Mental Health
The next item of business is a debate on motion S2M-1184, in the name of Malcolm Chisholm, on mental health, and three amendments to the motion.
The Executive and its many partners have a strong commitment to mental health in Scotland. I am confident that that commitment is shared by all of us.
This morning, I want to share with members some of the work that we are taking forward across the Executive and with our partners. It is appropriate that we have this debate in national depression week. Estimates show that depression will directly affect one in five of us at some point in our lives. It is a common illness but one that need not devastate lives. The aim of national depression week is to raise awareness about the realities of depression and to reduce the stigma associated with it. If we achieve those aims together, we can play a significant part in encouraging people to seek help at an early stage and improve their chances of recovery.
Getting our policies right on mental health provides us with a great opportunity in Scotland. Mental health is far more than the absence of mental health problems and mental illness. It is about how we think and how we feel about ourselves, how we interpret the world around us and how we relate to others. Good and positive mental health is an essential component of our overall health and well-being; if we improve our mental health, our overall health and well-being are significantly enhanced. We therefore gain huge benefits from working together to create a more mentally healthy Scotland.
At the same time, we need to be aware of the impact and the potentially devastating effects of mental health problems. We know that people with mental health problems die younger, live poorer-quality lives, are more likely to live in poverty and are far less likely to be in work. The economic impact in Scotland is estimated to be nearly £8 billion per annum. It can be no surprise, then, that since the birth of the Parliament we have made mental health a priority and introduced the most progressive mental health legislation in Europe. We have made a start on developing and implementing a range of policies, programmes and initiatives that will make a significant and practical difference to people's lives. I would like to take this opportunity to highlight some of that work.
In October 2001, I launched the national programme for improving mental health and well-being in Scotland, which was the first public policy programme on mental health improvement and public mental health in the United Kingdom. Some £24 million of new money is being invested in a number of practical measures, including work by NHS Health Scotland, which is implementing a programme of mental health first-aid training. That programme is based on work that was undertaken in Australia and it aims to raise public awareness of mental well-being and mental health problems. The programme is being tested throughout Scotland in a range of settings, including colleges, police forces, general hospitals and local communities.
We have funded see me Scotland, the national anti-stigma campaign, since 2002 and we have committed further resources to continue the campaign's work. The campaign has achieved a level of recognition and impact that exceeds our expectations, and I pay tribute not just to the campaign team but to the alliance of five organisations that continue to work together to support the campaign.
In December 2002, I launched choose life, a 10-year suicide prevention strategy and action plan. Our goal is to reduce Scotland's suicide rate by 20 per cent by 2013. The strategy is backed up with £12 million of funding for the first phase of national and local implementation. To date, there are 32 choose life co-ordinating groups working in local authority areas to address suicide prevention as part of the local community planning process.
Linked to the suicide prevention work is the breathing space telephone advice line, which aims to help people who are at risk of suicide. The line will be extended to cover the whole of Scotland by spring 2005.
People with mental health problems can and do recover; international estimates suggest that 60 to 70 per cent of people achieve recovery. There are many things that help to promote and support recovery, and good care and treatment services are a key component. The national programme is funding the Scottish recovery network to promote a wider understanding of what helps people to recover and to support local agencies to help people to recover.
I am grateful to the minister for that information, which is useful. In March 2004, the "National Mental Health Services Assessment" indicated that in 2002 there were nearly 900 suicides or undetermined deaths in Scotland—that is a horrific figure. The review also shows that access to services in times of crisis is a high priority. If someone is facing a potential suicide situation, that is an emergency. A helpline number is obviously important, provided that it is well known. Can the minister tell me the breathing space helpline number?
I do not personally know what it is. The helpline is operating in greater Glasgow and Argyll and Clyde but, as I indicated, it will be extended to cover the whole of Scotland by spring 2005. As Bruce Crawford points out, the issue is not just a matter of helplines, important as those are, and I will move on to talk about other services, including crisis services. As I have only five and a half minutes, I will have to do so without taking interventions. I will have to be selective, but I want to give an outline of the vast range of initiatives that are under way.
I take this opportunity to focus on some key elements of the efforts that are in hand to improve mental health services. When I spoke to the Parliament last year, I committed the Executive to undertake a national assessment of mental health services throughout Scotland to help us to identify the issues that we need to address in implementing the Mental Health (Care and Treatment) (Scotland) Act 2003. That work was completed and published last month, and I am grateful to Dr Sandra Grant and her team for their excellent work. Their findings were much as we and others expected—although there is much that we can be proud of, there are significant areas for development.
Using the results of the national assessment, each area has been asked to complete a joint local implementation plan to set out how the statutory agencies, with their voluntary sector partners and working with service users and their carers, will deliver on the act's requirements. To help with the implementation of the act, additional new resources have been allocated between 2003 and 2006. Some £27 million is being provided to local authorities, and partnership agreement funding of £15 million is being invested in national health service boards to support a range of work including the development of crisis response services.
I will pick up on a number of other areas for action that are mentioned in Dr Grant's assessment. The first area is work force issues. We established the national mental health work force group, which is chaired by the head of the mental health division, and it is considering work force planning for the new act, including recruitment, retention, development and retraining issues. It uses a partnership approach and it is supporting NHS employers and partner organisations to develop local implementation plans. The group is modelling future work force requirements in the light of the act, and it is gathering baseline intelligence on the current mental health work force. In the future, the group will focus on work force redesign, training and development issues. Specific work is in hand with the Royal College of Psychiatrists on those issues.
On the SNP amendment, redesign is important but I point out that we have created more training posts and specialist registrars for psychiatrists. There is a recruitment problem throughout the United Kingdom—indeed, it is far worse in England than in Scotland. We have increased the number of training positions for clinical psychologists, so important action is being taken.
The second aspect to highlight is service redesign. An appropriate example of that, given that we are in national depression week, is the work that is being done by the Health Department's centre for change and innovation. As I mentioned, depression is a common mental health problem in Scotland. It is costly, but it is also treatable. Access to local and timely responses and the full range of interventions and supports for depression are not yet universally available. The national doing well by people with depression project aims to address those issues. It is a three-year national programme with an initial budget of £4.5 million for 2003 to 2006.
Work is being done in a number of areas throughout Scotland to improve the way in which depression is managed. In practice, that means improving access to services and extending the range, quality and availability of treatments and interventions. The results of that work will be shared throughout Scotland to help to ensure the uptake of those new and improved ways of working to support people with depression.
A third area that we are progressing is improvement to care, treatment and support for perinatal mental illness. That work aims to provide services that are specifically targeted at the needs of mothers and their babies. The act places a particular responsibility on health boards to progress that important area of specialist care. In advance of implementation of the act, we have developed guidance for the organisation of admission services for mothers and babies. Greater Glasgow NHS Board is well advanced in that work, and I am delighted that it has invited me to open a dedicated unit later this year. Other boards are developing their plans.
I have deliberately left until last the most important element of Dr Grant's report: the experiences, views and wishes of people with mental health problems and their carers. Although a lot of good progress is being made, it is clear that we need to do more to truly involve, listen to and be influenced by the views of people who have direct experience of services. I want to see not just involvement but evidence of practical action that has been taken on their views and a sense of engagement from those who provide care, treatment and support. That is essential to achieve the person-centred focus that I want all our services to have.
An example of that is the way in which we are responding to the views that are expressed by people about the need for crisis services. In the partnership agreement, we committed ourselves to the development of mental health services, particularly crisis services. We have provided funds in response to the "Bid 79" report by the remote and rural areas resource initiative to help systems to develop psychiatric emergency plans. I have also been particularly encouraged to learn about plans to develop a crisis service that is led by people with experience of mental health problems, and we are considering how best to support that in partnership with the Scottish Association for Mental Health. I pay tribute to the work that that body has done on psychiatric drugs, including its most recent report, which again illustrates the importance of involving users as partners in their care.
An important aspect of supporting user involvement is the development of individual and collective advocacy services, and we are committed to ensuring access to independent advocacy for those who need support. There is a duty under the act to provide that, and substantial extra funds have been allocated. Finally, we are funding a major national service user conference, which will take place on 22 and 23 June.
My time is up so let me conclude. Mental health must be a priority for the Executive and for the Parliament and it will continue to be so. I am as conscious as anyone that more must be done to improve Scotland's mental health and well-being, but I believe that we are making progress.
I move,
That the Parliament acknowledges, in National Depression Week, the Scottish Executive's commitment, reflected in the Partnership Agreement, to maintain the mental well-being of the people of Scotland and to improve the situation of those with mental health problems; notes that National Depression Week aims to raise awareness of the realities of depression and to reduce the stigma associated with it; commends the work of the National Programme for Improving Mental Health and Well-Being and progress towards implementation of the Mental Health (Care and Treatment) (Scotland) Act 2003; welcomes specific initiatives in relation to workforce development and service re-design, such as the Doing Well by People with Depression projects, but also urges the Executive to continue to support efforts to reduce suicides through the "Choose Life" strategy, to remove stigma and to increase the range and quality of services available to those with mental health problems.
