Meeting of the Parliament

Meeting date: Wednesday, December 19, 2018

Official Report 1354KB pdf

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Mental Health Services

The next item of business is a ministerial statement by Clare Haughey on reforming mental health services. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.

14:40  

Thank you, Presiding Officer.

We all have mental health. That is a simple truth, but it has not shaped the services that support our health and wellbeing. For generations, mental ill health has been misunderstood and stigmatised. It has not been treated as being as important, nor has it been treated as comprehensively, as physical health. I know that there is consensus across the chamber that that needs to change.

The Scottish Government is absolutely committed to bringing change to people’s lives. We made Scotland the first nation in the world to introduce a waiting times target for child and adolescent mental health services and the first in the United Kingdom to have a target for psychological therapies. In 2017, we declared our ambition with a 10-year mental health strategy. We are now raising the bar higher. We have an unprecedented opportunity to build a world-class mental health system that works for everyone: today I will set out how we will do that.

We have already committed £0.25 billion of additional investment through our programme for government. Through a comprehensive package, we will take action to reform children and young people’s mental health services; improve specialist services for everyone who needs them; take a 21st century approach to adult mental health; respect, protect and fulfil rights; and make suicide prevention everybody’s business.

I start with the services that support our children and young people. Although specialist services see more people than ever before, waiting times are unacceptable and there are gaps in the community support that is available for children and young people who have less acute issues. Also, there is poor out-of-hours help available at times of crisis.

We have not shied away from open and honest discussions about those challenges: indeed, we commissioned an audit of rejected referrals. When the audit report was published in June, the Government accepted all its recommendations. That is why we established a joint task force with the Convention of Scottish Local Authorities, chaired by Dr Dame Denise Coia, to look at children and young people’s mental health. Dame Denise published her initial recommendations in September and I am pleased that the task force has published its delivery plan today. It is an ambitious programme of work that will inform what can be done by the whole of the public sector, and beyond, to realise our shared ambitions. In support of that work, I announced today that we will invest £4 million, which will be distributed through NHS Education for Scotland, to recruit additional CAMHS staff across Scotland. The staff will be instrumental in supporting the new services that were announced in the programme for government and reducing pressure on the existing system.

It is right that we take immediate action to support the workforce, because it is the heart of our efforts for achieving better mental health in Scotland. I give my thanks to the people who work with children, young people and adults who have mental health issues for their essential work and inspiring commitment.

The programme for government makes clear our commitment to rapid significant change, and mental health is at its heart. I want to ensure that we progress that work quickly and effectively. For that reason, I am pleased to publish today a delivery plan that sets out how we will use the resources and commitment in the programme for government to reform and improve mental health services in Scotland. The delivery plan sets out comprehensive reform of support for children and young people.

We will substantially expand the range of perinatal support that is available to women. From next year, we will provide the educational tools to meet workforce needs, recruit and train primary care psychological therapists and roll out more effective models of supporting perinatal and infant health.

We will ensure that early intervention to support children and young people is embedded in our schools. We will invest more than £60 million in additional school counselling services across Scotland, and create about 350 counsellors in school education. We will have an additional 250 school nurses in place by 2022, and we will enhance support and professional learning materials for teachers on good mental health. By the end of the 2019-20 academic year, every local authority will be offered training for teachers in mental health first aid.

In further and higher education, we will provide more than 80 additional counsellors over the next four years, through investment of about £20 million.

We will improve services for community mental wellbeing for five to 24-year-olds and their families. We want them to have direct and immediate access to counselling sessions, self-care advice and family and peer-to-peer support. During 2019, we will expand the successful distress brief intervention programme to include people under the age of 18. We will make mental health and suicide prevention training mandatory for all national health service staff who receive mandatory physical health training.

I turn to waiting times. In recent years, performance has varied across Scotland. Some NHS boards have regularly met, or have been close to meeting, the 18-week waiting times standard. Others have struggled to deliver over a sustained period. The Scottish Government is already investing £54 million over four years to improve access to mental health services. However, we are not yet seeing the improvement that we need, so we will intensify our actions.

