Chamber and committees

I know that folk will be looking at the framework of regulation, but Mr O’Kane is right that there needs to be cultural change as well. There is no doubt about that. We need to have a human-rights-based approach and listen to what people have to say. That has not been happening in many places throughout the country. Some things that are going on or have gone on in terms of delivery are ludicrous. The consultation talks about getting it right for everyone. That is what our ambition should be but, from some of the stories that I have heard, you would think that, in some cases, the ambition was how to get it wrong for folk, with silly situations that should not happen.

I do not want to go into depth in case I end up identifying circumstances, but we can provide the committee with some of the contributions that were made at the consultation events which, to be frank, show ridiculous instances in which folks have not been held accountable. We have to have accountability to be able to change the culture.

Accountability for all that will ultimately rest with ministers, but local accountability is also important and is sadly lacking in various places at the moment. Local accountability is as important as, if not more important than, the accountability of whichever minister is in the chair at a particular point in time. Let us not shy away from that, because some folks say, “Oh, all of this is going to be nationally run.” We absolutely need a framework of quality standards that are matched across the country.

It is also about local delivery and adaptability. Whoever will be sitting in my chair in the future will not be running the entire show day to day. It is not the case that there will be diktats through centralisation—it canna be. It is about local delivery and local accountability, but it is also about having a set of standards that folk should expect to be delivered.

Absolutely. Some of the anomalies in delivery are really stark. Five miles down the road from where you are, the level of service can be totally different or, in some cases, non-existent. People do not think about the boundaries of local authorities, health and social care partnerships and health boards; they think about the service that they need. We have to get that right across the country. That is why the change is vital.

Over the past number of years, even pre-Covid, there has been a rise in the number of people coming forward with mental health conditions. A lot of that is down to the fact that we are changing how folk think about their mental health. Much of the destigmatisation is down to a lot of hard work on the part of many stakeholders, but it is also due to the amount of investment that the Government has made through the see me campaign. Just the other week, in order to ensure that the campaign continues to thrive, the Government—this is also down to the Parliament, through the budget process—agreed to provide the campaign with £5 million over the next five years so that it has the comfort of knowing what it will be able to do over the piece.

It is a really good thing that we are destigmatising mental ill health, but we still have a long way to go. Let us be honest: there are still a lot of folk who will not discuss mental health issues or their own mental health. There are aspects that folk are still wary of discussing. The best example is probably the unwillingness on the part of many folk to talk about suicide and suicide prevention. The work that has been done here in Scotland by the national suicide prevention leadership group has been recognised by the World Health Organization. We need to go further, however, so we have said that we will double the suicide prevention budget during the course of this parliamentary session. We need to get folk to start speaking about the issues, which are often still taboo.

I will continue, if I may; I know that I have rabbited on for a fair while. A number of organisations and groups have major parts to play in helping us. The other week, I went to an event at St Mirren Football Club—which George Adam would, of course, say is at the centre of the universe, although I do not know that I could agree with that. For—if I remember rightly—the seventh year, St Mirren ran a conference day. It was initiated by a local lad who had seen some of his mates die by suicide and thought “Enough is enough.” That event was immense. It was heart rending and difficult, but it made people think about what is going on, what some folk are going through and what we need to do to help folk in their time of greatest need. That community-based approach is the best way, in some respects. The event brought a lot of footballers together for a very good competition, but that message was at the heart of it. We need to do more such things.

As I think that Mr Gulhane knows, those are not mental health link workers but community link workers. I do not have the detail of all that in front of me. As he said, 218 link workers are in post, and I will get colleagues to write to the committee around about other aspects of that. However, those are community link workers and not mental health workers.

There has been a huge difference through some of the things that we have done in recent times. Again, it would be worth the committee’s while to talk to other organisations about what different interventions have meant in different places.

To give the committee an example, distress brief intervention work is happening in a number of parts of Scotland. It has been expanded and we will no doubt also roll that out further. If you talk to the folks working in that area, you can tell the difference that it can make. Let us take the police, for example. Pressure comes off them if they can get others in to help folk at time of need, rather than officers being tied up, often for long periods of time and often without having the skill set to deal with the difficulty that the person is facing at that point—although, let us be honest, most of our officers are pretty immense. Those things therefore make a huge difference.

Another example, although not quite so recent, is work that went on at the Victoria hospital in Fife as part of a joint partnership between Shelter, NHS Fife and the Scottish Government, which focused mainly on housing but also on dealing with mental health. Getting folk housed and getting them support took pressure off the accident and emergency department.

There are a lot of things going on and a lot of learning is happening. We have to consider what is working, what is working well and how we can export that elsewhere. The co-operation that exists in many places is beneficial for all those organisations, but the outcomes can be immense for individuals who are vulnerable and in a lot of distress.

There was a huge amount in that question. Ms Webber said that it is all buzzing about in her head, and I think that it is probably all buzzing about in our heads at the moment, as well.

I explained to the committee earlier the level of engagement that we have with partners around getting all of this right as we move forward. At the moment, we have a significant number of folk in hospital who should not be there, and it is best that they are not there. Some of the solutions will be interim ones, but the ambition is to get folk back to living independently, with support, if that is possible and as soon as we can.

Rather than going on about all of the possibilities, we will write to the committee about what we are doing. We do not have some of the information that Ms Webber is asking for regarding people in interim situations. I will write back to the committee in more depth to explain how we are handling that.

I have a figure for the number of autistic people in Scotland; I do not have a figure for the number who are diagnosed each year, but I can see whether we can provide that for the committee.

According to the Scottish Government-funded microsegmentation of the autism spectrum research project, whose report was published on 26 March 2018, there are approximately 44,133 autistic people in Scotland, with a national Scottish autism prevalence rate of 1.035 per cent. Around 32.7 per cent of autistic people also have a learning disability. As I have said, I do not have figures for diagnoses per annum to hand, but we will see what we can do to provide the committee with that information.

I will ask Ms Campbell to respond and then come back in, convener.

I will be a bit controversial and say that I agree with most of what Mr Sweeney said. However, we must also recognise that services deemed good in the minds of some folk might be deemed not so great by others.

When I was in my previous role as Minister for Local Government, Housing and Planning, vast changes, some of which are still on-going, were made in homelessness policy, regulation and legislation, and the voices of folk with lived experience of homelessness were at the very heart of what we did. I am not saying that that was absolutely perfect—it never is—but we are on a good journey and in a good place, because we listened to people and their experiences. I fully intend to do the same in this role. Whether it be in relation to autism services, social care or mental health services, I will continue to listen to the voices of lived experience.

In some of the conversations that I have had thus far in coming into this new role, I have noted that some of the assumptions that we all make, rightly or wrongly, about what we think needs to be improved first and what our priorities should be are not necessarily shared by folks with lived experience. I have talked to folk about mental health services in general, and something that has cropped up again and again and that I think is one of the top priorities for the groups that I spoke to—I know that some folk will disagree with me—is the fact that the complaints system does not work for people. We need to look at that very closely in this area and in others.

Beyond that, in those areas where there is very good practice, you will usually find that service users have helped to shape the service in question. Again, that is something that we need to push further. Some local authorities and health and social care partnerships are very good at listening to the voices of lived experience and shaping services and while others are not quite so good. We need to continue on this journey to ensure that everyone is doing that. I would also point out that one of the proposals in the national care service consultation is for community health and social care boards to have the voices of lived experience at the table, which I think is essential.