Meeting of the Parliament (Hybrid)

Meeting date: Thursday, October 8, 2020

Official Report 1068KB pdf

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Mental Health Transition and Recovery Plan

The next item of business is a statement by Clare Haughey on Scotland’s response to the mental health challenge of Covid-19. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.

14:55  

We are all in the process of learning how to live with Covid-19. To say that a full national lockdown was tough is perhaps putting it mildly, but the introduction of temporary measures now will also be really challenging for people across the country. It shows that the road to recovery from the pandemic will not be linear or straightforward. We have all been through a lot and the importance of mental health and wellbeing has never been clearer.

It has been difficult enough to maintain good physical health during the pandemic and lockdown, but the experience will also have been immensely draining psychologically for many of us. I doubt that there is a single one of us who has not thought of our own mental wellbeing, or worried about that of others, at some point during 2020. The effects could include feeling down or anxious. People might have needed to be signposted to support, and levels of distress might have increased. There will also be cases of more serious mental illness.

Throughout this year, mental health has continued to be an absolute priority for the Scottish Government. We have been proactive in our approach and have announced a range of additional support. Reflecting how fundamental the issue of mental health is, today we have published our transition and recovery plan, “Mental Health—Scotland’s Transition and Recovery”. Given that the Parliament will debate the new temporary measures straight after my statement, the focus on mental health and wellbeing is very apt. The document lays out the Government’s response to the mental health impacts of Covid-19 and addresses the challenges that the pandemic has presented, and will continue to present, for the population’s mental health.

I want to speak about the process of developing the plan. From the beginning, we have known that it would be crucial to develop a full understanding of the mental health effects of the pandemic. In April, we established the mental health research advisory group to ensure that our response would be led by a robust understanding of evidence and data. The advisory group has followed closely research developments across the globe, and has provided us with timely and expert advice on how Covid-19 is impacting on mental health.

As well as embedding evidence at the heart of our approach, we have been determined to work collaboratively. A prerequisite for us was to hear at first hand about the effects that the pandemic was having. We have striven to reach mutual agreement on key areas in which we need to progress work. We have done so through sustained engagement with a stakeholder group that has met regularly over the past six months. I extend my sincere thanks to everyone who has contributed so passionately to that work. The organisations that have been involved have included, among others, the Scottish Association for Mental Health, the Mental Health Foundation, the Royal College of Psychiatrists, the Mental Welfare Commission for Scotland, Unison, Penumbra, Samaritans and voices of lived experience.

Echoing what we heard, we have structured the document around key themes. I hope that members will see that the plan is comprehensive—it contains more than 100 actions. To take some examples, we have included sections on whole population mental health. We want everyone across Scotland to remain engaged with and informed about mental wellbeing, including the need to reduce stigma, which is of critical importance.

We have concentrated on how the pandemic might impact on employment, including the impact that it might have on people who are in uncertain employment, those who might have been made unemployed as a result of lockdown and those who are currently trying to find a job.

We know that children and young people have been particularly affected, and we have laid out a range of actions to respond to the needs of our young citizens. Those actions cover emotional wellbeing, the support that is available in education settings and the route into specialist mental health services when those are needed.

We also recognise that older people have been just as impacted, as have those who are at higher risk because they have a long-term health condition or a disability. Many of those people have been shielding, which has been exceptionally difficult. In all those cases, we believe that further targeted action is needed to support good mental wellbeing.

We know how important specialist mental health services are and will continue to be. We have laid out our approach for the recovery and renewal of child and adolescent mental health services and psychological therapies. That includes a programme of enhanced improvement support. We will also work with NHS Boards to ensure that they are able to respond to any increase in demand over the coming months.

We now have a unique opportunity to focus on improving the quality of those services. We will make use of data, evidence and digital technology, where that is appropriate, as well as implementing a set of quality standards. We also know how vital the mental health services are that others—local authorities, health and social care partnerships and the third sector—provide. Those services will continue to be central to how we meet demand.