All NHS boards will have in place plans to drive rapid improvement by spring next year. NHS Healthcare Improvement Scotland will work with all NHS boards to support those plans. That will ensure that people get the right help at the right time, without being subject to unnecessarily long waits. That work will be overseen by a new mental health delivery board, which I will chair, that will ensure that progress is tracked regularly and that any obstacles are addressed quickly. The board will drive the actions that are set out in the programme for government delivery plan. I will report on progress to Parliament in the autumn.

It is equally vital that adult mental health services are considered in a coherent and complementary way. We need to put in place a much broader range of services to ensure that our approach is preventive and provides the right treatment at the right time. Our broader healthcare services, community services and wider society need to help people across Scotland to maximise good mental health. We all need to promote what good mental health means in the same way that we promote what it means to be physically healthy. We will drive that change through investment in changing primary care, our work on distress brief interventions, better access to mental health professionals, and our commitment to seeing the delivery of the access waiting times standards.

Alongside that work, we will help people across Scotland to benefit from digital services, such as the NHS inform service, the breathing space service and online cognitive behaviour therapy. The programme for government delivery plan sets out clear actions and timescales for doing the work.

We are also working to protect and realise our commitments to a rights-based approach. Two major reviews are under way: one on the reform of the Adults with Incapacity (Scotland) Act 2000, and one on how the Mental Health (Care and Treatment) (Scotland) Act 2003 meets the needs of those with learning disability and autism. We will continue to support stakeholders who are working to ensure that people can fully enjoy their rights, free from stigma and discrimination.

In August, we published “Scotland’s Suicide Prevention Action Plan: Every Life Matters”, which sets out our vision of a Scotland where suicide is preventable and where help and support are available to anyone who is contemplating suicide, as well as to those who have lost a loved one. As the plan makes clear, I want to build on our good work by reducing the suicide rate by a further 20 per cent by 2022. Collaborative leadership must be at the heart of our approach, which is why we established a national suicide prevention leadership group, under the chair of former Deputy Chief Constable Rose Fitzpatrick. The group will set out its plans to make that vision happen shortly, and its work will be backed by £3 million in funding over the course of this parliamentary session.

We need bold, dynamic thinking to ensure that our mental health and wellbeing is supported as well as our physical health. I am determined to accelerate the pace of change. I have used the word “reform” several times during my statement, and that is what we will see. Achieving that will depend on delivering change across the whole system. We will work in partnership with local government and others, because we must all recognise the role that we have to play and the importance of getting this right together.

We must do that in a way that ensures that the rights of individuals are always placed at the centre of decision making. It is about not just what we do, but how we do it. That is essential to making lives better, to fostering recovery and hope and to bringing the real and decisive change that Scotland wants to see.

The minister will take questions on her statement. I will allow 20 minutes for that, and I ask members who wish to ask a question to press their request-to-speak buttons now.

I thank the minister for sight of her statement. I welcome the report; indeed, there is no one in the chamber who would not want mental health to be given the commitment that it needs. However, there are still questions to be asked.

At the moment, almost a third of children who need it are not being seen for mental health treatment within 18 weeks. That is completely unacceptable, and the task force has recommended a reduction to 12 weeks. That is still an extremely long time to wait, but there was no mention of it in the minister’s statement. Does the Scottish Government intend to reduce waiting times to 12 weeks, and will the minister make a personal commitment to solving the CAMHS crisis by this time next year?

Moreover, despite a whole section of the draft budget being dedicated to workforce priorities, there was absolutely no mention of the commitment to recruiting an additional 800 mental health workers. I note that only three community link workers were recruited between July and September, even though the Scottish Government had committed to recruiting 250 by the end of the session. What progress has been made in that respect?

I thank Annie Wells for her questions and I am grateful for her support in improving mental health care across our country.

This morning, the children and young people’s mental health task force launched the delivery plan that Ms Wells alluded to. The group, which is co-chaired by Dr Dame Denise Coia and a member of the youth commission on mental health services, was commissioned by the Scottish Government in partnership with COSLA and reports to both of us.

