Chamber and committees

I suppose that there are two aspects to that, convener; Dr Cook can pitch in after me. On the one hand, we need to move away from practice that is unduly risk averse and make sure that positive decisions are made around risk assessment. I fully support the chief constable in her drive for safe and timely handovers, for a host of reasons that you will be well versed in.

On gaps in provision, the work around safe spaces is also potentially important in that sphere. However, the purpose of the partnership development group and its action plan and collaborative commitments is to give local areas the tools and wherewithal to ensure that they have good local relationships and that there is direct communication from services and people on the ground that is specific to individuals, and that local protocols and distress pathways are more clearly visible and identified.

The central goal is, I suppose, for every area to have well-developed distress pathways. We cannot fit everybody into a box. We have to recognise that, whether we are talking about health services or Police Scotland, first and foremost, they are dealing with people, and they are also dealing with dynamic situations.

The strength of the work is that it looks to support and develop from the ground up, as opposed to imposing a solution from on high, and I know that HMICS would endorse that point. However, not all the focus should be on the front line. Part of the partnership development group approach is that the people who are involved at strategic level all have responsibilities to implement decisions at that level. When the framework and the collaborative commitments are published, you will see that very clear commitments are made by named individuals in organisations.

I will check with Dr Cook whether there is anything more to say from a practice point of view that would help.

I will check whether the Crown Office wishes to do this, but I will ensure that the committee gets that factual information from the most relevant source, whether that is me or the Crown Office, on the pre and post positions with respect to the change in recorded police warnings that took place in 2021.

When it comes to the budget, any cabinet secretary will want to negotiate the best possible deal for their portfolio in their direct engagement with the finance secretary, and I am very pleased that the resource budget for policing will be increasing by £57 million and that the overall investment is £1.62 billion.

That said, any cabinet secretary also looks beyond what they negotiate for their own portfolio. You look at what investment colleagues have in their areas—in this case, health—and how it can be aligned with your own work. I always take a pragmatic approach to this; I am less bothered about trying to carve out or capture part of another portfolio’s budget than I am about how that budget is being directed and aligned.

Thank you, convener, and happy new year to you and everybody on the committee.

I am grateful for the opportunity to speak about some of the work that I have outlined in my correspondence to the committee, and for the opportunity to principally focus on policing and mental health. In relation to mental health concerns, the Scottish Government believes that there should be no wrong door to accessing unplanned or urgent mental health support, and that anyone in need of that support must receive the right care in the right place at the right time.

At the outset, however, it is only right that I acknowledge that not everyone who may have a mental health-related concern is vulnerable or in distress. There are many circumstances not related to mental health in which a person may be classed as vulnerable, unable to protect themselves or at risk of harm and exploitation.

It is also important to acknowledge that distress can be a normal response to life-challenging situations, and that does not mean that everyone experiencing distress will need formal mental health intervention. In any and all of those circumstances, individuals should be able to access the service that is best placed to meet their needs.

However, there are undoubtedly continued concerns about the demand that mental health-related calls in particular place on policing. We are working with partners, including Police Scotland, to improve individuals’ experience of accessing support and to ensure that resources are deployed appropriately to reduce unnecessary demands on police officers.?

Since 2021, we have been working with partners, including health boards and Police Scotland, through the mental health unscheduled care network to improve the mental health unscheduled care response and to ensure that those in need of urgent or unplanned mental health care are directed to the most appropriate service and receive support quickly. That is being facilitated by the 24/7 availability of a mental health clinician in every health board for those who require urgent mental health assessment or an urgent referral to local mental health services. Those clinicians are available to front-line services, including Police Scotland, through local community triage pathways.

Through the development of the enhanced mental health pathway, we have enabled Police Scotland’s command and control centres to direct calls from individuals who have been identified as needing mental health advice and support to NHS 24’s mental health hub. In her update to the Scottish Police Authority in November, the chief constable acknowledged the impact of the pathway in helping to reduce demands on officers: 10,611 referrals to NHS 24 have allowed 54,328 officer hours to be redirected to other duties.