Through the pandemic, we have driven national action and worked with partners to promote examples of good practice across the country. The clear your head campaign has become nationally recognised. We have expanded NHS 24’s mental health hub so that it now provides telephone support for people 24 hours a day, seven days a week. We have established mental health assessment centres, rolled out the distress brief intervention programme nationally and launched PRoMIS, the national wellbeing hub for health and social care staff, unpaid carers, volunteers and their families.

The plan outlines how we will build on success stories such as those, but it is really important to recognise that what we have laid out in the document is not set in stone. The situation remains fluid, as developments this week have too clearly shown.

I started by saying that the road to recovery will not be linear. That is likely to mean that different types of mental health need will emerge as time passes, and that will affect the extent to which further targeted measures are needed. Our response, as laid out in the plan, will be flexible and adaptable and will continue to evolve over the short, medium and long term and to be informed by the work of the mental health research advisory group. Our on-going use of evidence and data will be key.

As well as our stakeholders, I thank members across the chamber for their constructive input over the past few months. During the Government’s statement on mental health in June, I listened carefully to the priorities that members raised, which included the help that was available in schools, bereavement support, the importance of the third sector, and issues that can affect women, in particular during the perinatal period.

I hope that members will see their input from June specifically reflected in the plan and I look forward to working with colleagues as we move into its implementation and delivery phase. The focus on implementation is crucial: our plan is comprehensive and ambitious, but it is the work that we do now to deliver it that will make the difference.

We do not yet have all the answers for some of the emerging issues that we have identified—no single person or organisation does. The situation is not unique to Scotland; populations across the world face it as well. We will therefore continue our close work with stakeholders and voices of lived experience to develop detailed implementation plans where necessary, and introduce comprehensive governance to ensure that progress is made towards each action.

One of our commitments is for our third sector partners to be embedded in this process: we will ensure that that happens, because their involvement will be fundamental to our success. We will also closely involve those with lived experience to ensure that our commitments will make a real, positive and lasting difference to people’s lives. We will establish an equality stakeholder forum to ensure that equalities issues and a focus on rights are firmly at the heart of our approach.

Finally, I will briefly address the relationship between the plan and our parallel work on dementia, autism, and learning disabilities. Reflecting the critical importance of each of those issues, we are working with partners to develop a separate national Covid-19 dementia transition and resilience plan. That will build on our pandemic response for people with dementia and their families, as well as on our three dementia strategies to date. Work is on-going at a national and local level and across all sectors, and will continue when we come to the implementation phase of the new plan.

We also want to address the barriers and inequalities that exist for the autism and learning and intellectual disabilities populations—issues on which Covid-19 has shone a light. We are developing an additional framework and will shortly start national engagement. We will involve people with lived experience and organisations across sectors and publish that framework in December.

I once again thank everyone who has contributed to the development of the plan—our partners, stakeholders and MSPs alike—and I look forward to working together as we face, and respond to, the further challenges that lie ahead. Our transition and recovery plan sets out how we will do that and it will ensure that the mental health of the people of Scotland continues to be a fundamental consideration in our Covid-19 response. I commend the plan to the Parliament.

The minister will take questions on the issues raised in her statement. I have around 20 minutes for that. Loads of people want to ask questions, so if they could be succinct, that would be extremely useful.

I thank the minister for advance sight of her statement, and I caveat the questions that are about to follow by recognising the difficult decisions that the Government—and Governments the world over—are making as we tackle the Covid-19 pandemic.

The minister rightly highlights the severe psychological strain that the pandemic and the measures to combat it are having on the population as a whole. It has led to increased anxiety, loneliness and poor mental health, while restricting access to things that can help to alleviate such feelings, such as access to family, loved ones and friends, and the ability to participate in activities that we use to destress.

I would also highlight the plight of our teaching staff, who have told me that they are becoming overwhelmed by cases of pupils reporting anxiety and poor mental health. Teaching staff say that their concern is that, in their attempts to help everyone, they might miss something that leads to a much greater tragedy, which, in itself, compounds any anxious feelings that they already have.

Given that CAMHS was already under extreme pressure prior to the pandemic, what will the Scottish Government do to bolster the service? What will the engagement with the third sector that the minister mentioned look like, given that it might be better placed to deliver specialised help in many instances? What will the Scottish Government do to support staff in our schools to deliver mental health support to pupils who need it?