It is always entertaining to listen to Frank McAveety first thing in the morning, but it is slightly disappointing that his statement has abbreviated this debate.
The SNP welcomes the chance to debate mental health one year on from the passing of the Mental Health (Care and Treatment) (Scotland) Act 2003. We find it easy to welcome any initiatives that will improve the mental health of people in Scotland and we support any measures that will reduce the stigma attached to having a mental health problem, especially if those initiatives can lead to reduction in suicide among Scotland's people.
Our amendment recognises that resource constraints will severely inhibit the progress to success. At the time of the act's passage through the Scottish Parliament, we focused on the need for adequate resources to promote successful implementation. We share the minister's vision for improving mental health services in Scotland, although we do not necessarily agree about all the ways in which he seeks to do that. Sandra Grant's findings show that much needs to be done.
On a personal note, it is 40 years ago this month that I started work in a psychiatric ward during my time between school and university. For many people, mental ill health is an intensely personal experience during which sufferers experience stigma, employment difficulties and health support that is poorer than health support for almost any other segment of people who are treated by the health service.
Over the past five years, a number of MSPs past and present have suffered bouts of mental ill health. No segment of society is immune. The socially disadvantaged suffer greater ill health than average, although mental ill health shows slightly less socioeconomic bias.
We do not try to manage health provision on the basis of how many people each winter have a cold, which is a self-limiting disease. Similarly, the 70,000 or so who consult their general practitioner for depression each year are but a fraction of those who suffer from that debilitating illness. Assessing the need for mental health provision is quite significantly different from other types of assessment and we welcome the fact that the Executive is consulting on a draft code of practice and regulations under the act.
Sandra Grant's report is disturbing. The minister said that the report was much as expected, but that is pretty disappointing, given that we have one year to go until the full implementation of the act. Let me quote the words of the patients whose comments are included in the report and which are highlighted in the Scottish Association for Mental Health briefing:
"You can sit in your room alone all day and no one will come and see how you are."
Another comment was:
"cups were unwashed and stained, patients just stubbed their fags out on the floor—it was a hellish place".
Another patient commented:
"At one stage I was lying on the ground because I was so distressed and sad. All the staff did was walk over me in the corridor."
I absolutely accept that NHS staff are dedicated and that, at its best, the NHS is very good. However, those quotations show that, at its worst, the NHS is very bad. As a caring society, we must judge our performance by the worst. We must narrow the gap by raising the performance of the worst, not by lowering the performance of the best.
The report gives an honest picture but, in fairness to NHS staff, the NHS creates mental ill health because it does not look after its staff. We have too few people doing the job. Too many people are ill treated when they have workplace grievances and end up leaving due to mental stress.
Jean Turner makes an important point. It would be interesting to know what the incidence of mental ill health is among NHS staff compared with the general population. Perhaps the minister can enlighten us on that.
Stigma is also an issue. More than 100,000 Scots are denied work because of their mental ill health. Fewer employers would consider taking on someone with a mental illness than would consider taking on a physically disabled person. In the wider community, 41 per cent of those who live with mental health problems have experienced harassment in Scottish communities, compared with 15 per cent of the general public. That is why initiatives such as the see me campaign are a welcome sign of the Executive's commitment to change society's attitude. The minister said that the campaign has achieved good recognition and impact, but the question is whether it has changed the experience of people who suffer from mental ill health.
I welcome progress on reduction of self-harm and suicide. Like others, I will have been touched by suicide at some point in my life. I also welcome the signs that the focus is turning to younger people, who have been neglected in the provision of health services.
The NHS boards have formidable new burdens under the act. We have perhaps not yet seen progress in supporting health boards. The act's implementation must not be half-baked. We must not see the introduction of community-based compulsory treatment orders as an excuse for inadequate levels of hospital services. Such orders are not a sticking plaster or a cheap alternative. We need both community-based and hospital-based provision being driven by patients' wishes.
Sandra Grant's report highlights the fact that funding is not ring fenced and much has to be provided from existing money because new money has yet to be allocated.
On staffing, 9 per cent of consultant psychiatrist posts are currently vacant and some 5 per cent have been vacant for over six months. Between 400 and 500 student nurses specialise in mental health each year, but there is a chronic under-recruitment of 10 per cent.
The report's summary refers to some significant issues that Jean Turner mentioned earlier:
"There are major staff morale, attitudinal and cultural problems which, unless attended to consistently, will inhibit full implementation of the underlying principles of the new Act …
Workforce gaps are probably the most difficult issue to address in the short-term".
There ain't a magic bullet, but we need to hear more from the minister. Solving staff shortages cannot be done quickly. Our amendment refers to the lack of psychiatrists, which is a surrogate for a broader problem. We find it possible to support the other amendments, which have merit, as does the motion.
I conclude by drawing the minister's attention to the fact that none of the Executive's 14 health objectives makes any reference to mental health. Let us hope that, after the scheduling of today's debate, we see a welcome shift up the priority ladder for this rather forgotten corner of the NHS.
I move amendment S2M-1184.1, to insert at end:
"while expressing concern that the large number of vacant consultant psychiatrists' posts represents a significant barrier to delivering much sought after improvements."
I welcome today's debate. I regret that it will be short, given that many members have previously expressed their desire to speak on what is a very big subject. Mental ill health probably affects 25 per cent of the Scottish population at some time in their lives. That is a stark figure. Mental health may be an Executive priority, but that is not always apparent to people—those who suffer from the conditions and those who try to care for them.
The minister has talked a good game this morning, but we need to ensure that we get action to match. I welcome the resources that he has announced, but I am concerned about their size. Like others, I am concerned about whether we will have the trained work force that will be able to implement and use those resources in the best interests of sufferers and their families.
It is frightening that 30 per cent of employees in any one year will suffer from a mental health problem. As Stewart Stevenson rightly pointed out, that affects us in Parliament as well. Nobody is immune to mental illness. Part of the problem is to do with the way we lead our lives in our society and the pressures that people are put under.
My amendment highlights the point that Dr Turner made about retention of and support for the mental health work force. I had a family member who suffered from poor mental health. She was in a psychiatric ward in an old building that was not fit for purpose. However, more important was the fact that there were not enough trained people to man that ward fully throughout the week. If we went in on a Saturday or Sunday to visit—as we did—we found that some of the nurses had been co-opted from another part of the hospital and did not have the necessary training. That meant that trained members of staff were under tremendous pressure to juggle the needs of the various patients who might want assistance at any time. If we are to encourage people to take part in training to become psychiatric support workers such as nurses, psychiatrists and therapists—there is a huge shortage of therapists—we must ensure that they are well supported and safe in their work, because there are elements of risk in some situations.
In my amendment, I mention suicide, about which we are all concerned. No one in Scotland is unaware of the fact that suicide is the leading cause of death in men aged between 15 and 34—that point has been made in the chamber on many occasions. I welcome the minister's comments on the matter this morning. Once we are a little further down the road, I would like the minister to indicate—perhaps by placing information in the Scottish Parliament information centre—how the problem is being addressed, so that Parliament can have access to information about what is happening.
The minister and others have mentioned stigma, which is a very important issue.
I asked the minister to provide the telephone number for the breathing space helpline. I did not expect him to know it, but I was trying to make the point that it should be a 999 service because it deals with real emergencies. Does David Davidson share my view that people should be able to access the service in that way to get help?
I support any action that will enable access to care to be provided in a hurry. I thought that that would have been one of the tasks of NHS 24. In the absence of the direct number that the minister cannot remember, I would try NHS 24. I presume that I am helping the minister out by making that point.
I spoke recently at a function that was also attended by the head of the mental health division of the Health Department. Interestingly, people from areas other than mental health were at that function. Stigma is an issue—it is about being different but not being understood. We must take that vital subject to our hearts in Scotland. It relates not just to mental health but to disabilities in general.
I was disappointed that the minister did not say much about the voluntary sector and the wonderful role that it plays, despite its not being supported adequately. I know that the minister and his team support the establishment of a new organisation to support carers of mental health patients. I hope that in time he will be able to back that up, as I know that he has given his staff clearance to become involved, which I welcome greatly. Many carers throughout Scotland are grateful for that.
This morning there has been much talk about Sandra Grant's report, which highlights some issues in the community. There is a chronic shortage of community psychiatrists and support staff—instead of there being one psychiatrist per general practitioner practice, there may be one community psychiatrist operating in the community two days out of five and who has to cover six or eight practices. To be frank, that is not good enough; it is certainly not good enough for those involved and for sufferers.
We need to consider early assessment in all areas of mental health, not just for depression. If early assessment does not take place, we may end up dealing with chronic conditions, suicides and all sorts of habits, such as alcohol or drugs habits, which people develop as means of escape. If we assess people early, we must have the capacity and infrastructure in the health service to provide care to people once they have been assessed.
I hope that the Auditor General for Scotland is watching the outcomes of these developments. It is now his habit to examine various aspects of health care, such as infection in hospitals and cleanliness. I hope that he will start to consider mental health, so that adequate outside influence can be brought to bear on it.
