The next item of business is a debate on motion S4M-13599, in the name of Jamie Hepburn, on the Mental Health (Scotland) Bill. I ask members who are leaving the chamber to do so quickly and quietly.
17:45
The Mental Health (Scotland) Bill’s overarching objective is to help people with a mental disorder to access effective treatment quickly and easily. It does so by improving the operation of the Mental Health (Care and Treatment) (Scotland) Act 2003 and the Criminal Procedure (Scotland) Act 1995, which provide fundamental protections and safeguards to people with a mental disorder. The bill also introduces a victim notification scheme for victims of mentally disordered offenders in a way that respects the rights of both victims and vulnerable offenders.
I am grateful for the detailed and thorough scrutiny that the Health and Sport Committee gave the bill at stages 1 and 2, which has helped to ensure that we get it right and continue to maximise the protections and safeguards. The bill has been significantly improved during its parliamentary passage as a result, and I thank the committee members, as well as members who are not on the committee but have engaged with the process, for the work that they have done.
I will take a few moments to set out key aspects of the bill. The 2003 act brought in important protections including advance statements, which help to involve patients in decision making about their treatment by allowing service users to state how they would like to be treated if they become unwell. The bill strengthens the position of advance statements, gives service users greater confidence that their wishes will be taken into account in their treatment and ensures that the Mental Welfare Commission for Scotland has a better picture of the use of advance statements.
I am pleased that the Parliament supported Bob Doris’s amendment 28, which will help service users to access support in taking up the opportunity to make a statement. We want advance statements to be used far more widely, and that was a common theme in the committee’s scrutiny of the bill. Taking those provisions together, the bill should increase the use of advance statements and, through that, help more service users to have greater involvement in decisions about their treatment when they are unwell.
Many service users have found the role of the named person, which the 2003 act introduced, to be an important protection, as it gives someone they know a role to act independently to protect their interests. However, I listened to the significant concerns about the fact that service users do not always want a named person, particularly as that person will see confidential information about the patient’s medical treatment.
The bill means that a service user will have a named person only if they want one. That is an important step in promoting service users’ rights. Through stage 2 amendments, we ensured that protections are in place for vulnerable service users who do not have the capacity to decide whether to appeal an order or certificate, while ensuring that that does not impact on their privacy or autonomy.
The bill fulfils the intention behind introducing the excessive security appeal provisions in the 2003 act and the Millan recommendations by extending the right of appeal against being detained in conditions of excessive security to those who are detained in medium-secure units. The intention was to give patients in high-secure units and medium-secure units a right to appeal against detention in conditions of excessive security. We now need to ensure that the scheme that was provided for in 2003 can operate effectively in the present secure estate. Amendments that we debated today will ensure that we do that by extending the right to patients in medium-secure units as quickly as possible. I look forward to discussing that further when the committee and the Parliament consider draft regulations after the recess.
Those are just some of the key changes through the bill that will make the 2003 act work more effectively and enhance the experience of, and protections for, service users.
There has been widespread support for the introduction of the victim notification scheme for victims of mentally disordered offenders. The intention is that the scheme will respect the rights of both victims and vulnerable offenders and will closely resemble the scheme that is already available to victims under the Criminal Justice (Scotland) Act 2003. The scheme will be of huge benefit to victims who were not previously covered by the criminal justice scheme and it will provide them with greater reassurance when offenders begin the process of discharge from treatment.
We have also recognised that mentally disordered offenders may be vulnerable—that perspective was expressed by the committee during its consideration of the bill at its earlier stages—and we have taken that into account. I am grateful to the victims’ rights working group, which included representatives of Victim Support and Hundred Families, for its assistance in getting the balance right.
The bill amends the Mental Health (Care and Treatment) (Scotland) Act 2003, and I am aware that some members would have liked wider issues to be included. The bill is not a full stop at the end of a process, and I am happy to put on record my commitment to certain further steps. I have heard the concerns that a number of people and organisations have raised about the inclusion of learning disability and autism spectrum disorders under the definition in the 2003 act. I thank Jackie Baillie and Richard Simpson for the discussions that we have had on that. We have also debated the issue extensively at stage 3.
The 2003 act provides people with learning disabilities and autism spectrum disorders with protections, safeguards and—importantly—access to care and treatment, and it is essential that, in anything that we seek to do, we ensure that those protections continue. I have committed to reviewing the inclusion of learning disability and autism under the definition of mental disorder in the 2003 act. It is important that that review is genuinely participative and is commenced with an open mind about the outcome and process. As I set out earlier, we have started to discuss with stakeholders how we can undertake that engagement. I hope that the review further demonstrates our serious intent.
A number of committee members also raised issues about the role that psychologists play under the 2003 act, following consideration of the issue by the British Psychological Society, which I thank for its positive engagement. I also thank Dr Milne for raising the issue again today. It is important that we debate such issues. I have made the point before—I make it again—that I am sympathetic to the proposal in Dr Milne’s amendment 33 but that I was not convinced by the provisions in the amendment. It is important that we have widespread consultation on the matter and, as I said, I am committed to looking at the issue alongside the wider review of learning disabilities and autism spectrum disorders. That is a serious commitment.