In addition, I announced this morning an additional £4 million for CAMHS to increase staffing levels, which are already at a record high. The additional staff will help increase capacity in the system and help drive some of the changes that we need to increase early intervention and promote mental health and wellbeing. That, in turn, will help us to reduce demand for specialist services, allowing them to see and treat more quickly those children and young people who require more specialist treatment. Getting children and young people the appropriate help and support that they need, when they need them, is a Scottish Government priority.

I am quite happy to update Annie Wells on the 800 additional workers that she asked about. As responsibility for health and social care has been devolved to integration authorities for their areas, it is vital that they plan for and take into account local needs in collaboration with the relevant partners, to ensure best use of the additional resource. That is why the Scottish Government is currently working with integration authorities on this commitment and on how, in consultation with their partners, they are deciding on the allocation of the additional workers to the key settings that are set out in action 15 of the mental health strategy.

Can we get in?

This is ridiculous.

Are we going to get in?

As part of our discussions with the chief officers, we are also working on putting in place a reporting framework to capture information on workforce allocation, the location of the workforce and details of the trajectory towards the total of 800 by 2021-22. Part of the delivery board that I will chair will oversee some of that work.

Members do not have to make complaints offstage—I am handling the matter. In response to Ms Lennon’s question, I allow slightly longer answers at the beginning of the questioning, but afterwards I expect short questions and succinct answers.

Continuing with front benchers, I call Monica Lennon.

I thank the minister for her statement. Scottish Labour welcomes the additional investments in mental health services and a commitment to raising the bar further. We share the same ambition for Scotland to have world-class mental health services.

It was a chilling moment when the Scottish Youth Parliament published its 2016 report “Our generation’s epidemic: Young people’s awareness and experience of mental health information, support, and services”. I am proud that fighting for access to school-based counselling has been a Labour priority in recent years, and I am grateful that the Government is committed to delivering it.

However, it is not just in children and young people’s services that real change is needed, and today I pay tribute to campaigners such as Gillian Murray and Karen McKeown, who have lost loved ones to suicide. It is because of people like them, who have kept pressure on people like me and on this Parliament, that real action is being taken.

We have to keep listening to people like them and go further still. Gillian Murray says that there are problems not just in Tayside, but all over Scotland. That is why she is calling for a national inquiry. Karen McKeown says that she wants not sympathy but action, and she still wants answers. If we look at Dame Denise Coia—

I need a question. You have gone over your minute.

In conclusion, Dame Denise Coia has reinforced the point that there is still a lack of good data. We need to fill the data gaps to complete our understanding. Does the minister agree, and will she address those concerns? Is she taking forward a full review of services through the announcements that she has made today?

I thank Monica Lennon for her question and again welcome the cross-party support for improving mental health services. That work should be done outwith party politics.

As I mentioned in my statement, the suicide prevention leadership group will publish its delivery plan shortly. People who have been personally affected by bereavement by suicide have been on that group. Those who have been affected by suicide have provided a lot of input to the group. Rose Fitzpatrick has met many families who have unfortunately been affected. As I said in my statement, we will work towards reducing the rate of suicide by a further 20 per cent.

I agree with Monica Lennon that data is an issue, and it is one that we have come up against. Dame Denise Coia identified it as an issue. One of the workstreams that she is looking at is on the development of better data. We will look at that right across mental health services. I am sure that the issue will be raised at the mental health group that I will chair.

We have 14 minutes available and 11 questions. Let us get through them in an orderly fashion. Ms Ewing, please set the bar.

I very much welcome the announcement of £4 million to fund much-needed additional CAMHS staff across Scotland. In my Cowdenbeath constituency, I have been contacted on a number of occasions by worried parents of young people who are not getting the timely CAMHS autism assessment that they need to flourish at school. Can the minister clarify what will change in Fife as a result of her announcement today?

As is outlined in the task force delivery plan, which was published this morning, we will take forward a specific workstream covering neurodevelopmental services. Young people with neurodevelopmental conditions such as autism and attention deficit hyperactivity disorder may require specific support with a neurodevelopmental focus. They may also benefit from specialist clinical CAMHS. Additionally, NHS Fife has recently undertaken an autism spectrum disorder service redesign of its child diagnostic pathway, and the new ASD pathway will ease the waiting times in NHS Fife.