I move amendment S2M-1184.2, to leave out from "acknowledges" to end and insert:
"welcomes National Depression Week and its aims to raise awareness, reduce the stigma and make more effective the treatment of depression; notes the work of the Scottish Executive to implement the Mental Health (Care and Treatment) (Scotland) Act 2003 but also notes the conclusions of the National Mental Health Services Assessment which highlights shortcomings in mental health services; is concerned about recruitment, retention and support issues surrounding the mental health workforce; notes that the number of those receiving care in inappropriate settings is still too high, and urges the Executive to increase its efforts to address the rising incidence of suicide in Scotland."
I commend all the helpful speeches that have been made.
The figure of one in five has already been cited often in the debate. That figure could apply to the chamber, although mental health problems affect disproportionately those who live in deprived areas. I do not think that many members live in such areas, so perhaps fewer than one in five of us is affected by mental ill health.
There is a duty on the politicians in the chamber to help to remove the stigma that is associated with mental ill health by acknowledging contact with mental health problems, or experience of mental health problems that they might have had; for example, I have suffered from post-natal depression. Mental ill health is not about being different—it is quite normal to react, at some stage in our lives, to the society in which we live with a mental health problem.
Poverty is a big factor. People who live in the poorest areas are nearly three times as likely as the general population to be admitted to hospital for depression. Malcolm Chisholm said that people with mental health problems were more likely to be poor: poverty is both a cause and an effect of mental ill health. People who live in deprived areas are three times more likely to commit suicide, four times more likely to be admitted to hospital for self-poisoning, six times more likely to be admitted with schizophrenia and 10 times more likely to be admitted with an alcohol problem. We cannot address individual mental ill health without addressing the health of society in general. Unless we introduce radical measures to eradicate poverty, hopelessness and the despair that goes with them, we will not reduce seriously the number of people who are affected by mental health problems. Even within the limited powers of the Scottish Parliament, we could—for example, by abolishing prescription charges—do a great deal to reduce the economic burden on people who have been diagnosed as having mental health problems. We also need to consider prevention, which would be much more effective than treatment. We need to eradicate poverty.
One helpful measure would be to ensure that local authorities are able to offer people with mental health problems—as they do for people with disabilities—access to concessionary travel and appropriate transport schemes. The dial-a-bus scheme that provides a taxi-style service should be extended to those who are unable to use public transport because of anxiety disorder. Small measures of that sort would make a big difference to the quality of life of people who have mental health problems.
Reference has already been made to the situation in the workplace. The figures make it clear that a higher than average proportion of people who are in employment suffer from mental ill health—three in 10 employees have a mental health problem in any one year. NHS staff have been mentioned and it is absolutely true that a very high proportion of sickness absence among NHS staff is associated with stress and mental health problems. Just before I was elected, I dealt with issues relating to staff in acute medical receiving wards, which have sickness absence rates of up to 20 per cent. The majority of those absences were caused by stress. We must care for the staff who care for the patients.
It is clear that there is a case for money to be spent on preventive measures and for mental health services to be lifted from their current Cinderella status in the NHS. At the same time, we need to remove stigma from people with long-term mental health issues. Less than 10 per cent of people with severe and enduring mental health problems are in full-time employment and 72 per cent of people with psychotic illness are unemployed or economically inactive, which is unacceptable. Discriminatory attitudes that would be unthinkable for any other oppressed group are promoted by sections of the press and, unfortunately, fear and hatred of people with mental health problems are the last acceptable prejudices. Despite the see me campaign and all the great words that have been uttered in the chamber, in the latest issue of Holyrood magazine, ex-MSP Mike Russell casually uses the abusive word "loony" to describe political opponents. That is not acceptable. We have all been guilty of it in the past—I admit guilt—but we need to cut it out.
My amendment refers to several measures, including the abolition of prescription charges—one of the big issues—and a proper advocacy service for when there is debate. Access to cognitive therapy and counselling should be as easy as access to a prescription. The pharmaceutical companies have too great a vested interest in the profits that are associated with drugs and mental illness and I have grave concerns about the prescription of selective serotonin reuptake inhibitors.
It is unacceptable that people have to wait in excess of six weeks before they receive counselling. There should be equal access to alternative therapy and cognitive therapies that can be much more effective at achieving recovery, rather than merely stabilisation.
I also agree that we need to have emergency access. During the consultation on primary medical services in Lanarkshire NHS Board, mental health groups have consistently raised the issue of being unable to get a duty consultant psychiatrist when they approach out-of-hours services through their general practitioners or through accident and emergency units. All that is unacceptable.
Words are fine, but we have to apply resources in the long term in order to achieve real change, and we have to tackle the problems in society that cause the hopelessness and despair that lead to the majority of mental health problems.
I move amendment S2M-1184.3, to leave out from "through" to end and insert:
"; notes that mental health problems disproportionately affect those living in deprived areas and that despite the Executive's commitment to tackling mental health problems as a priority, mental health services remain underfunded and overstretched in many parts of Scotland; believes that abolishing prescription charges would help to address the poverty trap faced by mental health service users who return to work, and further believes that more resources should be directed towards treatment and rehabilitation in community settings, that there should be a greater emphasis on children's mental health, that in-patient treatment facilities should be housed in modern buildings, accessible to the communities that they serve, that more practical and financial support should be given to the families and other carers of those experiencing mental health problems and that, as a priority, a well-resourced, independent national advocacy service for users of mental health services should be established in Scotland."
I am pleased that Executive has given us the opportunity to consider the services that are provided for people in Scotland who have mental health problems.
There can be little doubt that mental health services have improved in recent years. However, there is no room for complacency. A little more than a year ago, the Parliament passed the Mental Health (Care and Treatment) (Scotland) Act 2003, which was the first major overhaul of mental health law for 40 years. It is clear that it will be some time before the effects of that legislation can be thoroughly examined, but much can be done in the meantime.
As Carolyn Leckie and Stewart Stevenson said, one of the first problems that someone who is suffering from mental ill health will encounter is the stigma that is unfortunately still associated with such conditions. The Scottish survey on public attitudes on mental health showed that half of all respondents said that they would not want anyone to know if they developed a mental health problem. Similarly, a survey that was carried out by the National Schizophrenia Fellowship (Scotland) showed that 41 per cent of people with mental health problems had experienced harassment while living in Scottish communities, which compares with the large figure of 15 per cent among the general public. That is unacceptable and we all have a role to play in bringing about a greater understanding of such conditions. A debate such as today's will play its part, but we as a society have to acknowledge that mental ill health is widespread but can in many cases be treated effectively.
The three-year mental health action plan that was announced last September contained several welcome initiatives and, just as important, the Executive is committed to providing the resources that are necessary to implement them, with £24 million coming from the health improvement fund. One of the priority areas that were identified in the action plan was the mental health of children and young people, which has not in the past been given the attention that it deserves, so I was pleased to see that the Executive will concentrate on it.
Last year, the Scottish needs assessment programme published its "Needs Assessment Report on Child and Adolescent Mental Health". The report noted that at any one time, about 10 per cent of people aged under 19 in Scotland—125,000 young people—have mental health problems that
"are so substantial that they have difficulties with their thoughts, their feelings, their behaviour, their learning, their relationships, on a day to day basis."
Clearly that is not an ideal start to life and, although it does not necessarily follow that those who suffer from mental health problems when they are young will continue to do so when they are older, it is certainly the case that the disruption that depression or other mental illnesses can have at such a crucial stage in a person's life can have a devastating effect on their later lives. It is certainly one area that we have to get right.
The Liberal Democrats believe strongly in health promotion and the prevention of ill health. That is particularly important when we deal with young people. It is no surprise that one of the recommendations of the Scottish needs assessment programme's report on child and adolescent mental health is to adopt
"An integrated approach to promotion, prevention and care".
The report found that although those themes should be complementary, in practice they are
"often discussed as separate or even competing approaches."
The mental health action plan states that the Executive will act on a number of the SNAP report's recommendations, but it does not say on which ones. I would therefore be grateful if the minister could tell me whether that is one of the recommendations that will be vigorously pursued.
Among the other priorities that are outlined in the action plan is the need to improve mental health and well-being in employment and working life. As David Davidson said, in any one year, three out of every 10 employees will be off work with a mental health problem. Although our main concern should be with the patient, the cost to employers cannot be overlooked, with the economic impact of mental health problems in Scotland estimated at almost £8 billion. I support the measures that are contained in the action plan to promote good health at work, especially the pledge to work alongside Scotland's Health at Work—SHAW—to promote mental health and well-being at work.
We must also remember that everyone has the right to work and that working is often an important part of ensuring good mental health. We must ensure that we break the vicious circle in which many people find themselves experiencing mental health problems, being unable to find suitable employment, and then experiencing further problems because of that.
One of the areas that was highlighted in the Liberal Democrats' manifesto for the 2003 elections was a pledge to
"Support the work of community mental health nursing teams, allowing services to be delivered within local communities."
That is vital because we should be ensuring that patients are, wherever possible—and, importantly, when they want it—able to stay in their homes.