Amendments were lodged at stages 2 and 3 on the investigation of the deaths of patients who were in hospital for the treatment of mental illness and on the reporting of homicides by those who are being treated for a mental health condition. Although I did not believe that a legislative approach was appropriate, I was happy to accept amendment 36 at stage 3. Further work is necessary, and my officials have already started to explore with the Mental Welfare Commission how we can bring together a working group to develop a streamlined and effective approach to reviewing deaths in detention.
In relation to the reporting of homicides by those who are being treated for a mental health condition, the Mental Welfare Commission will work with Healthcare Improvement Scotland and the Government to produce proposals that build on current practice, to ensure that all cases are reviewed appropriately. In doing that, they will consult key stakeholders such as the forensic division of the Royal College of Psychiatrists and organisations such as Hundred Families.
I will ensure that the Health and Sport Committee is informed of developments on both those issues, and I will always be happy to consider the committee’s perspective in any work that we undertake.
The bill is part of the wider work that the Government is undertaking to improve mental health services, including funding. I announced in May this year an additional £85 million for mental health over five years, beyond the £15 million over three years that was announced in November 2014 for the mental health innovation fund. That is £100 million in total.
We will work with NHS Scotland and its partners to get the maximum benefit from the investment. We will focus on further improvement to child and adolescent mental health services to bring down waiting times; improved access to services and in particular psychological therapies; and better responses to mental health issues in community and primary care settings, including promoting wellbeing through physical activity and, crucially, improved patient rights. I will be happy to keep Parliament up to date with progress on those matters.
The bill further enhances the ability of people with a mental disorder to access effective treatment quickly and easily, while maintaining and enhancing protections and safeguards.
I move,
That the Parliament agrees that the Mental Health (Scotland) Bill be passed.
17:55
I welcome the final stage of the Mental Health (Scotland) Bill. I thank the members who moved amendments this afternoon and who put all that work into considering the detail of the bill—specifically the minister and my colleagues Richard Simpson and Jackie Baillie.
We recognise that the bill is an important step in tackling one of the greatest public health challenges of our time. We can reflect today on the progress that we have made as a country in removing the stigma attributed to mental health problems and addressing the complex and varied need for support that the many people who are affected have. In acknowledging the rise in awareness of mental health problems and the growing confidence that people now have in coming forward to access help, we also recognise that we still have much to do to ensure that a proper preventative agenda is in place and that we support people to overcome or better manage mental health issues.
The bill brings to an end a long and often technical process, which implements much of the comprehensive and detailed work of Professor Jim McManus and his review team on how we help people to access quick and effective treatment for mental health issues. The amount of work—which builds on Bruce Millan’s review of some years ago—that has gone into the bill and the level of engagement on the detail from outside groups prove what a serious and important issue this is for our Parliament and Scotland.
I think that every member in the chamber shares my experience of dealing with a vast amount of constituency casework on mental health issues, access to mental health services and the effect of mental health issues on our communities and on families—every family in Scotland, I think.
I commend the Government for the early approach that it took to the passage of the bill by listening and responding to concerns that were raised at stage 1. I believe that we have improved the bill, which will be passed today with our support. However, there are areas in which we could have gone further, particularly on the definition of mental disorder and on patients’ rights.
As we know, the Millan review in 2001 recommended that there should be an expert review at an early date of the position of learning disability within mental health law. That was echoed by the McManus review, which said in 2009 that it was time that a review was done. That is supported by a number of groups, including Inclusion Scotland and Enable Scotland. Inclusion Scotland said:
“We believe that evidence presented to the Health and Sport Committee raises serious questions on whether the safeguards in the 2003 Act, particularly on the role of Mental Health Officers and the right to advocacy, are working as intended, and on whether mental health legislation is compatible with ... ECHR.
Inclusion Scotland therefore believes that the time is right for a more comprehensive review of mental health legislation in Scotland to ensure compliance with human rights obligations and to provide specific legislation to meet the needs of people with learning disabilities or Autistic Spectrum Disorders.”
Enable pointed out that
“14 years after a review was first recommended in Millan, people with learning disabilities are still waiting for a review to take place.
The case for a review was made very ably today in this chamber by my colleagues Richard Simpson and Jackie Baillie. Jackie Baillie’s amendment 1 would have instigated a major review of mental health services, putting rights first.
Will the member take an intervention?
I would like to make progress first, thank you.
A major review would have explored whether learning disability and autism should be considered mental disorders. It would have scrutinised the human rights implications of a patient’s right to refuse treatment. It would have allowed us to have a proper look at advocacy services and allowed transparent investigations into deaths in mental health units or under community treatment orders.
With both reviews calling for that change, many of the mental health charities and other organisations supporting it, and a well-argued amendment by my colleagues, this was an opportunity to make that change, which is needed. Although we are disappointed that the Government failed to support that approach today, there is enough in the bill in its current form for us to support the Government and welcome the passage of the bill.
Ms Marra suggests that we have rejected the approach that will see a review of the inclusion of learning disability and autism within the scope of the 2003 act. That is fundamentally not the case. I have committed repeatedly now to that review. We will undertake that review. I presume that the member will welcome that fact.
I thank the minister for that assurance but it is my understanding that Jackie Baillie’s amendment was rejected by the Government. Will the minister clarify that?
