Chamber and committees

As the First Minister will be aware, my Dogs (Protection of Livestock) (Amendment) (Scotland) Act 2021 is now in force, and it provides Police Scotland and the courts with greater powers to investigate those who allow their dogs to worry, attack or kill livestock in Scotland’s countryside. Livestock worrying can have serious animal welfare implications as well as significant financial and emotional impacts on farmers. In light of the approach of lambing season, can the First Minister outline what action the Scottish Government is taking to promote public awareness of the updated legislation?

I have continually lobbied for the strategically important A75 and A77, which connect Scotland to Europe and the rest of the UK, to be upgraded on the grounds of safety and efficiency. I have also called for improved rail and bus frequency and improved rail connectivity, which would be brought about by, for example, reopening Beattock station, to attract people and businesses to the south-west.

Will the cabinet secretary give examples of how STPR2 will improve transport infrastructure across the south-west, and reiterate how it will improve the attractiveness of public transport?

Good morning, cabinet secretary. Do you have any concerns about cross-border co-operation with the EU? It says in our papers that access to the EU’s early warning and response system will be on an ad hoc basis, which pretty much means that, if there is a potential health issue, it will be up to the United Kingdom to write to the EU and ask whether the UK can be part of the process.

Good morning, everybody. You have touched a lot on integrated services and partnerships, which I was going to ask about. Dr Stark has just mentioned poverty, which we know is a huge contributory factor in mental poor health.

I note from our papers that the Promise Scotland’s “Family Support” document outlines 10 principles of intensive family support that will be embedded in practice. I will not read out all 10 principles, but they include

“Community Based ... Responsive and Timely ... Work with Family Assets”

and

“Empowerment and Agency”.

A submission to the committee from Darren Little, of Dumfries and Galloway children’s services strategic and planning partnership, referred to the need for

“Multiagency strategic planning and implementation at a local level”.

We know that, if people work better together, that will support better outcomes. What impact would greater integration of services have on the demand for CAMHS and on service delivery? I will go with that question first, and then I will wind my other two questions into one.

Yes—to Shelley Buckley, and then to Sam March.

We are talking about cross-border co-operation with the EU, but there is also cross-border co-operation with our neighbours south of the border. I am thinking about zoonotic diseases such as severe acute respiratory syndrome, middle east respiratory syndrome, swine flu and avian influenza—even Creutzfeldt–Jakob disease, in the past. We need to make sure that all the scientists are working together. Will the framework improve co-operation within the UK, so that everybody shares their scientific knowledge and we are better prepared for any future pandemics that we need to worry about?

Having read our papers, I think that, when there are changes to legislation in England that could impact our healthcare system in Scotland, we need to ensure that the cabinet secretary keeps us informed and that we have an opportunity to pay attention to what is being taken forward. Especially when we are in a remote-working environment, it can be difficult to pick up non-verbal information, look at what we need to do and ask the right questions, so we need to ensure that the committee is kept fully informed about this kind of issue.

The cabinet secretary will be aware that isolation can be a key issue for the mental health and wellbeing of people living and working in remote rural areas. Will she join me in congratulating Sheena Horner on her success with her #Run1000 initiative, which is now in its second year?

I welcome the opportunity to speak in this important debate. Like colleagues across the chamber, I offer my condolences to the families, friends and loved ones of those who have lost their lives. I appreciate the huge amount of work that the minister and task force have already put in place, and I thank them all.

I will focus on two areas: tackling stigma and the action to address drug-related stigma, and naloxone treatment for people who are struggling with addiction in rural areas of Scotland.

Drug-related stigma is damaging, not only because it affects an individual’s mental health and sense of self-worth but because it discourages people from coming forward to obtain the help that they need. The minister, Paul McLennan and Gillian Martin have already spoken about stigma. By addressing stigma and the silence and alienation that it causes, we can make it easier for people to seek help, which will benefit everyone.

I welcome and endorse the vital work of We Are With You, which includes stigma reduction. That work is supported by the Scottish Government and includes the stigma charter that the minister described. It is good that active measures are being taken to address stigma. That will be one of the issues to be discussed in my upcoming meeting with the chair of Dumfries and Galloway Alcohol and Drugs Partnership.

In my previous role as clinical nurse educator, which I did prior to coming to the Parliament, I placed a great value on the role of education for all health specialities. I support education being delivered in different ways, especially during the pandemic, because face-to-face seminars have not been possible.

We need to reduce prejudice, discrimination and associated stigma. I have had feedback from nurses and support workers who work in alcohol and drug services who feel discriminated against because they are actively assisting people who need medical help, support and intervention so that their recovery can start. There persists the view among the public that people who make harmful use of drugs and alcohol are just low-lives and criminals who do not deserve anyone’s help. They do need our help. They are our sons and daughters, our friends and family members, and we need to support them. Attracting health workers into jobs in drug and alcohol services is difficult enough, so we must do whatever we can to reduce stigma around them.

In my professional career, I have witnessed the negative consequences of using stigmatising language such as “addict”, “alcoholic”, “druggie” and “junky”, and that needs to change. In November last year, I picked up that issue with NHS Education for Scotland in asking whether an online education module or modules could be created, aimed at teaching health and care staff who do not work directly in alcohol and drugs services what stigma is and ways to address it. Health and care staff who do not work directly in drug and alcohol services often come into contact with persons who engage in harmful use of illicit opiates and prescribed substances as well as alcohol. Online education could include allied health professionals, such as pharmacists, physiotherapists and occupational therapists.