It is clear that although there is still a lot of work to do, we are progressing in the right direction. By concentrating on important areas such as young people, well-being at work and—particularly important—health promotion and the prevention of ill health, we can ensure that people are in sound mental health in the future. There should now be less stigma attached to mental health problems than was the case in the past, but it cannot be denied that stigma is still present. We have to get the message across that mental health problems can affect anyone and everyone. There is no shame in someone's admitting that they have mental health problems. Help and support are available.
I will support the motion in the minister's name and I believe that it and the amendments serve to illustrate that there is infinite demand for finite resources, whether those resources come in the shape of funding or qualified personnel.
I applaud the efforts of Malcolm Chisholm, his colleagues and members of Parliament who have been united over the years and who have stated clearly that mental health will be a priority of Parliament, which reflects serious concern throughout Scotland. There is evidence of that commitment in legislation and regulations and in the funds that are being put in place. As I understand it, funding at the end of 2001 stood at just less than £0.5 billion.
Mental health issues have probably touched us all at one time or another. As an MSP, I have dealt with several cases, a number of which I have found to be very distressing. I have a young daughter who attends university in Fife and I know of several cases there that I have found to be profoundly distressing.
My election agent also brought the issues home to me. She was a psychologist in North Lanarkshire and had to take early retirement because of the burn-out that she experienced as a professional. Her perception was that the ratio of psychologists to patients was something like 1:60,000. There are therefore enormous issues in respect of recruitment, retention and training of staff.
I applaud the work of Dr Sandra Grant, and her report. I find it to be extremely informative; when we are implementing the new legislation, the report will inform us about the challenges that have to be faced in our own back yard. If I am allowed to do so, I will speak about the situation in Fife.
The hospital configuration in Fife is of serious concern and I want to impress on the minister that there is a real need in that area. We have been talking for five years about addressing the configuration of mental health services in Fife, so I plead that the minister and his civil servants address the matter by meeting urgently with Fife NHS Board to arrive—once and for all—at the conclusion that we must have at least one centre of excellence in Fife. That view comes through in Dr Sandra Grant's report and a number of my MSP colleagues in Fife share it. The configuration issue must be addressed.
I have visited Stratheden hospital, which for centuries now has been one of the mental health providers in our locality. However, the building is inadequate; it is enormous and it is heated throughout, although only half of it is used. Money is dripping through the bottom of a bucket that never fills up. If we are to consider waste, we must get the situation in Stratheden sorted. One of the worst cases with which I had to deal was that of a patient who was going to be a resident in Stratheden for the foreseeable future. However, he was living in one of a number of cubicles that had no windows and in which the walls were merely dividers that were only three-quarters of the height of the room, which did not allow for patients playing radios or having private conversations.
There are no children's beds in Stratheden and six of its adolescent beds have been closed. There are no separate in-patient facilities for mothers and babies. Dr Grant's report refers to those matters. There is no 24-hour response service in Stratheden. In some parts of Fife, community mental health teams are well established, but in other parts they are under-developed. Something must be done urgently to make community-based compulsory treatment orders a viable option.
The voluntary sector plays an important part in Fife, having widened the scope of the services that are provided. However, the services for carers in Fife are patchy and not well developed. There are no advocacy projects for carers and there is a waiting list for service users who want to access advocacy services. However, Fife Council and NHS Fife have a clear commitment to developing advocacy services.
The priorities in Fife that we want the minister to address are: providing mental health awareness training for the public; changing the system and the attitudes of psychiatric and medical staff; and providing a centre of excellence in mental health as part of a wider health centre. I can suggest a place in my constituency in which to build such a centre: Lochgelly. I believe that people throughout Fife agree that it has a central location. Lochgelly is adjacent to a motorway and has good access to every part of Fife. There is masses of space there for development. I believe that Lochgelly would be an excellent place in which to have a new-build facility. I am told that ministers review their capital spending allocations in June. If any underspend is found, I plead with the minister to think carefully about whether it could be used to provide a new facility in Lochgelly. Fife also needs more access to respite care and access to alternative therapies. I spoke briefly to the minister about that last night, so I know that we are pushing at an open door. Fife also needs better access to psychology services.
I thank the minister for all his and his team's hard work. From speaking with him, I know how heavily committed he is to mental health issues. He and his colleagues are addressing the issues against a difficult background of infinite demand and finite resources.
I preface my remarks by thanking the Executive for bringing the debate to the chamber today. The debate is timely in that it is being held during national depression week. In addition, the debate will help to raise awareness of depression and to fight the stigma that surrounds it.
It bears repeating that one in five people will be affected by depression at some stage in their lives. Treating depression accounts for 30 to 40 per cent of the work burden of NHS primary care services. The World Health Organisation predicts that depression will be second only to heart disease as the biggest global health burden by 2020. However, three in four cases of depression are neither recognised nor treated because the stigma that is associated with mental health problems continues to prevent people from seeking and finding help.
Therefore, while any and all initiatives that the Executive takes to raise awareness and tackle stigma are to be welcomed, there are legitimate questions to be asked about whether enough is being done to promote mental well-being and to combat mental ill health, given the scale of the problems and the history of underinvestment in mental health services over many decades.
Ministers are aware of the patchy nature of service provision across the country. Dr Sandra Grant's report identifies many gaps in services and it makes for grim reading. The notion that mental health is the Cinderella service of the NHS persists—under-resourced, under-staffed and under intense pressure is the reality for professionals who work in the field. Despite the central directives and the establishment of mental health as a national clinical priority, local NHS boards still appear to be reluctant to reallocate resources in favour of mental health. The minister's earlier announcement of extra resources is welcome, but ensuring that those resources reach their intended destination and have the required impact will need careful monitoring.
In the time that I have left, I want to focus on one or two areas for priority action. The first is child and adolescent mental health, which was until recently something of an invisible issue in the policy domain. As Mike Rumbles highlighted, recent studies have indicated that 10 per cent of the five-to-15 age group—125,000 of Scotland's children—suffer from mental health problems of such severity and persistence as to have a significant impact on those children's functioning and relationships. The rate is higher among children in lone-parent households and in low-income families. However, according to the Scottish needs assessment programme report that was published last spring, such problems often go unidentified and it is difficult to access the right support even when they are recognised.
Clearly, it would make sense to ensure that such problems are tackled when they arise, instead of allowing them to develop to the point at which they endanger a child's healthy development. Early intervention and prevention of mental ill health among children should surely be at the top of the priority list for Government action. Other studies show that it is possible to instil resilience—the capacity to cope with stress—through school-based programmes. Carefully designed and implemented preventive programmes can reduce the rate of subsequent mental health problems in high-risk populations.
I am aware that the child health support group is working on a guidance template to develop the SNAP report's recommendations, but I would appreciate an indication from the ministers today of their commitment to ensuring that implementation will be supported by sufficient resources. Dr Graham Bryce, who chairs the support group's work in that area, indicated yesterday to the cross-party group in the Scottish Parliament on mental health that a doubling of the budget on child and adolescent mental health services would be required to turn round the dire situation that specialist services will face within the next five to 10 years.
That may be necessary as far as treatment is concerned, but clinical services alone will not tackle the underlying problems. The range of children's services must be brought into play in the form of an intelligent network. Schools have a particularly important role to play not only in terms of referrals to specialist services, but in providing direct assistance to children. The importance of a major staff-training effort cannot be overemphasised.
We must move away from current practices in which children who are identified as having mental health or behaviour problems are all too often diagnosed by general practitioners who have little time or expertise to carry out thorough assessments. I am particularly alarmed at the growth in the use of drug therapies to modify children's behaviour or to deal with their mental health problems. That cannot be the way forward. I have run out of time, but that is an area to which I will need to return in future.
I welcome the opportunity to speak in this debate, and I am pleased that it is taking place in national depression week, as part of a much needed exercise in raising awareness of the realities of depression. I also welcome the Scottish Executive's commitment to improving the mental health and well-being of the Scottish population. Mental health in Scotland has always been designated as a priority by the Parliament.
The main focus of the money given so far to build up mental health services is on crisis services. If members have any first-hand knowledge of mental health issues, they will appreciate how vital a well-resourced and efficient crisis service is, but crisis services are only part of the equation. Mental health difficulties can often be chronic and recurring, and the new ways that are being used to support and treat people with depression are also absolutely essential. Unfortunately, however, mental health is an area that most people try to ignore.
We all realise and accept that our general health will have its ups and downs, and some of us are always more than happy to give chapter and verse about our aches and pains to anyone who will listen. Although we may not want to listen, we do not assign blame, but mental health is another story. Too often, it is an untold story, as the statistics show. As we have heard, one in five of us will face mental health issues sometime in our lives, which means that every single one of us will be affected in some way. If it is not oneself, it may be one's partner, children, parents or friends and, most certainly, one's constituents.
Another aspect of mental health is the fact that all categories of people are affected by it. More women than men suffer from depression problems, but more of the men commit suicide. The importance of "Choose Life: A National Strategy and Action Plan to Prevent Suicide in Scotland" cannot be overemphasised.
A surprising number of young people suffer from mental health problems. As a teacher of many years' experience, I know that it has only lately been recognised that young people in schools often have mental health problems, which lie at the heart of their learning difficulties. How can anyone concentrate on class work when they are clinically depressed? I am not sure that teachers are best placed to do the referrals, because they must first recognise that there is a problem and they must be instructed on how to pick that up and deal with it. I welcome the introduction of services to school pupils, but I know that it is not generally accepted that we should be looking after the mental health of young people—even those as young as primary pupils.