The debate was around the specifics of the amendment. We had the detailed debate. I am happy to go over it again in closing. Rejecting the amendment was not about rejecting the principle of having a review—I have committed to the Government undertaking that review; we will have that review. There were just some concerns about the specifics of Ms Baillie’s amendment.
When the minister sums up, I hope that he might put a timeframe on that review and make a commitment to that.
We welcome many of the well-thought-out steps that will be implemented as a result of the bill with regard to advance statements and advocacy. However, we cannot leave the chamber today with the sense of a job done. In Scotland, a quarter of people will experience a diagnosable mental health problem at some point in their lives. The varied and complex nature of mental health and the slow and invisible way in which a mental health problem can take hold of people’s lives mean that we have to stay vigilant and continually look forward to improve support for mental health.
Scotland has long been regarded as a world leader in its support for mental health, and the Parliament is rightly proud of that. However, if that is to continue, we must keep building on it and ensure that we are offering person-centred, rights-based support.
18:02
I add my thanks to the Health and Sport Committee clerks, the bill team, and the many witnesses and stakeholders who have been so helpful throughout the parliamentary process of the bill.
The Mental Health (Care and Treatment) (Scotland) Act 2003 was a very important piece of legislation, which sought to minimise interference in people’s liberty and maximise the involvement of people with mental health issues in their treatment, giving them the right to express their views about their care and treatment, the right to independent advocacy, the right to submit an advance statement about how they wish to be treated when they become ill, and the right to choose a named person to act on their behalf when necessary.
Twelve years on from that act, and following the McManus review in 2009, it became clear that some aspects of the 2003 act were not working as well as intended. The current bill aims to improve and bring additional clarity to the act so that patients indeed benefit from the intended minimum interference and maximum involvement with their treatment.
The principles of this amending bill were generally welcomed at stage 1, but it was recognised that significant amendments would be needed to ensure that the policy intention became effective, and there were serious concerns in certain policy areas. Amendments at stages 2 and 3 have served to allay a number of the concerns that were expressed to the Health and Sport Committee by witnesses and stakeholders, but some remain unresolved.
The minister has made it very clear that he sees the current bill as a light-touch review of the 2003 act and that he does not intend to accept more fundamental changes without further detailed consultation and review.
Among the amendments to be welcomed is the one that removes the initial proposal to extend the period of short-term detention from five to 10 days—an issue of concern that was raised by the Law Society—and the Mental Welfare Commission for Scotland is pleased to see the limit of a suspension of detention kept at 200 days and not extended to 300 days as originally proposed.
The tightening of the bill to ensure that a named person is identified only when the patient wants one, the requirement for health boards to publicise the support that they offer to make or withdraw an advance statement and to respond to requests about such support from the Mental Welfare Commission, the right of appeal for named persons in cases of cross-border transfer, and the steps taken to gather information about the provision of advocacy services so that they may become more readily available to people who wish to use them are all very welcome improvements to the bill as originally proposed.
However, concerns remain, particularly—as we heard a lot this afternoon—around people with learning disability and those on the autistic spectrum, who are currently included within mental health legislation because they have those lifelong conditions, whether or not they are also mentally ill. There are differences of opinion among experts as to whether that is right, but there is strong feeling among those affected that current mental health legislation is inappropriate, and that learning disability should be defined as an intellectual impairment rather than a mental disorder. A strong plea has been made for a wholesale review of mental health and incapacity legislation.
Such a review was proposed by the Millan committee as far back as 2001 and it was again recommended by McManus in 2009, so there is understandable frustration that it has not yet been achieved. The minister’s clear commitment to a comprehensive, participative review of the inclusion of learning disability and autism in mental health legislation is very welcome, and I can understand why he does not want to commit to a timescale that might curb the scale of the review. Nevertheless, there is a degree of urgency about this, and I am sorry that the minister did not accept Jackie Baillie’s stage 3 amendment to ensure that it would be done within three years.
I understand where Nanette Milne is coming from and I understand the frustrations that exist out there—that is one of the reasons why we have committed to undertake the review. She spoke about urgency and the necessity of getting on with the task, and in that regard I can say—as I have already pointed out—that officials are in dialogue with some stakeholders on the process. We are beginning the process. I hope that that gives a signal of our intent.
I understand and fully accept the intent, but we would really like to know when the process will end, rather than that it has begun.
There are unresolved issues around the use of psychoactive substances. The minister has agreed to consider them during the promised review, which is welcome.
This amending bill, which intends to clarify and improve the implementation of the 2003 act in the interests of the patients who are affected by it, is timely and welcome, but I expect that more changes will be required after further review has taken place. Significant advances have already been made in helping patients with mental health problems, but that is still work in progress, and continuing scrutiny of current legislation must be on-going, with an open mind regarding further changes as and when required.
I have confined my remarks to some of the proposals in part 1 and have chosen not to elaborate on parts 2 and 3, on criminal cases and victims’ rights. I merely add that the legislative changes proposed in parts 2 and 3 are welcome, and we are supportive of them. All in all we are comfortable with the amending bill, which we will support at decision time this evening.
18:08
I welcome the Mental Health (Scotland) Bill as amended at stage 2 and stage 3, which I very much hope and believe will be passed this evening. The bill is specific and focused and will deliver in a number of significant, although in some regards incremental, ways to benefit the people of Scotland.
