategy is data and intelligence driven, and I very much welcome the work of Police Scotland to develop a dashboard to quantify the number of mental-health-related incidents that police attend.
Of course, a cohort of the people who are found in those circumstances enter police custody, and I welcome the Scottish Government’s commitment to increase healthcare staff in custody settings. A range of models are, indeed, already in place across Scotland, including on-site 24/7 healthcare practitioners, hub models and on-call GP models.
I also welcome His Majesty’s Inspectorate of Constabulary in Scotland’s—
Thank you, Ms Nicol. I must ask you to conclude your remarks at that point.
We move to winding up speeches, and I call Sandesh Gulhane.16:55
The Scottish Conservatives welcome this debate during mental health awareness week 2023. I wear this green ribbon from the Mental Health Foundation Scotland to show my support.
Sue Webber rightly highlighted the debilitating issues of anxiety and was so brave to give us her personal story.
We are at a critical moment for mental health in Scotland. Tess White explained why the SNP strategy is gender blind. As a general practitioner, I am seeing more and more people with mental health issues, ranging from children to the elderly, and as a result of the SNP cutting funding, we have no link workers.
There is an urgent need for radical change to how mental health support and services are developed, resourced and delivered. The SNP-Green Government is still almost 20 per cent off meeting its child and adolescent mental health services target. As Sue Webber pointed out, that will cause a problem for the adults of tomorrow.
In 2022, almost 9,000 children were refused mental health treatment. The outgoing Children and Young People’s Commissioner Scotland, Bruce Adamson, said that Nicola Sturgeon failed to address the issue of children’s mental health. As for adult mental health, in 2022, more than 3,000 adults were refused mental health treatment.
Between 2018 and 2022, almost 75,000 NHS staff members missed work due to anxiety, stress, depression and other mental health issues. That exacerbates staffing issues, which Tess White told us were the cause of the closure of the Mulberry unit, resulting in long travel times for vulnerable people, and there is more: Humza Yousaf’s pledge to recruit an additional 1,000 mental health specialists has been delayed.
Gillian Mackay, Alex Cole-Hamilton and Clare Haughey spoke about one of the most devastating consequences of poor mental health, which is suicide. It affects people from across society. Each suicide is a tragedy that could have been prevented with the right help at the right time. Suicide does not affect only the person who died; their loved ones suffer greatly, and there is simply not enough help, despite the efforts of charities such as the Scottish Association for Mental Health. I commend the British Transport Police, which I met this morning, for its approach to finding people in crisis and getting them the help that they need.
Under the SNP’s watch, Scots across the country are waiting far too long for mental health treatment. The Scottish Government’s own child and adolescent mental health target has never been met, and waiting times for adult services are nowhere near good enough.
From one devolved policy area to another, the SNP-Green Government comes to this chamber with big announcements, but its record on delivery is abysmal. We have seen no evidence yet that this SNP-Green Government has the wherewithal when it comes to tackling mental health. It lacks ideas. It needs a fresh approach that incorporates modern, efficient and local solutions into healthcare.
Let us see mental health ambulances and crisis cafes, which the Scottish Conservatives have called for, rolled out across Scotland to help people who are struggling with their mental health to get the support that they need. We call on the SNP-Green Government to implement bespoke solutions for our rural communities, such as establishing networks of trained mental health advisers, which was thoroughly explained by Rachael Hamilton.
Finally, we call on the SNP-Green Government to wake up and realise that it has a duty of care to its NHS workforce. More than 700 registered mental health nurse posts are vacant—a vacancy rate of 9.5 per cent. We call on the Scottish Government to get a grip of reality, stop this self-congratulatory nonsense, as we saw in yesterday’s Covid vaccination debate, and focus on delivering the solution.
My final remark is to encourage everyone to talk and, most importantly, to listen and to create a safe space for those who are struggling with their mental health.
I draw members’ attention to my entry in the register of members’ interests as a practising NHS GP.16:59
I thank all members for their contributions. As always, I am convinced that speakers from all parties ultimately want the same thing: a high-functioning mental health system that provides the right help at the right time at all levels of need. It does not matter when or where anyone asks for help with their mental health and wellbeing—the system should respond to make sure that they get that help quickly.
I will further unpick one of the points that I made during my opening remarks in relation. Reducing stigma is foundational. It takes courage to ask for help and we know that a barrier to doing so can be the fear of being judged. There is so much good work being done every day by services, communities and the third sector to tackle stigma. We can also lead by example in this chamber.
I will pick up on the issue of rejected referrals. CAMHS is a very specialist service and we know that it will be the right service for only a small proportion of children and young people. We want all children and young people to get the right support at the right time. There is record investment in our CAMHS system, which is currently seeing the most positive changes in waiting lists that we have seen in the past decade. We have also invested £30 million in the past two years to provide alternative community-based health supports for children and young people. Those services were accessed by 45,000 people between July and December last year. As well as that, we have introduced a national CAMHS specification that includes a clear expectation that children and young people whose referral is not accepted for CAMHS are sensitively and appropriately signposted to a more suitable service.