If one has what is called a sunny disposition, it is extremely difficult to comprehend the darkness of the cloud that can settle on someone else, and it is also difficult to take in the prevalence of depression. It is now accepted, however, that consideration of health must include consideration of mental health. The report "Towards a Healthier LGBT Scotland" contains a section that states:
"Anxiety, depression, self-harm, suicide and attempted suicide have all been linked with the combined effects of the experience of prejudice and discrimination".
Thus it becomes less surprising to read in that report about the
"Higher levels of LGB people reporting psychological distress",
especially in light of the finding that "Gay" is
"now the most commonly used term of abuse in the school playground".
That is a fact that most teachers would corroborate, but I am not confident that most teachers know how to deal with it.
Because mental health cannot be considered in isolation, as Carolyn Leckie said, the problems that accompany depression can be wide ranging and quite paralysing. Problems with unemployment, housing, debt and prescription charges for essential drugs are additional problems that we must consider more seriously. For young people, education itself, bullying and general health are the problems that can come up, so it is crucial that we work to raise the general level of services across the board. Mental ill health multiplies the ordinary pressures of life, yet there is still a tendency to ignore it.
I conclude by commending the award-winning see me anti-stigma campaign, and I ask each of us to start looking around and really seeing one another. That is what the campaign is about. I also congratulate the stigma stopwatchers, who are challenging misleading or inaccurate representations of people with mental health problems in the media. That is something that we can do here as well; we can challenge such representations in the chamber. Importantly, the stigma stopwatchers also know when the media get it right, so there is a positive side to that initiative too. We need to start talking openly about mental health and give real support and good service to all those affected. I end on a lighter note by recommending the greeting used by the fictional, but very astute, Dr Frasier Crane, and by wishing everyone "Good mental health."
Although Carolyn Leckie, Marlyn Glen and other members have mentioned the statistic that one in five people will be affected by depression, I seem to remember that the British Medical Association wrote to us to say that more than 30 per cent of visits to GPs involved an element of mental health, so I think that the one-in-five figure may be an underestimate.
Too often, we concentrate on staff, on drugs and on day centres, assuming that if we throw more money at mental health all the problems will be solved. I suddenly realised that we do not actually spend much time talking about the causes of depression or recognising those causes, as other members have said. Last night, many MSPs turned up for the briefing from the National Association of Funeral Directors. I was touched to hear the speakers talking about unresolved grief, which is obviously a problem that funeral directors recognise but cannot deal with. They said that they can do their bit at the time of death and that they are aware of that enormous problem, but when they refer people to bereavement counselling—particularly to Cruse Bereavement Care in Edinburgh—those people have to wait for more than three months. Instead of always talking about drugs, psychiatrists and psychiatric hospitals, we should perhaps start to look at giving people help where it is needed, rather than telling them to wait for three months and to cope on their own. The point about early intervention has been well made.
Members of this Parliament should be proud of achieving the passing of the Mental Health (Care and Treatment) (Scotland) Act 2003. The Westminster Government had been considering such legislation for some years and then shelved the Mental Health Bill, but we just got on with it. The complexity of the 2003 act and the speed of its passage through Parliament is a matter for concern, but its provisions are nonetheless to be welcomed and I am sure that ministers and MSPs in all parties will closely monitor its implementation.
I commend the work of the Mental Welfare Commission for Scotland. I have contacted the commission on behalf of constituents who had complaints and I believe that in any discussion of mental health we should commend the excellent work that it does. However, when the Mental Health (Care and Treatment) Scotland Act 2003 was passed, the shortage of psychiatrists and mental health officers was highlighted. At that time, we were 29 psychiatrists short in Scotland and required a further 28 to implement the act. Although staffing is crucial, the considerable bed blocking in mental health is also due to the shortage of day centres, crisis care centres, supported housing and residential care. Sandra Grant's thorough report highlights those shortages.
In this Parliament, we are capable of raising concerns about postcode prescribing—we are right to raise those concerns—and I was pleased to hear the point that Adam Ingram made, but that debate often leads to the view that there is a pill for every ill. In mental health, that is particularly the case, whether the problems are long term or short term, but drugs can never be the only answer. In fact, the side effects sometimes cause greater problems than the drugs attempt to resolve. I make no apology for once again mentioning the prescription of Ritalin to young children, which is a matter for serious concern. There are also concerns about the use of Seroxat for adults. I have worked with several constituents in the Highlands who have been trying to reduce their intake of Seroxat and I am aware of the horrendous side effects that they have suffered. I acknowledge that that is not the case for every patient, but it is the case for some.
Psychological support is also needed. Given the severe staff shortages, that area is sadly neglected. As other members have said, hospitals are not just about containment. I am always shocked when I hear about people who are on suicide watch in a psychiatric hospital but who go out at 9 o'clock in the morning and come back at 9 o'clock at night. I am also amazed that so many people are reported to the police as missing from psychiatric hospitals. Psychiatric hospitals are there to support people and should not just offer bed and breakfast. The people whom they support should be closely monitored.
Carolyn Leckie mentioned therapy, counselling, complementary medicine and so on. In Scotland, 40 per cent more prescriptions are handed out for depression than in England—that is a shocking statistic. I commend the work that Adam Ingram is doing in the cross-party group on mental health. At the group's meeting yesterday, Graham Bryce talked about suicide among young men. If we think that a helpline is the only answer to that problem, we are really missing the point. Many young men and women are depressed because they are unable to express their feelings and fears. Earlier this week I met speech therapists. I had tended to think that they could help only people who have physical impairments, but in fact they have a tremendous input into helping people to express themselves. I hope that speech therapists, as well as other professions allied to medicine, will be made available. Let us not naively think that the answer to everything is to roll out the breathing space advice line throughout Scotland.
I commend the community mental health team in Nairn for its excellent work in supporting patients safely at a local level, which consistently reduces admissions to psychiatric hospitals.
I welcome the opportunity to debate mental health, which, thanks to much of the action that the Scottish Executive has taken, is not quite the Cinderella of the health service that it once was. I acknowledge the key role that the national programme for improving mental health and well-being will have as a driver of change. Change is desperately needed.
Let us set the situation in context. Adam Ingram was right to cite information from the World Health Organisation that suggests that mental health problems are likely to be the second greatest cause of illness—after cardiac problems—in the next decade or two. That should concern us all. I agree with Marlyn Glen, Carolyn Leckie and others that there is a causal link between poverty and disadvantage and between substance abuse and mental health problems, but we must be careful not to over-generalise. Mental illness affects as many as one in five people, as we have heard, so it clearly impacts on people in all different walks of life. There is no uniformity to mental illness; it affects people in very different ways, so we must ensure that we deliver an appropriate range of services, as locally as possible.
In the context of mental health care, small is indeed beautiful—that is different from some of the other principles that drive health service reform. I stress that point because small units are clinically advantageous, not just for the service but, more particularly, for patients. Successful treatment of mental illness, whether the illness is long or short term, depends to a large degree on the delivery of local care. I think that everyone agrees that local care that is delivered by community mental health teams and provided with appropriate support is the best option in most circumstances.
However, we should not assume that the pattern of any particular mental illness remains static. As with most other illnesses, there will be crises, when appropriate in-patient services will be needed. We need a critical level of in-patient beds throughout Scotland that can be accessed locally, rather than through a centralised system. Like others, I believe that Sandra Grant's report helpfully charts the journey that is still to be undertaken. The report identifies the need for: out-of-hours and crisis services; more support for people in the community who cope with mental health problems; easier access to local, rather than centralised, services; and much better cohesion between the agencies that are involved. Perhaps most important, the report identifies the need to involve users and carers in shaping the services that are provided.
Let me be parochial for a minute. I was privileged to visit the Christie ward in the Vale of Leven hospital, which provides 24 in-patient beds. Staff there take a holistic, personal approach to the needs of people with mental illness and the ward operates as a centre of excellence—as many people would also describe it. The relocation of such provision, even to a site that was 15 miles down the road, would be detrimental to the needs of patients, because someone's recovery is partly aided when it takes place in their local community, where they are surrounded by familiar faces and vistas, rather than in a strange environment. Staff in smaller units can have a much more personal relationship with the people for whom they care and that continuity is important.
There is a worrying trend in relation to access to in-patient services. Beds have closed throughout Scotland. It is absolutely right that that should happen in institutions such as Woodilee hospital, which are not appropriate for the care of people with mental illness. Notwithstanding that, we must ensure that sufficient short-term beds are available. Many people regard in-patient care facilities as places of safety for people who might be particularly vulnerable during an illness, just as they are places for people who are deemed to be at risk or unsafe. Assessment beds should therefore always be available for voluntary patients. There has been a 300 per cent increase in sectioning during the past 13 years in Scotland, so the risk that voluntary patients might have to be sectioned just to obtain a bed or escorted safe transport is fast becoming a reality. We need sufficient local in-patient care that can respond to a crisis and that is flexible enough to respond to local need. I commend to the minister the model that Argyll and Clyde NHS Board provides, in which the Christie ward works alongside a developing community mental health team. That is a model that can deliver results.
