Meeting date: Wednesday, February 17, 2021
Meeting of the Parliament (Hybrid) 17 February 2021
Agenda: First Minister’s Question Time, Education, Mental Health, Business Motions, Parliamentary Bureau Motions, Decision Time
- First Minister’s Question Time
- Mental Health
- Business Motions
- Parliamentary Bureau Motions
- Decision Time
The next item of business is a Liberal Democrat debate on motion S5M-24138, in the name of Alex Cole-Hamilton, on mental health. I ask members who wish to contribute to the debate to press their request-to-speak buttons now.15:33
As he leaves the chamber, I say to the Deputy First Minister that he undermines the Government position with such personal and shabby attacks during a serious debate. I hope that the Government will reflect on its tone.
The Liberal Democrats have brought this motion to the chamber—[Interruption.]
Will the member take an intervention?
I will not right now, thank you.
The Liberal Democrats have brought the motion to the chamber because, quite simply, there is a mental health crisis in Scotland. I believe that that has been clear for some time, but the coronavirus pandemic has wreaked havoc and devastation not only on physical health, but on emotional health. Societal bereavement, cabin fever and anxiety around personal prosperity have all taken their toll, but isolation is one of the worst contributing factors to poor mental health, and our communities have had that in spades. The 19th century French novelist Honoré de Balzac said:
“Solitude is fine but you need somebody to tell you that solitude is fine.”
Fifteen months ago, when the Liberal Democrats led a debate on the mental health crisis, the statistics were shocking, and the stories stark. I am sure that I was not alone in being profoundly moved by the personal testimonies of members and the situations that their constituents faced. However, I am also deeply concerned because 15 months ago the Minister for Public Health, Sport and Wellbeing told the Parliament:
“Mental health is a priority for the Government. It is not a short-term priority and it is not a here today, gone tomorrow political issue.” —[Official Report, 27 November 2019; c 21.]
I thank Alex Cole-Hamilton for taking my intervention, although he would not take Ms Todd’s.
I take it that the member will welcome the announcement that was made yesterday by the Cabinet Secretary for Finance about the additional £120 million going to mental health.
I certainly will. Every additional pound that is spent on mental health is welcome, but every extra pound that the Government spends on an unwanted independence referendum is a yet another pound that is not spent on it.
The Government refuses to acknowledge that Scotland faces a mental health crisis: its amendment does so again today. It is not rocket science to work out that for a problem to be solved, it must first be acknowledged. That was why this Parliament declared a climate emergency. We must now declare a mental health emergency to drive change, to ramp up services and to improve intervention and prevention.
The changes that I want could have been set out in my motion. There should be local, direct and fast access to help wherever and whenever someone needs it. The mental health workforce should be expanded. There should be no more long journeys for those who seek treatment. All the good things that I want are made harder if we cannot get over the first hurdle, which is to agree that there is a crisis.
The situation in our schools was urgent 15 months ago. The number of days that have been lost to mental ill health by teachers and school support staff has risen from more than 140,000 in 2017-18 to more than 180,000 in 2019-20. The children and young people whom they teach are meant to be supported by a guarantee that they will be treated within 18 weeks. That is a long time for anyone who faces mental ill health, such as an eating disorder, post-traumatic stress or suicidal thoughts. However, even that target is not met in two out of five cases. That was true before the pandemic and it is true now. There has also been no change in the record number of children waiting for more than a year for treatment.
As I have said many times, if one’s daughter fell off her bike and broke her arm, one could reasonably expect her to be in plaster by the end of the day. As it is, if she came with profound anxiety and self-harming behaviour she would join the longest queue in the national health service.
Staff are working hard round the clock, but they have never had the resources or support that they need to meet the considerable demand that they face. We know that in-patient care is struggling. I have raised many times the case of David Ramsay, who took his own life after being turned away from Carseview in Tayside. His niece Gilly messaged me today to say that that kind of thing is still happening, and with tragic consequences.
I do not doubt the Scottish Government’s concern for the mental health of people across the country, but we must acknowledge that there is a crisis, if the response is to match its scale. Liberal Democrats have determinedly pressed the Cabinet Secretary for Finance to improve funding for mental health services. Extra resources are welcome and are a good start to the Government taking a better approach to mental health, but if Parliament agrees to our motion to declare that Scotland faces a mental health emergency, we must go further.
I will end by echoing the sentiments of the First Minister, which is not something that I do often. When answering questions from a panel of young people in 2019, the First Minister said:
“On mental health, we still don’t do enough ... and we don’t do it well enough.”
She certainly was not wrong.
We understand a crisis to be
“a sequence of events at which the trend of all future events is determined.”
We were in a mental health crisis 14 or 15 months ago: we have been in it for a long time and the Government has failed to act. I appeal to the Government not to make the same mistake this time.
The debate is an opportunity for members of all parties to come together and acknowledge the situation in Scotland’s mental health for what it is: a crisis. In doing so, we can help to ensure that the Government and other public agencies work together to take meaningful action on the scale that is necessary for, and equal to, the challenge of the crisis.