I am pleased that members agreed to my amendment to place a duty on health boards to publicise any support that they offer in the making and withdrawing of advance statements and to require them to provide information to the Mental Welfare Commission in meeting that duty. I very much hope that that will drive change, boosting the awareness, numbers and use of advance statements and ensuring that the wishes of those with mental health disorders regarding their treatment and their lives are respected where they can be.
I am pleased that we have extended rights in other areas, such as the rights of victims of crime to a victim notification scheme. It is fitting and correct that we have done that.
This bill has also been a listening process. As I said, the Scottish Government listened to my case about advance statements at stage 3, and it backed a variety of other amendments, including some at stage 2. One of my amendments was about restricting the amount of invasive treatments that a cross-border absconding patient could receive as emergency treatment should they arrive in Scotland. The Government moved to protect the rights of those vulnerable, if at times challenging, individuals, and it was fit and proper that that was done.
The issue of learning disabilities in the bill has been shaped by the whole Parliament. A Government that listens will accept some—quite a lot, but not necessarily all—amendments that are lodged, which is right. There seems to be an undercurrent that if the Government does not accept all the amendments on learning disabilities it is somehow not listening, but that is simply not the case. I look forward to receiving more information about a review of learning disabilities, and I hope that we will have a rights-based approach to treating people with learning disabilities and those living with autism.
I hope that we can give cognisance to how aspects such as the implementation of self-directed support by local authorities, particularly in Glasgow, has negatively impacted on those with learning disabilities in the city that I represent, and I hope that that can be reflected in how we take the measure forward. We need service provision for those who are living with learning disabilities. Some fine learning disability centres in Glasgow were gateways that enabled vulnerable adults to engage and interact with the wider community, but many of those people have been left without the required support because their right to that facility was withdrawn by the local authority. In considering how we treat and respect those who live with learning disabilities, we must look at the role of local authorities and ensure that they fulfil their obligations regarding the rights of those people—certainly the people who I represent in Glasgow feel that many of their rights have been withdrawn. I look forward to supporting the bill, which will improve the lot of those who live with mental health challenges in Scotland.
18:12
This bill is welcome and the changes that it makes to the law will make a positive difference to the lives of individuals. However, it is clear that much more needs to be done. We must give mental health the same focus and consideration as physical health. There is still a huge amount of misunderstanding and stigma surrounding mental health, and through the laws we make we need to tackle that.
Like other members I was disappointed that amendment 1, in the name of Jackie Baillie, was not accepted. It is clear that mental health legislation covers people who are not mentally ill but who have learning difficulties or other conditions such as autism. Those people need additional support, but their condition is not a mental illness, albeit that at times they may be predisposed to mental illness due to their isolation from wider society. We need laws that not only support and protect such people but go further to integrate them into society—perhaps we need laws to change societal attitudes and structures so that people do not face the barriers and attitudes that prevent them from playing their full part.
When I spoke to constituents about the bill, they told me about the lack of services available for people who have personality disorders. Those people do not receive crisis mental health support and they are often left for the police to deal with. Sadly, one constituent told me that that was not necessarily such a bad thing, given that the police often showed more compassion than those providing mental health services. Although I acknowledge the compassion that the police exercise when dealing with vulnerable people, that should not be the only help available for those with personality disorders who have become psychotic. There must be a better way of providing them with emergency mental health support through the health service.
There is also a lack of support for carers, especially when the cared-for person comes out of hospital. We all know that that transition is a time of the greatest risk of suicide, yet carers are often ignorant of that risk and how they can best support their loved ones. That is not right. Carers should have the information and support that they need to help recovery, especially during the early stages, when the risk is greatest.
That issue was raised with me recently by carers of people who had suffered brain injury. I reiterate that mental health services deal with illness rather than injury or disability. Carers are left to care for their loved ones, not knowing how the condition will progress, whether it will improve and what, if anything, they can do to enhance recovery. There must be a better way of supporting people in that situation.
We need to reassess what is covered by our mental health services and where the gaps are with regard to disabilities and brain injuries. We need to ensure that services are available to all and are compassionate and caring. I hope that the Government reviews the current legislation and renews it in order to make it fit for its intended purpose and to ensure that emergency provision is available for all.
I welcome the bill but hope that we will deal with the issues of mental health impairments and brain injuries before too long. Carers and patients cannot afford to wait much longer.
18:16
I am pleased to see the Mental Health (Scotland) Bill at this final stage. I am hopeful about the positive changes that the bill will make to the Mental Health (Care and Treatment) (Scotland) Act 2003. As I noted earlier, the bill must aim to protect the vulnerable while extending their rights. Like others, though, I believe that if it had been amended today in certain areas, it would have been so much better.
Throughout the passage of the bill, we have heard concerns that patients are not its focus; that patients’ rights are compromised for the sake of administrative ease; that issues of patient privacy are not taken as seriously as they should be; and that mental health officers and staff are expected to undertake an overwhelming number of tasks despite overstretched resources and a reduced workforce. Like other members, however, I was pleased that there was wide outreach to key stakeholders and organisations. The British Psychological Society, Inclusion Scotland, Autism Rights, the Scottish Association for Mental Health and many others helped to improve key components of the bill. We are very grateful to all of those organisations.