Finally, I know that mental health remains a priority for the Executive. However, I also know that ministers will focus attention on the drive to improve services, because that is the key to making a difference in the experience of people with mental illness.
I welcome the chance to speak in the debate from the perspective of remote and rural areas, such as parts of the Highlands and Islands, where there are particular problems in promoting mental health and in delivering services to people with mental health problems. Although there are difficulties in the delivery of health care in remote areas, it is a matter of principle that services should be based on need, rather than on where people live. However, there is often a dearth of specialist services in remote and rural areas. That must be addressed, especially given that some mental health problems, such as alcoholism and, most worrying, suicide, are more prevalent in rural areas.
I have mentioned specialist services, but of course the majority of contacts for people with mild and moderate mental health problems are with GPs and their teams in primary care. Those teams must be adequately resourced. Where necessary, health boards should take advantage of the new GP contract to commission and enhance GP mental health services—I hope that the minister keeps a watching brief on that. We must support work force planning in primary care, for example through the expansion of the GP rural fellowship scheme.
I was glad to hear in the minister's opening speech that some of the recommendations in the Bid 79 document, "Recommendations for the safe management of acutely disturbed psychiatric patients in Scotland's remote and rural areas" have been acted on. All of us who come from rural areas are aware of distressing stories of acutely mentally ill people who have to be held in, for example, police cells, which are clearly inappropriate, because there is a lack of appropriate facilities. That is unacceptable. The report makes 10 recommendations and I would be interested to know how many of those have been or will be acted on. The report recommends that each NHS board produce a psychiatric emergency plan for its area in collaboration with appropriate agencies. It also recommends patient focus and public involvement, so that service users have an input into in the drawing up of such plans. It considers staff governance and protocols on, for example, the use of sedation or restraints.
In the document "National Mental Health Services Assessment Locality Reports", the section on Highland says, on page 82, that the priorities of service users in Caithness include
"Easier transfer to hospital—waits of 18 hours in police cells are not acceptable."
We can take it that the recommendations to which Eleanor Scott refers have not yet been implemented.
I am sure that the member is right. I received a letter from someone in Thurso who was held in a police cell in an acutely distressed state. The police acted as well as they could, but dealing with such cases is not their job. The situation was distressing for everyone concerned, including the police. There are issues about the use of community hospitals as more appropriate facilities for dealing with such cases, although that obviously involves consideration of risk management issues. I would like the Executive to state clearly that the use of police cells as a place of safety is inappropriate.
I want to focus on recommendation 10 in the RARARI document, which has the heading, "Further Development". It states:
"A Rural Mental Health Network should be established on a formal basis involving all NHS Boards with responsibility for remote and rural areas. The network's functions should include collection of data on psychiatric emergencies, collaboration on the drafting of PEPs"—
psychiatric emergency plans—
"sharing good practice across the country, and audit of arrangements in remote and rural areas for psychiatric emergencies."
That recommendation is crucial and I want to hear from the minister that the Executive endorses it unequivocally. I know that rural GPs seek the establishment of such a network, which would formalise and facilitate good practice and produce the necessary resources.
The end of RARARI has left a gap in the examination of health care—not just mental health care—in remote areas. I believe that the management of mental health care in those areas is an aspect of health care that will be adversely affected by that. I have already mentioned that suicide rates are higher in remote and rural areas. We need to tackle that, but we need proper resource planning to take account of the special problems and needs of people in those areas. We must consider the implications of the lack of resources and the need for the provision of staffing and support on a network basis. I will be interested to hear from the minister how those issues are being progressed.
We move to closing speeches. We are slightly ahead of the clock at this stage, so closing speakers can have a little flexibility. In theory, Carolyn Leckie has six minutes, but she can take a bit longer.
Thank you. I hope that I will not need that extra time.
The debate has been highly informative. I particularly want to agree with the comments of Mary Scanlon and Jackie Baillie. My amendment refers to the need for local access to services and patient beds so that people can be treated in their communities in a small and friendly environment. I hope that my amendment attracts support.
Mary Scanlon spoke about prescribing and how matters were being viewed through the wrong end of the telescope. We should be examining the causes of mental health problems. The World Health Organisation's statistics are frightening. They paint a picture of a society from which people feel disengaged and about which they are despairing. That leads to mental ill health. Without a fundamental change in society, we will not address those appalling statistics.
I want to concentrate on some aspects of my amendment that I was unable to cover in my opening speech. Adam Ingram referred specifically to children's services. The situation is unacceptable—there needs to be urgent resourcing of children's services. Children make up a fifth of the population, but only a twentieth of the mental health service budget is spent on children's services. When he sums up, I would like the minister to identify what specific measures will be taken to address that matter. In particular, I want him to deal with services for looked-after children—which require urgent attention—as those children are most vulnerable to, and most affected by, mental health problems.
We should consider prevention as well as treatment and should put greater emphasis on it. That is where education and our schools come in. The curriculum should foster an awareness of mental health and emotional well-being in children. From a very early stage, children need to be encouraged to express their emotions and how they feel—their sadness and their despair, for example, which might result from bereavement, such as the death of their parents. Schools sometimes still put far too much emphasis on discipline and conduct in the class and repress the expression of our children's emotions, so it does not surprise me that when children in this country reach adulthood, they are highly vulnerable and susceptible to mental ill health problems.
I suspect that the roots of our high suicide rate—which applies especially to young men—are associated with that sort of culture, which our society and our schools perpetuate. We need to begin to combat low self-esteem when children are very young. We cannot avoid the fact that low self-esteem among children is disproportionately related to poverty and social problems in the homes from which the affected children come.
I concur with the concerns that have been expressed about the increase in recent years in the prescription of psychiatric medication to children. There is a dearth of research into the effects of psychotropic drugs on developing nervous systems. It is irresponsible for the Executive not to check and monitor the rapid increase in the prescription of such drugs to children. We need urgently to conduct research into the prescribing of such drugs and the circumstances of their prescription and to assess the impact on the children concerned. GPs must account for that shift in practice. When someone is under pressure and under-resourced, it is sometimes too easy for them to write a prescription. Although the development of services from which children might benefit more might be a bit more resource-consuming, such services might allow children to recover rather than to remain doped up with drugs. I would like the minister to mention children's services in his summing up.
In his opening speech, Malcolm Chisholm talked about perinatal services. I agree that the development of a special unit by Greater Glasgow NHS Board is long overdue. When I did psychiatric training as part of my training to be a midwife, I did a short stint at the Southern general hospital, which had just lost its unit for handling mothers and babies. A new special unit in Glasgow has been a long time coming. Such units are urgently required throughout the country. When mothers and babies can stay together, it is unacceptable that they continue to be separated when the mother requires treatment. I want the Executive to provide a timescale for eliminating that practice in Scotland.
Words are fine, but resources are necessary to deliver on the strategy and on our aspirations. Given that health boards have deficits of tens of millions of pounds, I am concerned that mental health services, which have always been the Cinderella service, will continue to be constrained as health boards attempt to balance their budgets. I would appreciate a commitment to provide resources for mental health services and an assurance that they will not face further stringent measures in the future as a result of the financial strictures on health boards generally.
I have been struck by the positive tone of this morning's debate and the constructive engagement that has taken place throughout the chamber. However, I am disappointed that there are only 17 MSPs present. I am not making a party-political point—on this occasion, my party, the Liberal Democrats, is the worst offender. It is a shame that 112 MSPs are elsewhere and are not listening to the debate in the chamber; I hope that some members are watching the TV screens.
Among many points, Malcolm Chisholm mentioned that one of the Executive's targets was to reduce suicide rates by 20 per cent by 2013, which is in nine years' time. I have nothing against targets, as they can be a good thing, but I would like Tom McCabe to explain when he sums up why a figure of 20 per cent was chosen. Was it pulled out of the ether? I would like to know the reasoning behind it.
Stewart Stevenson, among other members, focused on the stigma that is associated with mental ill health; that important theme ran throughout the debate. David Davidson focused on the shortage of trained staff, and his personal experience helped to illustrate the point.
I want to spend a little more time over the points that Carolyn Leckie made. She urged us not to use the word "loony" to describe political opponents and said that she had used that word in the past. I, too, hold up my hand. Mary Scanlon—quite rightly—has had occasion to take me to task on the issue. I shall certainly endeavour not to use the word again. I agree that MSPs must be sensitive and careful about the way in which they use language, especially in the chamber. The point is important, particularly in relation to the subject of our debate this morning. In my role as health spokesman, on considering the issue and reading through some of the literature, it struck me that the stigma of mental ill health was a constant theme throughout the literature. It is interesting that nobody from the lobby groups mentioned that point to me. We have to do what we can across the chamber to get rid of some of the stigma.
Mary Scanlon, in an extremely good speech, talked about recognising the causes of depression. She used the term "unresolved grief", when talking about the group that she had spent time with yesterday. Help, where and when it is needed, and early intervention are required. Drugs can never be the only answer. Mary Scanlon made a positive and helpful contribution to the debate.