NES responded by saying that it intended to create such education modules, but I have not seen those on the ground yet. I therefore ask the minister if that work is being taken forward and whether there are any timescales for the completion and publication of such online modules, so that education for health professionals who are not working directly in those services can be taken forward. Even third sector organisations would benefit from anti-stigma advice and learning so that they can help to engage and ensure that persons can access the treatment that they need without discrimination, prejudice and judgment. Accessible online learning could be a key way of helping to deliver anti-stigma education for professionals in healthcare across Scotland. I would welcome the minister’s comments on that.

I will now address naloxone and its provision in rural areas. I welcome the fact that, during the pandemic, families of those who use opiates, as well as professionals who work in drug services, have been allowed to supply take-home naloxone kits to anyone who might be likely to witness an overdose. It is welcome that it is intended that naloxone be given to police officers across Scotland to help when they attend cases of suspected overdose.

Across areas of rural Scotland, however, concerns have been raised about the availability of places for naloxone and the number of people who are being given naloxone who are trained to use it. We know that naloxone, given via nasal delivery by the police who are trained, and by injection by others who are trained, is the first line of defence against overdose. In Dumfries and Galloway, 30 per cent of non-fatal overdoses were people who do not access services, so other places need to be considered to support delivery of naloxone kits. That has occurred really successfully in some places such as Aberlour and Dumfries. Can the minister help local ADPs to identify and assist with making naloxone pick-up at the less formal, non-medicalised sites that people access?

I ask the minister to assure us that rural Scotland is absolutely part of Scotland’s national drugs mission, that people who live rurally are considered equally for all treatment pathways for their alcohol and drug harm, and that the Government continues to pursue this as a public health issue, not a criminal issue. I thank the minister for this past year’s work.

Prior to the pandemic, there was already an increasing demand for mental health services in Scotland, and we know that that demand has been exacerbated by the pandemic. Covid-19 has changed many aspects of our lives, and it has allowed for a far greater understanding of the need to take mental health seriously and have a society that puts the wellbeing of its citizens first and foremost.

The exacerbated mental health challenges have also shown the need for greater emphasis on mental health services, and they have created a need for improved service delivery, including through better integration with primary care and the third sector.

I welcome that significant progress has already been made by the Scottish Government in expanding capacity and access to mental health services in GP settings. Action 15 of the document, “Mental Health Strategy: 2017-2027”, outlines the Scottish Government’s commitment to funding 800 additional mental health workers in key settings, including GP practices, all accident and emergency departments, every police station custody suite and prisons. As of 1 July 2021, an additional 654.3 full-time equivalent mental health roles have been filled using action 15 funding. That equates to 82 per cent of the total overall target. Since 2019, the Scottish Government has made available more than £51 million to deliver action 15, and it will continue to invest in 2022 to ensure that the commitment is met.

In addition, it is welcome that the Scottish Government has invested more than £60 million to create provision for local authorities across Scotland to employ mental health counsellors. I credit Dumfries and Galloway Council for really taking the initiative on board. The local authority has named its counsellor staff “youth information officers”. The name is used to reduce stigma, which is hugely important. The staff work as part of Dumfries and Galloway Council’s Youth Enquiry Service team, accessing schools and young people across the region from Monday all the way through to Saturday. The staff are also forming strong links with local primary care and NHS staff, and responding to new demands arising from the pandemic.

I welcome that the Scottish Government has provided additional funding and support for crucial mental health services. Since March 2020, more than £18 million of dedicated funding to help to respond to the specific mental health challenges of the pandemic has been allocated.

I am pleased that the Government has supported the mental health and wellbeing of our front-line health and social care staff. During the pandemic, I have continued to work as a registered nurse and had direct contact with many health professional colleagues. They say that they have been resilient, but some of them have also suffered from stress due to the challenges. Therefore, the money to help with the health and wellbeing of front-line healthcare workers is important, and it is very welcome.

More than £1 million has been invested in the roll-out of the distress brief intervention programme on a national basis, including to people under 18. DBI includes seeing front-line health, police, paramedic and primary care staff who are trained in mental health first aid response. The DBI programme is hugely important, and it demonstrates how different agencies can work in partnership with primary care.

DBI has already been accessed by more than 4,000 individuals in the NHS 24 pathway, but I know that many more have already been involved. It has been proven to support people who are particularly at risk of acute mental ill-health, including people who are struggling with eating disorders.

At yesterday’s meeting of the Health, Social Care and Sport Committee—and previously at the mental health cross-party group, of which I am co-convener—we heard that there has been an increase in eating disorders during the pandemic. I also have concerns over the number of suicides and reports of persons who self-harm.

The Covid restrictions have prevented face-to-face engagement. I ask the minister to ensure that DBI, as well as other online cognitive behavioural therapy support, continues to receive the funding that is needed to move those services forward.

My final point relates to social prescribing. A large part of the Scottish Government’s revised vision for mental health focuses on the importance of social prescribing and on the third sector playing a crucial role in promoting positive health and wellbeing.

I am a member of the Health, Social Care and Sport Committee, and I was a member of its predecessor committee in the previous parliamentary session, the Health and Sport Committee. One of the challenges that we recognise is that primary care practitioners do not know which services are available to refer or signpost people to. That issue was raised at the Health, Social Care and Sport Committee just yesterday, as part of our current child and adolescent mental health inquiry. Support is available and signposting people to that support is vitally important.

Third Sector Dumfries and Galloway has created a website with an app called DGLocator to help signpost people to the services that are available. DGLocator is similar to A Local Information System for Scotland—ALISS—which is a Government-funded service.

DGLocator, which lists all local services, is up to date, and is easy to navigate and access. It is linked to GP practices across Dumfries and Galloway, to make it easier for link workers and for support to be signposted. I would ask that the minister—