Given the importance of regular contact to positive mental health, what will the Scottish Government do to ensure that care home residents have regular visits from loved ones in a Covid-secure environment that is warm and welcoming?

I thank Brian Whittle for his questions; I will try to answer each of them in turn. We recognise that it might be a difficult time for some pupils who are going back to school, but we also recognise that being at school actually helps some children, in terms of their mental health and socialisation, and provides them with support that they might not have if schools were not open. However, I appreciate that that can put stress on teachers.

One thing that we have committed to in the plan is to develop training resources for teachers by, I think, summer 2021, to give them the confidence to deal with some of the difficulties and issues that Mr Whittle raised. We are also committed to ensuring that there is a counsellor available to each secondary school in the country, and we are on track for that to be delivered by autumn this year. In addition, mental health first aid training is available to teachers and other appropriate staff in schools.

Mr Whittle asked about engagement with the third sector. We absolutely want to work with the third sector to support children and young people. We have some good examples across the country of third sector organisations already embedded in schools; one example is Place2Be, which is an organisation that works closely with schools in Edinburgh. I have seen personally some of the work that it does in schools to support children and the teachers who support them.

The issue that Mr Whittle raises about care homes is really important. It has been raised in the Parliament on many occasions and addressed by the Cabinet Secretary for Health and Sport. I accompanied the cabinet secretary to a meeting last Friday, I think—I am sorry, I lose track of the days, but I am pretty sure that it was last Friday—to meet a group of people whose family members are in care homes and who were expressing their concern and distress about being separated from their loved ones. The Minister for Older People and Equalities was also in attendance at that meeting.

The stories that we heard were heartbreaking. We recognise that it is very distressing for relatives to be separated from their loved ones in care homes, but we also recognise that we have to protect the health of the staff and residents in care homes. The cabinet secretary gave an undertaking to keep under review the current guidance and I am sure that further information on that will be coming soon.

I, too, thank the minister for advance sight of her statement. The statement would have been more welcome back in March or April. The statement and the transition and recovery plan lack urgency, with many of the deadlines being set for next spring and summer. The Scottish Government has not grasped the enormity of the mental health crisis that the country faces.

I want to raise two specific issues with the minister. On employment support, thousands of people face unemployment now, and they require mental health advice and support urgently, not in March next year. On shielding, it is unacceptable for people with long-term physical health conditions and disabilities to have to wait until March next year while the Government develops a plan for those who are shielding. The Scottish Government must prioritise the mental health of those who face redundancy and those who are shielding now, not next March.

The transition and recovery plan refers to mental health services being restarted by March 2021. I would be grateful if the minister could tell members which mental health services have been stopped.

I think that Mary Fee has perhaps misunderstood some of the contents of the plan, which is about things going forward. Mental health services have continued during the Covid pandemic, albeit that some of them—group therapy, for example—have had to stop. Because of the Covid restrictions, a number of people could not physically be in a room; that simply would not have been safe. However, mental health services have continued, and they have prioritised urgent and emergency presentations and people in distress. Mental health units have remained open, wards have been open, and staff have provided care and treatment.

Mental health services are currently open. We are looking at providing almost a bespoke response to the situation that we currently find ourselves in, and which we expect that we will find ourselves in in the coming months. None of us is able to predict what the mental health impact will be across the country, so we are trying to ensure that, from services to tackle discrimination and stigma right through to specialist in-patient services, mental health services are able to provide care, treatment and support for people throughout the country.

Mary Fee raised the issue of shielding. We absolutely recognise that people who were shielding faced a particularly difficult time when all of us were facing a difficult time. There was support for people who were shielding, and they were able to access services. We expanded some of our online and telephone services in response to some of the demands that were being made on the service that could not be facilitated face to face. For example, we expanded the NHS 24 mental health hub to a 24/7 response, and we rolled out distress brief interventions throughout the country.

Come to a close, please, minister.

We have been responding to mental health needs, and we will continue to respond to them throughout Scotland.