Jackie Baillie said that, thankfully, mental health is not the Cinderella service of the NHS that it was at one time. That is absolutely true. The Scottish Executive is doing a huge amount to raise the issue and the profile of mental health services, as is the Parliament.
Eleanor Scott focused on the specific problems of the management of mental health care in Scotland's remote and rural areas. Politics is not only about addressing issues in the chamber; it is about making choices and allocating resources where we think that they will do the most good. Eleanor Scott's point about the special needs of remote and rural Scotland was well made.
The debate has been constructive. The motion is a good one and I have no problem in supporting it. To be honest, I think that the amendments were lodged more to convey parties' participation in the debate and not because of any real intention to change the motion. The motion should attract support from across the chamber.
Like all members in the chamber, I welcome the debate, which comes during national depression week with its aims of raising the awareness of depression, reducing the stigma that is associated with depression and mental health in general, and making treatment more effective. It has been a well-informed debate, which has shown clearly the interest of the MSPs who are in the chamber in the mental health well-being of the population.
Statistics show the seriousness of the situation that faces mental health services at present—one in three GP consultations involves some aspect of mental health and a quarter of the population are affected by mental illness at some stage in their lives. That means that fewer of us will go through life untouched by mental health problems in one way or another—either personally or among our family and friends.
When we learn that more young men are dying at their own hand than are killed in road traffic accidents and that suicide is the leading cause of death in Scottish men aged between 15 and 34, we know just how important it is to tackle the problem head on and to unravel the complex issues that underlie it. Mary Scanlon touched on that point.
There is no doubting the Scottish Executive's commitment to maintain the mental well-being of the Scottish people and to improve the situation of those with mental health problems. As the minister illustrated in his opening speech, many of the initiatives that are under way have that intention. I was particularly pleased to hear the minister's statement about advocacy services. As has been acknowledged in the debate, however, there is still a long way to go before the Executive's aspirations are achieved.
Undoubtedly, there are serious shortfalls that have to be addressed in the provision of early intervention, crisis and respite services. Access to a range of treatments is patchy across the country; I am thinking of access to medication, complementary therapies, counselling, psychotherapy and social support. Services are not accessible at the local level, nor are they always effective in responding to people's needs. For many patients, a shortfall in specialist help can still result in GPs prescribing antidepressants and other mood-altering drugs when counselling, specialist help and psychotherapy would have been much more effective and beneficial. Bed blocking remains a serious issue and mixed-sex wards continue to cause distress to many of the patients who have to be treated in them.
As we heard, the national mental health services assessment highlights the many shortcomings of the current service and the pressures on staff to cope with the added demands of new legislation. It also highlights the perception of the chronic underfunding of services in the face of rising needs and the demands and expectations of the public and, indeed, politicians. The assessment notes the continuous change agenda and restructuring that get in the way of the prime duty of caring for patients. Stewart Stevenson's quotations from Dr Sandra Grant's report revealed the worst in the service. Clearly, all of us hope that such conditions will soon be history.
The increasing bureaucracy that is associated with monitoring and accountability and the perception of increasing centralisation and control from the Executive—despite the rhetoric of devolved power—all lead to low morale in the service and contribute to difficulties in the recruitment and retention of staff. As Jean Turner pointed out, lack of concern for staff well-being is a major factor: it hits staff morale and leads to the loss of many able and well-trained people.
Dr Grant's report contained a clear recommendation that more authority, responsibility and accountability—including for budgets—should be devolved to front-line staff in the future, with the objective of enabling those staff to work closely with the voluntary sector, service users and carers. I hope that the minister will support that recommendation and that he will not be put off by the fact that it is in line with Conservative party policy.
I am pleased that Mike Rumbles and Adam Ingram highlighted the need for more work to be done with children who have mental health difficulties. I, too, heard and was impressed by Dr Bryce's excellent presentation at the cross-party group meeting yesterday. Dr Bryce gave us the frightening statistic, which Mike Rumbles and Adam Ingram quoted, that 10 per cent of the population aged between five and 15 years of age have serious mental health problems at any one time. That is 125,000 children—enough, as Dr Bryce said, to fill a football stadium.
The breakdown in health of many of those children can be foreseen by teachers, primary care and social work professionals who form the network of people who know about the underlying risk factors that hit those children. I am thinking of issues such as family breakdown, which is increasingly common, and the misuse of drugs, alcohol and other substances. The network, however, is not really in the loop as far as early diagnosis is concerned.
The children who were questioned by Dr Bryce's organisation cited the need for discussion about issues such as family breakdown. They want to have it out with adults; they want to know how family breakdowns come about and they want to talk about the emotional consequences. They also cited the need for adults to learn how to communicate with young people; how not to talk down to them; and how to find language with which young people are in tune. The children pointed out the lack of leisure and recreational facilities in many communities. They showed concern that, although many schools pay lip service to issues such as bullying by having policies on paper, they do nothing very much to deal with the issues.
Work is under way to develop the NHS work force and the network of children's services. That includes several of the initiatives to which the minister referred in his opening speech, such as the see me anti-stigma campaign, the health-promoting schools unit that deals with emotional health and well-being and the choose life suicide prevention strategy. All those measures aim to move services closer to children, at home and at school. For those who are already ill, the mental health and well-being support group is looking at services for the seriously unwell and those who come under the provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003.
There are, however, major problems facing child and adolescent mental health services. There are serious shortages in all the professions, and there is difficulty in providing an integrated system for young people that involves health, education and social work services. The separate structures and budgets of those authorities make joint planning and joint service provision hard to achieve. I urge the minister to give serious consideration to unifying the health-related social budgets so as to help alleviate that problem.
I reinforce what David Davidson said about voluntary services and urge more use of the voluntary sector. It has the skills and expertise that are required, as well as flexibility and willingness to work with the private sector. Voluntary organisations know that they could do more and they feel frustrated that they are often left out of the equation, despite the fact that they are able and willing to help.
Mental health is a massive issue. Progress is being made on several fronts, but there is still a very long way to go before people who are suffering from mental illness get the care that they require. Money is tight and morale is low, and there is undoubtedly a serious lack of trained professionals in health and social work. That must be addressed. There has been progress, but much more is needed. That is why I am happy to support the amendment in the name of my colleague David Davidson.
Like other members, I welcome the opportunity to debate this important issue. The timing of the debate is appropriate, as it comes one year after the passing of the Mental Health (Care and Treatment) (Scotland) Act 2003 and one year before that act is fully implemented. The debate gives us an opportunity to assess what has happened and what we can do to make improvements before 2005.
I used to volunteer for mental health services, and I seem to remember doing a lot of outreach work, particularly in housing schemes. Unfortunately, a lot of that work has been discontinued but, having read Sandra Grant's report, I see that things have moved more towards community work, which should be commended. I look forward to the day when we go back to having more community health services, which were useful. I will return to the subject of community work, which was raised by Carolyn Leckie, Jackie Baillie and others.
One of the issues in Sandra Grant's report that was raised most frequently by service users and carers was the services that they wanted to be either improved or continued. In particular, they wanted the see me campaign to be continued, and I thank the minister for his announcement on that. That campaign has been very successful and I know that users and carers will welcome the announcement. Service users and carers mentioned responsible and positive reporting by the media, and I will return to that subject, too. They also wanted openness on the part of mental health services about what services are available and what information they can access; in particular, they wanted such information to be made available for carers, and not just for users.
Stewart Stevenson raised the paramount issue of the work force. Sandra Grant's report mentions that the position is likely to deteriorate further in Scotland. We need to take that into consideration, bearing in mind the level of training that is required. As we all know, there will not be any early change for the better; it was worrying to read that in Dr Grant's report. The report is honest, as members have said, and we should take cognisance of what it says.
David Davidson and Mike Rumbles mentioned the important issue of stigma, which has been raised again and again. I, too, would like to quote some figures from the survey that Mike Rumbles cited earlier. According to the survey, 64 per cent of young people said that they would be too embarrassed to disclose a mental illness or health problem to a prospective employer. I find that quite worrying. Only 37 per cent of employers said that they would be prepared to take on somebody who had said that they had a mental illness. I find that very worrying, too.
According to the same survey, 50 per cent of people said that media portrayal of mental health problems was much more negative than positive. That is why I ask the minister whether he could monitor the see me campaign. Once the campaign has run its course, perhaps another survey could be done to find out the extent to which it has improved society's perception and, I hope, that of the media. If 50 per cent of people say that the media's portrayal of mental health problems is negative, that is a terrible indictment of the society in which we live today. I worry about that very much.
Carolyn Leckie highlighted the plight of people who live in deprived areas and the accessibility of services; the accessibility of services was also highlighted by Jackie Baillie and Mary Scanlon. Services must be accessible in the community, and I agree that we must ensure that people are not denied services simply because they cannot afford them or because they are not provided locally. That is a major issue, which Carolyn Leckie described very well.
We need to consider advocacy. I welcome the minister's recognition of the fact that demand for advocacy services will rise and I hope that he will ensure that advocacy is available to all, and not just to people who can access it and who can afford to do so. That is where the community aspect of the matter has to come in.