I was pleased that a number of amendments to the bill sought to address some of its shortfalls. There was Dr Simpson’s amendment on psychotropic substances and the minister’s move to safeguard patients’ rights by extending notification of detention to a patient’s guardian or welfare attorney. Jackie Baillie urged ministers to review the meaning of “mental disorder” within a specified period. I was disappointed that that amendment was not passed. By successfully amending the bill, we would have created a stronger bill, which would have addressed a number of those shortfalls. Much hard work still lies ahead, including addressing the rights of those with learning disabilities.
Although the bill aimed to help people with a mental disorder to access effective treatment quickly and efficiently, I remain concerned about the state of our mental health system in Scotland. We can legislate, and we can try to protect the vulnerable and ensure that everyone’s rights are protected, but we cannot ignore the condition that the mental health system is in. Services are severely underfunded and staff are overworked, all against a background of a growing number of people of all ages asking for help and support.
Most important is the fact that mental health is not yet enshrined in law as being of equal importance to physical health. That is a provision that is lacking from the wider legislative framework in Scotland. I am pleased that steps are being taken by Parliament to address mental health but remain worried about how much longer we will have to wait until serious action is taken to remove the disparity.
I praise the member for his consistency in raising that issue. I will not rehearse again the fact that there is already equality in law. Jim Hume suggests that there was a need to legislate. We had a legislative vehicle—we had the Mental Health (Scotland) Bill—but I am not aware of Mr Hume having introduced an amendment to that effect.
We looked into that but realised that the structure of the bill was such that we could not introduce an amendment seeking parity of status between mental health and physical health.
We know that mental health problems do not affect just a small and invisible group of people; they affect one in four Scots at some point in their lives. Children and adolescents are being admitted to hospitals in growing numbers due to self-harm and eating disorders, and people are taking more and more days off work because of underlying causes such as depression and anxiety, which are conditions that our society continues to stigmatise.
I am hopeful that we are taking the right steps today to help our fellow citizens get better access to treatment while ensuring that their rights are protected. I hope to see further action taken in law and in practice to create a mental health system in Scotland that sets a standard to be followed and is fit for the future. We shall, of course, support the motion on the bill at decision time today.
18:20
The bill is a very important piece of legislation, but it is close to me personally for a number of reasons. I have experience of close family members who have gone through periods of mental ill health, some of whom continue to go through such periods. I therefore have a very strong interest in mental health. Aside from that, I am also interested in learning disability and the autistic spectrum, so I will address that issue first.
There is often a feeling that in politics we invent division where division does not exist. Amendment 1, in the name of Jackie Baillie, was rejected, but the intention behind it and what it sought to do were broadly supported; indeed, they were supported by the Scottish National Party in the Parliament, which is why the minister has committed repeatedly to undertake a review. However, I rejected amendment 1 because I felt that it had technical elements that might have constrained the process at a later stage.
One thing that might be helpful—I am interested to know whether the minister might be open to this at a later stage—is to have an early, wide-ranging stakeholder event that could look at, for example, terms of reference for the review and other matters that require to be considered. That could be an opportunity to demonstrate good faith to those on different sides of the chamber who have expressed doubt about the Scottish Government’s commitment to the matter and could be a helpful approach. I wonder whether the minister could address that in his closing remarks.
To respond to Jim Hume’s comments, I think that another difficulty that we often face in politics is that we overstate the effect of certain situations on sections of our society and our health service. There is no doubt that mental health services face pressures, but all our health services face pressures. It is the nature of the health service that it will face pressures, because it is a demand-led service and people will seek out support and help from it as they require it.
If we look back to mental health services prior to the SNP Government coming into being, we see that there has been a remarkable improvement in the funding that is allocated to them and in the driving down of waiting times for treatment. I would not disagree for a second that there is more to be done; indeed, the minister has said repeatedly that there is more to be done on waiting times for mental health treatment. However, I think that anyone who looked at the situation that the SNP Government inherited and compared it with where we have got to would be hard pressed to say that no progress had been made. That is not to say that there is not more to be done, though. That is why it is welcome that the minister has on more than one occasion announced funding allocations specifically to drive improvement in mental health services.
Funding is not the only answer in this area, however. Funding for mental health services is important, but it often focuses on dealing with problems as they arise. We cannot prevent all mental health conditions from arising and we know that mental health problems can affect anybody in society at any time, but we can look at where in society there are more occurrences of certain mental health problems and see whether they are linked to societal pressures. In particular, I would welcome an opportunity for us to consider—perhaps not in the Parliament but elsewhere—the great pressures that young people in society now face as a result of their interactions with one another through social media. The impact that those can have on young people’s mental health merits further examination at some stage.
I welcome the bill and I hope that it receives unanimous support at decision time.
18:25
I, too, welcome the bill. As ever at stage 3, we have to decide whether the glass is half empty or half full. On one hand, we certainly welcome the fact that several amendments that were lodged at stage 2 and 3 were accepted, but on the other we are disappointed that the Government rejected some good amendments today. I should say to the minister that the glass is quite small compared to that for the original bill in 2003. I note that the minister has had 48 amendments to deal with at stage 3 today whereas, in 2003, there were 756 amendments at stage 3 and 1,367 at stage 2.
Does Malcolm Chisholm agree that that speaks to my collaborative and open approach at stage 2?