The front-bench questions and answers have taken far too long. If we want to get through the questions, members need to be a bit speedier. There is no spare time to eat into this afternoon.

How has the Scottish Government worked with health boards throughout the pandemic to promote the mental health and wellbeing of our incredible NHS workforce and ensure that it is supported in carrying out its vital roles on the front line of the pandemic? I remind members that I am a registered nurse.

We have worked closely with partners across health and social care, including NHS boards, health and social care partnerships and local employers, to ensure that a range of mental health and wellbeing support is in place for our amazing workforce. During the pandemic, a wide range of measures to protect staff wellbeing has been put in place at the local level. Sometimes those measures have been site specific and sometimes they have been across entire health boards. They have included dedicated private staff spaces to rest and recover, peer support, leadership development and coaching initiatives, mental health guidance and support, staff communication, and digital tools.

We have also taken action at the national level. We have launched the national wellbeing hub, which signposts staff, unpaid carers, volunteers and their families to relevant services and provides a range of self-care and wellbeing resources. We have set up a new national wellbeing helpline for the health and social care workforce, which is based within the NHS 24 mental health hub. That provides a 24/7 service to those who need psychological support, including in the light of the coronavirus crisis.

We have also established—

I must stop you there, minister. I am terribly sorry about that. I know that there is a lot of information, but members have lots of questions that they want to ask so I would ask you please to shorten your responses.

The minister will know that, before the pandemic, there was a mental health crisis in rural and remote parts of Scotland such as the Highlands and Islands. That crisis will no doubt be exacerbated by the pandemic. What specific actions is the Scottish Government taking to help organisations that support those who are suffering in rural communities during the Covid-19 pandemic?

The Scottish Government provides funding to the national rural mental health forum for work to improve mental health and wellbeing in areas of rurality. In our transition and recovery plan, we have committed to work in partnership with the national rural mental health forum to develop an approach to ensure that rural communities have equal and timely access to mental health support services. When the four DBI pilot areas were chosen, we deliberately included a broad mix of urban and rural locations.

I call Fulton MacGregor, to be followed by Pauline McNeill.

[Temporary loss of connection.]

We will go to Pauline McNeill, and then try to come back to Fulton MacGregor.

I am dealing with a young 19-year-old woman who made an attempt on her own life after a general practitioner twice refused a mental health referral, and she is yet to get an appointment from NHS Greater Glasgow and Clyde. She says, “No one cares, not even the NHS.”

The Mental Health Foundation says that urgent measures need to be put in place for those aged between 18 and 24. The Scottish Youth Parliament has called for that, and SAMH has said that the Government already has a commitment to it. When will the dedicated mental health service for that particular age group go live? I believe that it will happen in 2021, but I would like more information about whether that will be in the first or the second half of the year.

If Pauline McNeill wants to write to me with the details of that specific case, I would certainly be happy to look at it.

The community mental health and wellbeing centres, which we are developing in conjunction with our local authority colleagues, are for people in the five to 24 age range. Some of the centres will be in place before the end of the financial year. I am certainly happy to get further detail for Ms McNeill about the Glasgow area so that she is aware of what resources there will be for her constituents.

We have found Fulton MacGregor.

Thank you, Presiding Officer.

Following on from the previous question, I, too, welcome the Scottish Government’s commitment to introduce community mental health support services for children and young people. In addition to the update that she has provided, can the minister expand on what children and families should expect from those services?

The community wellbeing services will support children and young people to access support for their mental health and emotional wellbeing in their communities. We have allocated £2 million to local authorities towards the development of community mental health services for children and young people, and we are allocating a further £3.75 million in this year’s budget specifically to fund those services.

The majority of services are expected to be in place for the last three months of 2020-21, and a further £15 million is expected to be available from 2021-22 onwards, assuming that those services are fully in place. A framework developed by the children and young people’s mental health and wellbeing programme board will support the development and delivery of those services.

The emotional impact of the pandemic on those who are living and working in our care homes will be considerable and difficult to bear, particularly at this time, when we see cases rising once again.