Many members, including Nanette Milne in her summing-up speech, mentioned children. It is very worrying to think that there are 125,000 children with mental health problems. Nanette Milne was right to say that early intervention is important if we are to help those vulnerable kids. If we could prevent something in society from getting worse, we would all be proud of that. We must pay special attention to the fact that such vast numbers of children are suffering. I am sure that all of us will be thinking about that carefully.
The minister mentioned the fact that the Executive is looking to more outreach work being undertaken. As I said, I used to do outreach work in the voluntary sector. Whole families used to come along, even if only one person in that family was suffering from some form of mental health problem, and I found that to be a good thing. Services were provided in centres—or clinics, as they were called in those days—that were located in the middle of communities, so families could bring their children, and mothers and fathers could come with the rest of the family. Perhaps because people were able to come along to meetings, there was less stigma. Neighbours and others got to know about the service, and I was amazed at the number of people who came along. I hope that we can get back to having more localised services like that. We must try to reach out and help the people concerned. The Mental Health (Care and Treatment) (Scotland) Act 2003 was a good piece of work but, as Sandra Grant's report said, we must consider improving certain of its provisions.
Once again, I welcome this opportunity to debate the issue. We have heard about a number of issues around the lack of surgeons, psychiatric consultants, community services, advocacy and, obviously, funding, which I would like the minister to address when he sums up. Although there is funding for local health boards and local authorities, Sandra Grant's report found, as have people on the ground, that the money that is allocated for mental health services is not always used for that purpose; basically, the money is soaked into the general grant. Adam Ingram picked up on that point. Is there any way that the minister could ensure that that money is spent on mental health issues? There is an issue of ring fencing, which the minister might wish to address when he sums up.
We have to know where the money is being spent. It is all right to say that money is being given to local authorities and health boards to spend on mental health services, but if—as Sandra Grant's report, users and carers are indicating—the money is not being spent on those services and is being soaked up for something else, we require answers.
We must move forward. I appreciate the fact that we are doing something that Westminster might never have got round to doing. The Scottish Parliament should be proud of that. Let us get things moving. We recognise the problems. Let us solve them and give people with mental health issues a better deal and a higher quality of service.
I thank members for their constructive contributions to the debate. Yet again, a good debate has shown the commitment throughout the chamber to addressing mental health issues. I will do my best to respond to some of the points that have been made.
I say to Stewart Stevenson that mental health is one of our three national clinical priorities. Although people are quite right always to advocate additional resources for any aspect of health, it is important to put the matter in perspective. Around 10 per cent of all health spending is now directed towards mental health, which is by any standards a considerable amount of money.
I say to Adam Ingram and Sandra White, who raised concerns about monitoring the implementation of spend, that we intend to monitor the way in which the moneys that have been made available to local authorities and health boards are implemented. That is important. We are only too well aware that money can easily be diverted to other causes, so we intend to monitor the spend as vigorously as we can.
Will the minister take an intervention?
Not at the moment. I have just started.
I emphasise the impact of mental health problems, which we have heard are both a cause and a consequence of social exclusion and can lead to a lack of opportunity for work, training, education and participation in social and community life. One in four people will be affected directly by a mental health problem at some time in their life. Such problems can affect any one of us, regardless of our economic or social circumstances, but, as many members have said, we know that people living in deprived communities are more at risk of mental health problems and are more likely to experience negative effects on their lives.
The Executive is working with partners to reduce the social exclusion and inequalities that many people with mental health problems face. For example, we are focusing attention on opportunities for employment. I will say more on that in a moment, but I want to stress that anyone can encounter mental health problems, no matter their social standing, profession or qualifications—it can happen to anyone. We cannot say often enough that there is no shame, that stigma comes from a lack of understanding and that there is no place for and no sense to discrimination.
Stewart Stevenson mentioned the benefits of work. A key route to recovery is through the work of Jobcentre Plus, with which we are working to consider ways to improve its staff's training on and awareness of mental health. We are also working with the Department for Work and Pensions on welfare-to-work and benefits issues and, in particular, on supporting pilot schemes that are designed to support people back to work and ease the transition from benefits to work.
A national pilot that is taking place in Argyll and Clyde works to support back to work people who are currently on incapacity benefit. The success of such schemes is vital, because in some areas of Scotland up to 35 per cent of people on incapacity benefit have mental health problems. There are also a number of supported employment schemes throughout Scotland. In tandem with those schemes, there are a large number of local projects and services that work with people to support them in getting ready for work; they help to rebuild confidence and self-esteem and give people hope for the future. I had the opportunity earlier this week to visit the Redhall walled garden in Edinburgh, which is an excellent example of the contribution that our voluntary sector partners can make to improving participation and inclusion for those with mental health problems.
For people who are already in work, we are working closely with Scotland's health at work, which has developed an employment and mental health training programme for employers to help them fulfil their roles and responsibilities on employment and mental health. The programme is being rolled out throughout the country and each area will have access to a trained instructor.
We need to continue to seek ways to reach out to those who are vulnerable to poor mental health and who may feel particularly excluded. We are working on a range of vulnerable groups of that kind. In particular, with the National Resource Centre for Ethnic Minority Health, we have an initial two-year programme of awareness raising and development work and a series of information and good-practice seminars are taking place throughout Scotland in the next eight months. The centre is also being funded to take stock in each local area and to examine in depth the provision of services and support for the mental health of people from ethnic minority communities. The results will help in the planning of appropriate services and access to them.
As has been said during the debate, we know that the cost of inequality can be high. People who live in the most deprived communities of Scotland have a 10 times higher risk of suicide than do those who live in the least deprived communities. The figure for suicide in Scotland is 800 a year, with 600 deaths being attributed directly to suicide and the remaining 200 deaths being unattributed. In the Executive's choose life strategy, we are working to address those inequalities and we are about to introduce a community based training course. Over two weeks—one week in West Lothian and one week in Glasgow—48 instructors from throughout Scotland will be trained in applied suicide intervention skills. The course is run by experts in suicide prevention from Living Works Education, Inc at the University of Calgary in Canada and has been developed over 20 years. It has proved successful in helping agencies, community representatives, family members and others to assist in the prevention of suicide.
Mike Rumbles mentioned the target to reduce by 20 per cent the incidence of suicide by 2013. That target, which is consistent throughout the United Kingdom, reflects our determination to focus on this critical area, but also to be realistic.
I turn to the challenges that we face in providing services to those who experience mental health problems. Mike Rumbles pointed out rightly that one in 10 of our children and young people under the age of 19—125,000 of our young people in Scotland—will have mental health problems that are so substantial that they have difficulties with their thoughts, feelings and behaviour day to day.
Will the minister join me in commending Lochyside RC Primary School in Fort William, which the First Minister, Jim Mather and I visited separately on Monday, for its excellent relationship with the pupils whereby the staff listen to and build partnership with the pupils and encourage them to express their feelings through art projects?
Of course I warmly welcome such developments. I hope that the pupils were not diverted too much from their studies and thoughts by all the people who visited them earlier in the week. I am sure that the visits made a contribution and did not detract from their work.
I am happy to reassure Mike Rumbles and Adam Ingram that the Executive is proceeding with several strands of work following the publication last May of the Scottish needs assessment programme report on the needs of children and young people with mental health problems. The work will cover promotion, prevention and care and will involve a range of agencies including those in education, social work, health and the voluntary sector.
We are aware that there are particular concerns about the provision of in-patient services for children and young people and the child health support group is considering the range of in-patient services that are now needed throughout Scotland. I note the concerns that Mary Scanlon and Carolyn Leckie expressed about Ritalin. Its prescribing is subject to a Scottish intercollegiate guidelines network guideline, but it will be reviewed in due course.
There are important issues to address in relation to the arrangements for planning, resourcing and delivering mental health services. We are conscious of the opportunities and challenges that community health partnerships will present for the delivery of properly integrated local mental health services. Officials have therefore been working with partners from health boards, local authorities and voluntary organisations to develop guidance, which I expect to be available soon in draft for discussion with the wider mental health community.
I believe that the Executive has in place a clear policy on mental health. We want to see an overall improvement in the mental well-being of the people of Scotland, towards which the national programme is making real progress. We also want to see a real improvement in the services that are provided to those with mental health problems. The Mental Health (Care and Treatment) (Scotland) Act 2003 is an important part of that and the follow-up to Dr Grant's review will be critical, not just to ensure that the act is implemented but to improve the range and quality of services for all the people in Scotland who need them.
I reaffirm the Executive's commitment on mental health, which is to reduce the risk and prevalence of suicide and the stigma associated with mental health problems, including depression; to promote and support recovery in all senses; and to improve services overall for those with mental health problems. It is clear from this morning's debate that the Parliament shares that commitment and those aspirations and we look forward to working together to make a difference in mental health awareness and services for all people in Scotland.
I have two brief announcements. First, members will wish to join me in welcoming to the public gallery His Excellency Mr Masaki Orita, the Japanese Ambassador. [Applause.] Secondly, after First Minister's question time, I will make a brief statement on Holyrood.