I think that we were collaborative in 2003, as well.
Clearly, the bill is an amending bill, so in due course there might well be a need for a wider review, not only of the learning disability issue—I hope that that review will proceed without delay—but, in the longer run, of how the mental health legislation interacts with the Adults with Incapacity (Scotland) Act 2000, given the different and overlapping functions and the different definitions of incapacity.
Obviously, the discussion is set against the backdrop of the principles of the 2003 act, including those on reciprocity and the least restrictive alternative. All the things that we have discussed today relate to what was set up in the 2003 act—for example, the Mental Health Tribunal for Scotland, the named person and advocacy rights. On the progress that has been made, it is good that changes were made at stage 2. The proposal in the bill to extend short-term detention from five days to 10 days was reversed, and the proposal for a default named person was also rejected at committee.
Today, we have made progress on suspension of detention and—through two Richard Simpson amendments—on statistical information and the review of deaths in detention. On advocacy, we have had perhaps one of the most welcome advances today, and all credit to the minister for that. We have also had Bob Doris’s amendment about health boards publicising support for people to make advance statements. However, we in the Labour Party are disappointed that there is not a stronger duty to promote advance statements. We are also disappointed with the limited progress on levels of security, although I will not rerun that debate now.
I am very disappointed that there was no movement on psychologists. At one point—perhaps it was in committee—the minister invoked the fact that it is not appropriate to deal with that issue in an amending bill, but the proposal was for a very discreet change, particularly given that it was to be done through regulations. It was unfortunate that the minister completely rejected that opportunity.
Some recommendations in the McManus review have not been taken up, although we welcome the fact that many of them have been. The 2010 Equal Opportunities Committee report on McManus is worth looking at, as it focuses very much on the equality issues in McManus and the original legislation. Equality was one of the 10 Millan principles, but there are still concerns about equality issues for some groups in relation to the legislation; for example, we know that there is still an issue about young people in adult beds. McManus and the Equal Opportunities Committee also highlighted the duties of local authorities under sections 25 to 31 of the 2003 act to promote the wellbeing and social development of all persons in their area who have or have had mental disorders. That is outwith the scope of the amending bill, but we should not forget those wider aspects of mental health.
My final point is made just to remind us of that. I welcome all the progress that has been made on mental health, but we have all seen the horrifying story on today’s front pages about a postnatal depression tragedy that arose in my area because a service was not available for the woman in question.
We know that there is a lot still to do, but we welcome the progress that has been made on mental health in general and in the bill.
18:30
I, too, commend the members of the Health and Sport Committee for their sterling work on the bill, and give credit for all the progress that is contained in it. I appreciate that it is a step in the right direction, but we would be failing in our duty to mental health if we did not put on record how much more there is to do.
In amendment 1, Jackie Baillie asked for a review. It is reasonable that the minister said that he would conduct a review, but we were promised the Sandra Grant review of mental health services in 2004. We thought that we were being very reasonable in giving that review 10 years to be completed, but 2014 came and went, and we are still waiting for it. I know that it is supposed to come later this year, but the Government needs a prod in the right direction.
In preparing for the debate, I looked at my closing speech on the Mental Health (Care and Treatment) (Scotland) Bill in March 2003, which was made in the week before dissolution of Parliament. I said that it was with “a sigh of relief” rather than a sense of pride that I contemplated the passing of the bill, given the huge number of amendments that had been lodged. I said at the time—I think that others said it, as well—that the legislation would be effective only if health boards and local authorities gave it the priority that it deserved.
I looked up what the Mental Health (Scotland) Bill’s policy memorandum says about local authorities. Paragraph 168 states:
“The Scottish Government does not consider that the measures in the Bill have any disproportionate effect on local government.”
The policy memorandum also states:
“Mental health officers are affected by the terms of the Bill”.
It seems that the Scottish Government has not been listening to the many calls that have been made. I give credit to Jim Hume and many other members who have highlighted the drastic shortage of mental health officers across Scotland and the increased workload that Parliament has imposed on them. At Highland Council last week, it was stated that mental health officer reports that are legally required within three weeks under the Adults with Incapacity (Scotland) Act 2000 are taking three years. That patient group’s being unlikely to complain is not a good reason for not providing sufficient staff to ensure that support is given. I do not disagree with the abolition of ring-fenced funding for local authorities, but the Scottish Government should at the very least ensure that local authorities fulfil their statutory obligations in line with the bill that we will pass today and with previous acts of Parliament.
It is worth considering why mental health should be a priority. According to an Audit Scotland report, up to 75 per cent of people who use illegal drugs have a mental health issue. Up to 50 per cent of people with alcohol problems have a mental health issue—that is often called self-medication. Seven in every 10 prisoners are identified as having mental health problems, one in every three visits to a general practitioner is to do with a mental health issue, and about 9 per cent of our population are on anti-depressants.
The bill deals with access to treatment. The first Millan principle is:
“People with mental disorder should, wherever possible, retain the same rights and entitlements as those with other health needs.”
If those people have the same entitlements as others, why do only eight health boards meet the child and adolescent mental health services target of 90 per cent being seen within 18 weeks? In NHS Tayside, only 35 per cent of children are seen within 18 weeks, and there is a median wait of 49 weeks. That is not good enough. In March this year, 4,200 children waited to start treatment in a CAMH service, which is not good enough. If that was not bad enough, I was absolutely shocked to read that 17,530 people are on the waiting list for psychological therapies. That figure is up by 1,500 since the minister took office.