More broadly, we are working with a number of partners to deliver the actions in the mental health and wellbeing strategy’s first joint delivery plan and workforce action plan, which were published jointly with the Convention of Scottish Local Authorities. They seek to create real and lasting change in the country’s mental health, with a whole-systems approach that has a renewed focus on prevention and early intervention.

In its thematic review of mental health demand on policing, HMICS recognised that mental health is a multifaceted issue that needs an effective whole-systems partnership response. HMICS set out a number of recommendations for Police Scotland, the Scottish Police Authority and the Scottish Government. As part of our commitment to implement the review’s recommendations, the Scottish Government, the Scottish Police Authority and Police Scotland have established a partnership delivery group, or PDG, which is working across organisational boundaries to identify and deliver support to individuals that can be delivered in a person-centred and trauma-informed way.

I am pleased to inform the committee that those on the group have worked together to support the Scottish Government to develop a framework for collaboration. The framework, which will very shortly be published, aims to promote—crucially—a multi-agency collaborative approach to improving local distress pathways. Alongside the framework, a mental health and policing action plan will be published, outlining numerous collaborative commitments across sectors, which will further bolster the PDG’s aim of improving the multi-agency approach to mental distress.

I extend my heartfelt thanks and gratitude to our partners for their support in developing the framework and collaborative commitments, and I acknowledge the tireless efforts of all those who continue to contribute to the delivery of mental health services, including our ambulance, policing and third sector partners, whose roles are crucial.

In all of this, partnership working is undoubtedly the key that will unlock many shared challenges. It is only by working together that we can deliver real, lasting and meaningful change. The Scottish Government remains fully committed to continuing the partnership approach that has been so crucial to the development of the framework and collaborative commitments, particularly as we move forward to implementation.

Policing is absolutely is a 24/7 service, but so is health—

It is a 24/7 service, although I acknowledge that some services are not available 24/7.

The work of the mental health unscheduled care network and partnership is particularly important in this area, and there is specific investment in and a strand of programmed work on unscheduled care with regard to mental health. Obviously, this forms part of the enhanced mental health pathway, and the use of the mental health index has been rolled out across Police Scotland, too.

However, I would point out that the police can access clinicians 24/7; in particular, they have access to the mental health hub via NHS 24, and, as I outlined in my opening remarks, that access can happen directly through the command and control centres. I would highlight, too, the work of the distress brief intervention programme, to which referrals can be made not just from the command and control centres but from an operational on-the-ground centre. Obviously, that might also involve third sector partners.

As for assessments of those who are impacted by substance misuse, I will ask Alastair Cook to address that matter, but my understanding is that things have moved on in the past decade or so—and certainly since Mr MacGregor and I were in the field—and that, unless someone’s functions and communication have been severely impacted by intoxication, assessments can still take place if the person has consumed substances. However, I will ask Dr Cook to say a wee bit more about that, because I think that you might find it interesting.

I believe that I do understand the direct impact that mental health-related calls and issues in our community have on policing. There is a reason why our work around mental health and policing features in the programme for government, and I hope that that gives out the strongest possible signal and demonstration that we take that range of matters very seriously indeed.

I am conscious of the evidence that has been given by the policing associations—the Scottish Police Federation and the Association of Scottish Police Superintendents—and the chief constable. I think that I mentioned earlier that the vast majority—87 per cent—of the 100,000 mental health-related calls that are received by the police involve no offence.

At the tail end of last year, when the chief constable gave evidence to the Scottish Police Authority in November, she mentioned the fact that, on a busy day, the police can get three to four calls a minute in relation to mental health, which equates to 600 police officers per year. That is a very stark statistic. From the adult support and protection work that I am involved in, I also know that in excess of 40,000 adult support and protection referrals are made, nearly 30 per cent of which come from the police.

I accept that too many people still go through the wrong door, if I can put it like that. However, we can demonstrate—the committee has heard evidence on this from a range of stakeholders—the breadth and depth of the work that is being done in this area. There needs to be clarity on people’s respective roles and functions, and I do not think such clarity always exists. I hear different views expressed by different stakeholders about what they think their partners should or should not be doing, but I am very conscious that, under section 32(a) of the Police and Fire Reform (Scotland) Act 2012,

“the main purpose of policing is to improve the safety and well-being of persons, localities and communities in Scotland”.