I am confident that our forthcoming mental health and wellbeing strategy is based on a thorough understanding of the issues that have been raised today. Those issues have been accurately and fairly articulated during the debate. The strategy will also be based on what we have seen done well—on the fantastic work across Scotland that provides a blueprint for what good looks like.
I am grateful to the minister for taking an intervention. I would also be grateful to know whether the percentage of the health budget that is spent on mental health will increase. If we look at the experience under the SNP over the past decade, we see that the percentage of the budget that is spent on mental health in the NHS has decreased.
Jackie Baillie is well aware that part of the Bute house agreement between ourselves and the Green Party is that we are aiming for 10 per cent of the health budget to be spent on mental health, and we are on track to reach that aim.
The services are working to meet their waiting times targets, but they also do many other things. There is the on-going expansion of our digital offer, or the further £15 million investment in our communities mental health and wellbeing fund for adults. Those are the things that we see working around Scotland at the moment. That fund will provide continued support to grass-roots community groups, playing a vital role in building resilience, tackling social isolation and addressing mental health inequalities. On Monday, I visited a service in Dundee that provides support for families who are awaiting a CAMHS assessment for neurodiversity.
Will the minister give way?
The minister is concluding.
There are so many examples of good practice across the system for us to build on, as well as continuously improving elements of the current offer that we know are lacking. I am determined to strike that balance so that we move forward to achieve the vision of our forthcoming strategy, which is
“of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible”.17:03
Despite the harrowing stories from today’s debate, I am pleased to be closing it on behalf of Scottish Labour. Why? Because the Government needs to be held to account. Given the minister’s contribution, it is absolutely right that we in Labour focus in our time to lead debates in the chamber on the crisis in mental health that is impacting so many across our country and putting significant pressure on NHS and community services.
The minister is new to post and “confident”, and I hope that she delivers. However, after reading the SNP amendment and listening to the minister’s contributions, people could be forgiven for thinking that all was well with the provision of mental health services in Scotland, but there has been a failure by the Government, and we need to be honest about that. I ask back-bench SNP members to be honest, because part of their role is to hold their front-bench colleagues to account. Yet again, the SNP pats itself on the back, blames every factor other than the obvious one—its governance—and still refuses to see the urgent need for systemic change in this area.
Across the chamber, we all agree that nothing is more important than the wellbeing of our population. That includes their physical, economic and social wellbeing; critically, it also includes their mental wellbeing. As we have heard in the debate, and as is set out in Labour’s motion, there are almost 30,000 children, young people and adults on waiting lists. Adults from our most deprived areas are more likely to experience anxiety and depression and, tragically, are more likely to die from suicide.
Despite all that, the key commitment to hire 1,000 mental health specialists to help to improve community mental health services has not even started to be delivered. That is not representative of a Government that prioritises mental health treatment. It is representative of a Government whose inability to address staff shortages undermines efforts to improve care—a Government that is no stranger to a strategy but which has a poor relationship with delivery.
As my colleague Jackie Baillie mentioned, and as our motion says, the number of mental health-related calls to NHS 24 was almost seven times higher in 2022 than it was in 2019. We all accept that the pandemic had a significant role to play in that, but it would be disingenuous to suggest that that is when the problem started. The challenges that we face today with the delivery of mental health services in Scotland are a result of long-term inaction by the Scottish Government. Our communities, our mental health workforce and our patients deserve so much more.
We must all echo the call of my colleague Jackie Baillie for at least 11 per cent of the overall NHS budget to be directed towards mental health services. I urge the Government to look at that again. I also ask the minister to address the question that my colleague asked about the research and analysis by the Royal College of Psychiatrists. Proportionately, Scotland’s mental health budget is less now than it was a decade ago. Will the SNP Government address that?
We must also look at how the budget can be targeted and our investment focused on community-based services. As well as having a focus on early intervention and CAMHS for our young people, we need to address the root cause of the loneliness and isolation that members of our elderly population experience. Such targeted spending must be underpinned by a willingness to support people in our most deprived areas to tackle the prominent and divisive health inequalities that exist in Scotland.
Our call for the provision of a dedicated mental health worker in every GP practice and a mental health A and E department in every health board so that patients can be fast-tracked should not be seen as controversial. The minister should get behind some of the suggestions that have been made.
The crisis in mental health treatment in Scotland is concerning and damaging. Time and again, it is our most vulnerable who are let down by the Scottish Government. It knows—as, I am sure, do SNP back benchers—that its performance in this area has been unacceptable. We must be honest and look to shift in the right direction. More warm words and self-congratulatory comments will not cut it. The mental health crisis demands action, and if the SNP will not deliver, it should step aside, because someone has to.