The Government needs to look at how positive mental health can influence physical health. We do not need more legislation; we simply need better understanding, more empathy and better working together. It need not cost more money.
18:35
The bill is modest but, as Mark McDonald and Jenny Marra said, it is important. It is based on the McManus report but, as Malcolm Chisholm reminded us, there was a massive number of amendments to the 2003 bill—the number of amendments today was fairly modest, thank goodness—but even then not all the McManus proposals were included.
I welcome the fact that the Government carefully considered the evidence, the stage 1 report and the stage 2 debates. As a result, I can commend the Government for acknowledging concerns, which has led it to withdraw some of the original proposals, such as the proposed 10-day extension to tribunal hearings, the length of time to appeal against transfer, and the proposed possible extension by 100 days of the community treatment order suspension period.
I also particularly welcome the victim notification scheme and some of other measures in the bill that will undoubtedly help the mental healthcare and treatment of people in Scotland. I regret that the nurse’s power to detain was not left as it was. I still do not understand where all that came from or what consultation was done on it. It is fine to tighten up the rules, but existing cases were not being reported to the Mental Welfare Commission in the first place, so that is what needs to be tightened up rather than the rules and whether detention should be for two or three hours.
I also regret that many of my, Jackie Baillie’s and Nanette Milne’s amendments were rejected. They were lodged after careful consideration of the evidence that had been presented and after discussions with and support from a number of organisations. Notwithstanding their rejection, I hope that many of them will be part of the wider review that the Government has already instructed civil servants to start thinking about. I welcome the sense of urgency that the minister is lending to the issue. I hope that he will be able to continue to apply that pressure.
Learning disability, or intellectual impairment, and autism spectrum disorder will need to be addressed. Mark McDonald called for a wider stakeholder conference to look at the remit for the review. I hope that the minister will consider that and I hope that it will not be some sort of internal review that leads to a bill, but that there will be a full-blown commission of the same sort as the Millan commission. Millan and McManus recommended that all the acts—the Criminal Procedure (Scotland) Act 1995, the Adults with Incapacity (Scotland) Act 2000, the Mental Health (Care and Treatment) (Scotland) Act 2003 and the Protection of Vulnerable Groups (Scotland) Act 2007—be considered. As the minister has said, that will be complex and will require a commission that is of good standing and which can command broad support. If we begin with the sort of conference that Mark McDonald suggested, we might be able to set an appropriate remit.
There are serious concerns about a range of issues. The right to refuse treatment is fundamental, but it is not applied to people who have mental health problems except under specific conditions. It does not apply if they give an advance statement; that was rejected today.
The use of psychoactive medicines is still far too widespread. The fact that antidepressants were being used in increasing amounts was appropriate because GPs were learning to prescribe appropriate doses for longer periods. However, the amounts that are being prescribed have gone on rising and it is becoming a matter for concern, although the particular target on that has been dropped.
There is the vexed question of the difference in application between a seriously impaired decision-making ability under the 2003 act and the definition of incapacity under the 2000 act. That needs to be addressed. Use of physical restraint has been addressed in respect of children, but it needs to be looked at again for adults because it might be being used inappropriately in one or two situations. The number of people who have been adversely affected by the issues that I have mentioned might be small, but one is too many. The guardians of good care and treatment should have more powers.
The Mental Welfare Commission in its many helpful reports draws attention to too many occasions on which it has not been able to get the information that it requires. The acceptance of amendments 25, 35 and 36 will undoubtedly help in that regard, but Scotland must have regulators that have teeth. If we continue to have regulators—the Healthcare Environment Inspectorate and, on occasion, the Mental Welfare Commission—covering only small areas, that will not be enough. We need to look again at HIS, the Care Inspectorate, and the Mental Welfare Commission. We decided not to integrate them during the previous reform, which was the correct decision at the time, but there are now issues that may need to be looked at.
I agree and disagree with Mark McDonald’s comments on mental health. I agree that there has been progress in care plans for patients who have severe and enduring mental illness. However, on child and adolescent mental health, although there was progress on the issue of admissions to adult wards, which was welcomed by the Mental Welfare Commission, the situation has gone backwards since 2009, as Malcolm Chisholm reminded us.
Mary Scanlon listed a number of issues, including the number of MHOs, which has reduced, and local authorities’ ability to deal with mental health. She also listed a number of other areas of concern with which I agree, particularly in relation to prisoners, in respect of whom far more must be done.
Rhoda Grant drew attention to personality disorders, which are still not being managed effectively in Scotland, as well as to intellectual impairment that is associated with brain damage.
I thank all those who gave evidence, and the many organisations that helped me to formulate the amendments and gave support on issues that were raised. I also thank the Parliament’s legislation team, whose drafting and responses to the changes that I sought were always patient and often creative.
The debates have been of value if only to inform the review. We have made progress since 1999, but we must keep moving forward and acknowledge the changes that have been made, in particular in neurodevelopmental science, but also in the culture. We must change things, but Labour will fully support the bill tonight.
18:41
I thank members for their speeches. I will try and cover as much ground as I can.