The latest data shows that 26 young people in Lothian waited over a year to be seen by mental health professionals, which is totally unacceptable. Minister, those are Scotland’s young people—our future. Is the Scottish Government committed to a 12-week target for young people getting CAMHS?

I agree with Mr Briggs that having to wait over a year is not acceptable. That is why, this morning, I announced £4 million of additional funding for CAMHS to free up capacity so that we can address longer waits and develop the early intervention services that we need if we are to prevent people from developing a more severe illness and help them at an earlier stage.

We know that there is a link between exercise, leisure, relaxation techniques and mental health. How is the Government working with leisure and fitness providers such as leisure trusts, particularly in disadvantaged communities where access to such facilities may be more limited, to provide opportunities for everyone, including young people, to access those services as part of a comprehensive package to meet mental health needs?

I thank Mr MacGregor for that question. We must consider the barriers to participation in sport and physical activity, which are often complex and varied. We need to help people to overcome those issues and enjoy the clear benefits that sport and physical activity can bring for their physical and mental health.

By adopting a person-centred approach in delivering services and activities consistently across the sport and physical activity community, we can create services and activities that meet the needs of communities and target groups. In partnership with sportscotland, the Robertson Trust and the Spirit of 2012, we have already invested £1 million in community-based sport and physical activity projects in Scotland in a new changing lives through sport and physical activity fund that is managed by Spirit of 2012, which is aimed at changing lives and creating a more inclusive and healthier nation.

What specific support will the Scottish Government provide—or what support has the task force recommended that the Scottish Government provide—to families when a person with poor mental health has taken their own life?

I am a bit confused as to whether Mary Fee is referring to the children and young people’s task force or the suicide prevention task force. The suicide prevention leadership group is about to produce its delivery plan, and one of the actions in that plan is to look at providing consistent support for people who have been bereaved by suicide. That issue has been raised with me personally, and I am sure that it has been raised with many members. Families have found themselves feeling cast adrift at a time of absolute crisis and unbelievable difficulties in their lives. The provision of consistent support for families and people who have lost a loved one is one of the actions that that group will look at.

Is the minister confident that the pledge to create 80 to 90 additional counsellors in further and higher education over the next four years is sufficient to tackle what the National Union of Students Scotland describes as “a mental health crisis” in our universities?

We are currently carrying out a scoping exercise to see where we have counsellors in higher and further education so that we can better plan the provision of those services to meet the needs of young people in higher and further education.

The minister knows that she enjoys the support of Liberal Democrat members for her work. I am very happy to see the investment to create 350 new counsellors in Scotland’s schools. However, given that there are 700,000 pupils in Scotland’s schools, 43 per cent of whom may require mental health support at any one time, that is 2,000 students or pupils per counsellor. Will the minister signal to members that that is just the start of a package of investment in counsellors? Does she share my view that we should see something of the order of a quadrupling of the number of counsellors to serve every child in Scotland?

Thank you, Mr Cole-Hamilton. That was a long question.

I am always happy to receive support on mental health from the Liberal Democrats.

School counsellors are not the only resource that will be available to children and young people. We will roll out training for trainers in mental health issues and in mental health first aid to each local authority by the end of the 2019-20 academic year, so that teachers will feel better equipped to assist children. The task force has recommended that we also look at community wellbeing centres. I was at one of those this morning, when I visited the Junction—Mr Cole-Hamilton may be aware of that centre. That is a fantastic resource that children and young people can drop into to receive counselling and support, including peer support, without an appointment.

School counsellors are part of a package of layered support that includes the additional 250 school nurses, who will focus on physical and mental health wellbeing, and we envisage that there will be fewer referrals to CAMHS because people will have alternatives. Therefore, children who require specialist services will have much more rapid access to the services that they need.

I hope that that reassures Alex Cole-Hamilton.

Will the minister outline what the Scottish Government is doing to reduce sickness absence from work on the ground of poor mental health and how the increased funding of £27 million in the draft budget will improve employees’ mental health so that they can remain at work?