By its very nature, that is not a narrow responsibility.

I make it crystal clear that the whole purpose of my interest and commitment in this area of work is absolutely to improve services to individuals, but it is also to ensure that policing resources are deployed appropriately and that the demand on policing is reduced.

I will quote the outcomes from the work in North Lanarkshire with Q division of the police. I have visited the service. It has a triage opportunity whereby there is 24/7 access to a psychiatric liaison nurse. The result of that is that potential police attendance at A and E has reduced by 80 per cent. The North Lanarkshire community triage service has been used on 2,000 occasions. The latest figures for that are from 2023. It is a good demonstration of what can be achieved. It is a win-win for individuals, the police and the NHS, because there is a 24/7 service and people are referred to the appropriate service at the appropriate time.

I recognise the frustrations of the Association of Scottish Police Superintendents. I am not blind to those and I am not unsympathetic or insensitive in any way to them. However, 2025 is the crucial year for implementation. There is demonstrable progress, but it is clear that, without a whole-systems approach, organisational change will not happen on the ground.

The partnership development group, the action plan and the collaboration commitments are all about driving forward action and that whole-systems approach. Justice services do not operate in isolation, because you cannot pigeonhole people. To a great extent, how justice agencies interact and the service that they deliver depends on other services—social services and health services in particular. I hope that, by this time next year, the Association of Scottish Police Superintendents will feel more positive about the work and that it is making a demonstrable difference on the ground because 2025 will be a crucial year for embedding it and moving forward in outstanding areas.

I am content that we have the right connections with regard to information internally in Government. Our job in Government is not only to collaborate and co-operate, but to challenge one another and ensure that colleagues are aware of any unintended consequences of work that they are pursuing in their area and the impact that it could have on others. I hope that that goes without saying.

All of my work is located in the justice vision, which places an obligation on me to contribute towards improving the physical and mental health and wellbeing of people who come into contact with the justice system. We know that, among those who come into contact with the system, there is an overrepresentation of vulnerable people and people with poor physical and mental health, so I have a direct interest in the work being led by health colleagues, just as they have a direct interest in my work, too. It is an obvious point, but we will of course keep the committee informed.

It was remiss of me not to commend the committee for its on-going interest in and work on the issue. You have certainly helped to keep the wind behind the sails of the Scottish Government and all our partners.

You are absolutely correct that the demographic around vulnerability is indeed complex for policing partners and other services to deal with. Although we know from adult protection referrals that those struggling with mental health are the biggest single client group, there are a number of indicators of vulnerability, including learning disability, age and a whole host of other challenges. It is right that we recognise vulnerability in the broadest sense, but a sharp and forensic focus on mental health is particularly important.

I appreciate the recognition that, although we still have some way to go, we are shifting the dial, which is imperative for people who need to quickly access a service. We also need to ensure that policing resources are appropriately deployed because, at the end of the day, that will ensure that we reduce unnecessary demands on police officers.

The work on safe spaces is very interesting and complex. There are good examples of peer support in community settings. We know from the scoping work that, when the approach is prioritised and designed locally, it can become more of a reality of service delivery. There is a sense of reimagining and rescoping safe places, and ensuring that there is a wider spectrum of support. That should include non-clinical support, but we need to ensure that such support has the necessary links to clinical care. Safe places can be crucial in preventing an escalation of matters.

It becomes more complex where we get into issues around the proximity of a safe place to A and E departments. The need varies geographically, so the type of formalised service that works, for example, in Glasgow—the city has a mental health assessment unit to which police can refer people on—might be different from what is needed in other areas of Scotland.

We always come back to issues of safe staffing and the ability to accommodate various population groups and people of different ages. It may be that tiered provision is required that can cater appropriately for different population groups. There is also the issue of how we ensure access in particular for those who are affected by substances.

The nuts and bolts of mental health provision relate to standards, care planning and risk assessment, safe staffing and what the procedures are when matters escalate. That work is in-depth and complex but potentially very important.

Colleagues in Government, in particular those working in mental health, are considering the next steps. Part of meeting the collaboration commitments will be to consider what is next, following the scoping work. We can perhaps look at a toolkit that supports local development. It is fair to say that there is still a fair amount of work to be done in the area.