Although the bill has a relatively narrow focus, many of its provisions will make a difference for service users. Jenny Marra was right to talk about the constituents who approach us about many mental health-related issues. It is always important to have them in mind as we progress this work.
The bill has, at its heart, the aim of protecting service users’ rights and interests and of ensuring that the system under the Mental Health (Care and Treatment) (Scotland) Act 2003 works as effectively as possible. As I have said before, I am grateful to members and stakeholders for working with the Government to get the provisions exactly right. It has been a collaborative process. We have been able to work with the Health and Sport Committee very effectively to ensure that the bill is as good as it possibly can be.
The bill is only part of the Government’s wider programme to improve mental health services. Rhoda Grant is right to say that more must be done. She and other members can be assured that my focus will always be on that. Nonetheless, it is important that those who need compulsory treatment under the act are able to access treatment quickly and to have their rights and interests protected. The bill will play a key role in doing that.
Jenny Marra raised concerns about the bill’s compatibility with the ECHR. I take seriously the responsibility to have due regard to human rights. It is essential from a human perspective; it is also a legal requirement. The bill is underpinned by various processes of appeal and rights to express a view. I believe that the bill is compatible with the ECHR. I am unaware of any ruling that says the 2003 act and this bill are not compatible with it. I assure her that I will always listen and respond to serious concerns.
Various members have raised the review of the inclusion of learning disability and autism spectrum disorder in the scope of the 2003 act. I recognise the disappointment that the review has not taken place sooner. Let me be clear: I made the commitment to that review in the Government’s response to the committee’s stage 1 report. That commitment was made in advance of amendments at stages 2 and 3. It is a serious commitment.
Work has tentatively begun to engage stakeholders. I hope that that is an indication of our serious intent. Bob Doris asked whether the approach would be rights based. He can be assured that I absolutely commit to that being the process that we will follow.
I say to Mark McDonald—and to Dr Simpson, who latched on to his suggestion—that I am absolutely open to an early stakeholder event to help move the process forward. I will ensure that Scottish Government officials move forward on that basis.
There is no disagreement across the chamber on the need for a review. The Government was not able to accept the amendment on that—amendment 1—that was debated earlier not because of the principle but because of some of the mechanisms. It contained a hard timescale, which is not necessarily helpful to ensuring that we have the fullest review possible.
More substantially, amendment 1 provided for the removal of learning disabilities from the definition of mental health disorder by way of regulations if the review concluded that that had to be done. I am not convinced that that is the best way forward because it would summarily remove all the protections and rights that people with learning disabilities have under the 2003 act without replacing them. I do not think that any of us would want to proceed on that basis. The point that was made about the need for scrutiny of any measures that might be introduced is valid, and I am not convinced that that could readily be done by introducing regulations.
Let me be clear: the review will be participative and we have not yet determined exactly how it will be conducted. We want to involve stakeholders in shaping it. I am committed to beginning it as soon as possible, and I do not want to put an artificial timescale on its conclusion. The timescale that was set out in amendment 1 might be possible. I make my commitment: I want the review to be concluded as soon as possible but it is important that we do not curtail it, especially in light of the fact that I have also committed to the review covering the use of psychotropic substances and the inclusion of psychologists in the scope of the legislation.
Jim Hume and Mary Scanlon referred to the burdens that the Parliament places on mental health officers through its legislation. I recognise the invaluable contribution that mental health officers make to improving the lives of mental health patients, their friends and their families. I said earlier that the Government has announced an additional £85 million of investment over the next five years but, taking the investment that was announced in May and November last year, our additional investment in mental health services is £100 million.
The Scottish Government has also undertaken a scoping exercise to gather evidence on the capacity of the mental health officer workforce. That includes data provided in Mental Welfare Commission reports and the Scottish Social Services Council’s most recent workforce data report on mental health officers in Scotland. We will consider the draft report of that work in due course.
I gave the example that Highland Council, which should, under the Adults with Incapacity (Scotland) Act 2000, provide a report by a mental health officer in three weeks, cannot do that in three years. How will the £150 million—I think that that is what the minister said—impact on the workforce planning? Does that mean that more mental health officers are coming through the system?
It is important to clarify that it is £100 million, not £150 million, although that is still a substantial sum of money, as I am sure Mary Scanlon agrees. There is a range of ways that the additional money can be used to improve systems, including what Ms Scanlon suggests.
Malcolm Chisholm raised the need for further promotion of advance statements. The Mental Welfare Commission is currently undertaking a project to promote them, and the provisions in amendment 28, which Bob Doris moved, will complement that work. As I said to Mr Chisholm in our debate on amendments, I have also suggested that the working group on the code of practice consider further whether the guidance that it has could help to promote their use. It is essential that advance statements be used more widely, and I am serious about us working to that end.
I have heard general support for the bill from across the chamber. That is very welcome. I have also heard some disappointment that some amendments were not accepted. I understand that. The amendments were all proposed earnestly, but they were not necessarily an effective way forward.
I also recognise that, beyond the bill, there is more to do. The bill is only part of the work. Members can be reassured of my commitment to doing everything that the Scottish Government can do to ensure a better sense of mental wellbeing throughout Scotland.
I commend the bill to the Parliament.
Next
Business Motions