We all know that work is good for mental health, and we want to support employers to assist people to stay in work and to support any employees who are experiencing poor mental health. The Scottish Government funds NHS Health Scotland to provide a range of programmes to improve mental health in the workplace, including Scottish mental health first aid training. We are committed to continuing our support for that work.

In our engagement paper on suicide prevention, which we published on 8 March 2018, we outlined a draft action of the development of a new mental health and suicide prevention training programme. The Scottish Government provides £1 million a year for See Me Scotland’s work to end mental health stigma and discrimination, and a new programme—see me in work—has been developed to support employers to create mentally healthy workplaces.

In questions on previous mental health statements, I have made the point that the Scottish Government’s solutions deal with people who are already in crisis. The Mental Health Foundation highlights the importance of nutrition, and the Scottish Association for Mental Health focuses on physical activity as a route to good mental health, as Fulton MacGregor mentioned. How does the minister intend to prevent people from falling into poor mental health in the first place? Perhaps we should start with our healthcare professionals and teachers, given how crucial they are to delivery of the Government’s plan.

People fall into mental ill health for complex reasons. I agree that early intervention is needed and that, as I said in my answer to Mr MacGregor, physical activity can be a good way of relieving mental distress and stress. I encourage people to keep physically active, as that helps their mental health. As I said in my answer to Mr MacGregor, we have invested in supporting people to access physical activity and sport, as that is very important.

One of the main drivers of mental illness and mental ill health in this country is poverty, and the party that Mr Whittle belongs to actively supports austerity, benefit sanctions and the roll-out of universal credit, which is promoting rent arrears and homelessness and driving people to food banks. Mr Whittle might like to think about that before telling the Scottish Government how it should treat people with mental illness.

More people than ever are spending a large amount of time on computers and personal devices, which we know can, in some cases, have a detrimental impact on an individual’s mental health. What work is the Scottish Government doing to determine the scale of the issue? What plans, if any, is it making to lessen the impact?

I did not see that issue mentioned in the statement.

It is important to point out that technology has the potential to be used in a hugely positive way. It can connect and empower people, especially young people. The same can be said of specific uses of technology—I am thinking, in particular, of social media. In today’s world, technology can be crucial in helping young people to find the right help and support for any issues that they might face and to talk about how they feel. Technology can be especially powerful in the case of mental health, given that many people find it easier to describe how they feel online than in person.

It is important that we promote the healthy use of technology and, in particular, the healthy use of social media, as we are aware of the links between unhealthy social media use and poorer mental wellbeing in children and young people. We recently commissioned a study on the reported worsening mental wellbeing of teenage girls and the reasons for that. The results of that study, which will be published shortly, will include analysis of the role of technology and social media.

On the welcome £4 million cash commitment to CAMHS, how will the minister find the doctors and deploy them to the areas that are most in need? This summer, NHS Tayside’s CAMH service had three full-time consultant vacancies out of seven. Although it had the money to pay for those posts to be filled, it could not find the doctors. Only 41 per cent of children in Tayside who need to access CAMHS are seen within 18 weeks. That is the worst statistic in Scotland. How will the minister make sure that doctors go to Tayside to turn around that scandalous statistic?

We anticipate that the workforce that will be funded by the additional £4 million will be drawn mainly from psychology, nursing and the allied health professions and that it will receive a small amount of administrative support.

We have time for a brief question from Emma Harper.

I welcome the minister’s statement, and I note the implementation date of 2022 for school nurses. When will the minister be able to give us some information about the provision of mental health counsellors in schools across Dumfries and Galloway? When can we expect to see mental health counsellors in schools in the south-west of Scotland?

We are working to strengthen child and adolescent mental health in schools and higher education, and we know that prevention and early intervention make a big difference in reducing the risk of people developing mental health problems. We have developed a suite of aims and principles for meeting the commitment to have mental health counsellors in schools, and we are having discussions with key partners to ensure that the commitment is met in full by September 2020.

Additionally, the Scottish Further and Higher Education Funding Council and the Scottish Government are considering a financial allocation from the funding that has been committed to both sectors as part of the academic year 2019-20 funding in the programme for government, to enable a first tranche of counsellors to be in place by the start of the term commencing in September 2019.

Thank you, minister. I also thank all members, because we reached all the questions.