What specific steps are being taken now to prevent a mental health crisis among care home residents, who may have lost close friends? What specific mental health support is in place now for Scotland’s skilled care workers, who provide companionship and support to many residents and maintain their dignity in their final hours and moments?

Alison Johnstone speaks of the care home workforce as highly skilled people who provide care to some of our most vulnerable residents, which is what we all feel about them .

As I mentioned in a previous answer, we set up the staff wellbeing hub, which we have now expanded so that it is available not only to NHS staff but to care home staff. We did so in recognition of the difficult situation that care home staff find themselves in and because they might not have as easy access to occupational health services as NHS employees do. That service, which is available online, can signpost them to resources that can provide a range of support, from emotional to financial. In addition, the helpline, which I have also mentioned and which is hosted by the NHS mental health hub, is available to social care staff.

Before the onset of the pandemic, a record number of children were waiting more than a year for first-time mental health treatment. What is the tailored programme of enhanced improvement support, and how will it succeed where previous efforts have failed?

We still do not have suicide statistics beyond 2018. When we will see them, and will the minister look again at moving to a system in which services can understand what is happening right now, in real time, and respond accordingly?

I will take the point on suicide statistics first. My understanding is that the statistics will be published in November this year; they have been delayed because of the Covid pandemic. With ISD Scotland, we are looking at how we can get more real-time statistics on suicide and self-harm, so that we can work with the national suicide prevention leadership group to target interventions more effectively. That is certainly on our radar.

Mr Cole-Hamilton also asked about CAMHS. The Government has identified mental health as a clinical priority. We know that there has been a regrettable knock-on effect with regard to some of the timescales for the delivery of care and treatment. CAMHS have continued throughout the pandemic, although there will have been adjustments in how they are delivered. Services are in the process of returning to previous levels of activity and are dealing with any backlogs that have developed.

Our transition and recovery plan sets out a number of actions to progress improvement on access to CAMHS, including the implementation of our CAMHS service specification and the restarting of our improvement programme of work, which will include targeted support.

The minister previously mentioned the digital mental health resources that were launched during the early part of the pandemic. What mental health support is available for those who are elderly or who might not have access to online support services, to ensure that there is no digital divide for those who need the support?

I thank George Adam for raising that important issue. We understand that older people are more likely to experience circumstances that contribute to poorer mental health, such as poverty, isolation, loneliness and poor physical health. The wider impacts of Covid-19 might exacerbate those circumstances further.

That is why we have set out key actions in the document to support the mental health and wellbeing of older people. We have committed to ensuring that older people have equitable access to mental health support and services. We will also work with stakeholders to support the development of the peer support approaches to maintaining good mental health that have emerged among older people during lockdown.

We know that many older people have found this period particularly difficult, as physical distancing restrictions have made it more challenging to stay connected to friends, family and loved ones. We will develop further actions to support people who are experiencing loneliness as a result of the pandemic and the associated physical distancing restrictions, building on the Scottish Government’s existing strategy for tackling social isolation and loneliness.

Research from the University of Glasgow has highlighted the disproportionate impact of Covid on the mental health of black and minority ethnic communities. In particular, men from south Asian backgrounds have seen a 23 per cent rise in mental distress due to lockdown, compared with a rise of 6.5 per cent for white men. With that in mind, what actions will the Scottish Government take to improve its understanding of the experiences of our black, Asian and minority ethnic communities, in order to ensure that no part of Scotland gets left behind?

I am really pleased that Annie Wells has asked that question, because that issue has not been raised yet in questions from members, although I spoke of it in my statement.

In the transition and recovery plan, we have committed to establishing an equality forum to help us identify the specific actions that we should take to address mental health inequality on an individual and a structural basis. The issue of ethnicity is relevant in all aspects of that work, and as part of that we will actively review what research is required nationally to further our understanding of the impact of the pandemic on the mental health of black and ethnic minority communities.

That concludes questions on the minister’s statement. I apologise for not being able to take questions from Rona Mackay, Joan McAlpine, Claudia Beamish, Liam Kerr and Neil Findlay. It is particularly difficult when members are asking questions remotely, but I ask all members to bear in mind that, if questions and answers are overlong, all that that does is disadvantage fellow members.