That the Parliament recalls its resolution on the debate on motion S5M-20035 on mental health on 27 November 2019, and now recognises that there is a mental health crisis in Scotland.15:38
This is a critically important topic that unites all members. The mental health impacts of the pandemic have brought new and significant challenges across Scotland. We have been through several stages of lockdown, restrictions and recovery. Each of those phases has had a widespread impact on the mental health and wellbeing of people across the country. The experience has been psychologically draining for many of us, and the importance of mental wellbeing has been all too clear.
We know that the mental health impacts will continue to be wide ranging. This is an on-going struggle, and we should remember that it is a time of national trauma. Some impacts will be long term, and others will be exacerbated by underlying inequalities in society and, especially, by pre-existing mental health conditions.
Yes—this is a time of collective trauma. That is, sadly, inevitable during a global pandemic. How we respond is crucial, so I have lodged an amendment that focuses on a proactive and comprehensive response, rather than simply describing the issues.
Mental health is, and will continue to be, an absolute priority for the Government. Ahead of the debate, I reviewed the motion on mental health, as amended, to which the Parliament agreed in 2019. It referred to “parity of esteem”, the ability of services to respond to increased demand, the creation of new supports and the dedication of staff who work tirelessly every day to help those in need. All those things remain paramount in our Covid response.
Yesterday’s budget announcements by the Cabinet Secretary for Finance should—I hope that they will—leave nobody in any doubt about the priority that we attach to mental health, or about our commitment to providing the right help in the right place at the right time. The £120 million that we announced for our mental health recovery and renewal fund is the single largest investment in mental health in the history of devolution. That is in addition to the £142.1 million that we had already allocated to mental health in the 2021-22 budget. That total of £262.1 million for mental health in the coming financial year means that we have more than doubled the mental health budget for 2021-22 from that in 2020.
I will not make a speech in the debate, but I have a question. The money is welcome. We could have some argy-bargy over its source, but what I want to know is whether it will get to the right place. Will the third sector and grass-roots charitable organisations on the ground be seeing any of that cash, and will a plan be presented for where it is going?
We certainly value the work of the third sector, and we work closely and engage with those organisations at Government and ministerial levels. If Jamie Greene acquaints himself with our plan, “Mental Health—Scotland’s Transition and Recovery”, he will see exactly where we are going with mental health services across the piece—from challenging stigma through to our specialist in-patient services.
The funding that I have described takes our total spend on mental health in 2021-22 to in excess of £1.2 billion. The recovery and renewal fund will ensure delivery of the mental health transition and recovery plan, and will prioritise our on-going work to improve specialist child and adolescent mental health services, address long waiting times and clear waiting-list backlogs.
Nearly £10 million will be allocated to clearing backlogs in psychological therapy waiting lists for adults, and we will provide significant additional support for mental health in primary care settings. We recognise the need to focus on supporting people at the earliest possible stage, so we will invest in enhanced community supports. That £120 million fund builds on the £20 million of dedicated funding that we had already announced over the course of the pandemic.
We have expanded the NHS 24 mental health hub so that it is available 24 hours a day, seven days a week. We have also increased the capacity of the Breathing Space telephone helpline and web support service. We have created extra capacity for computerised cognitive behavioural therapy, and our distress brief intervention programme has been rolled out nationally to provide rapid, accessible and focused one-to-one support for people who are in distress.
We have also invested in supporting children and young people by providing funding to local authorities to support the mental wellbeing of five to 24-year-olds in our communities, and to address the impact of the pandemic on children and young people.
In addition, our transition and recovery plan lays out more than 100 actions that are designed to support mental health needs across Scotland. The plan sets out our commitment to supporting the whole population’s mental wellbeing and summarises our work to address the impact of the pandemic on specific population groups. That includes children and young people, people with long-term physical conditions and disabilities, and those who are experiencing suicidal ideation, among many other types of need.
We need to remember that there is hope, and that there will be recovery. The success of the vaccination programme and, in time, the easing of restrictions, will play a significant part in that.
The Government will continue to work tirelessly to invest in the right mental health support and to target that help where it is needed most. Yes—this is the most challenging period that many of us will ever face in terms of our mental health and wellbeing. It has been traumatic and some people are really struggling, and our focus is on helping them to get through it.
I move amendment S5M-24138.3, to leave out from “, and now recognises” to end and insert:
“; further recalls that the motion as passed agreed that mental health and physical health must be treated with parity of esteem, welcomed additional investment in services, and that the mental wellbeing of some of the most vulnerable people in society has been negatively impacted by a series of welfare cuts by the UK Government, starting with the Welfare Reform Act 2012; believes that the Scottish Parliament must advocate solutions; recognises that the COVID-19 pandemic is taking a significant toll on the mental wellbeing of people across the country, and that recovery of NHS services must ensure that mental health has the same priority as physical health; welcomes that, in addition to the plans in the draft Budget for 2021-22, a further £120 million will be allocated for a Mental Health Recovery and Renewal Fund, which would take total planned spend on mental health in 2021-22 to in excess of £1.2 billion, and notes that the additional funding will help deliver the mental health recovery plan, including a headline focus to improve specialist CAMHS services and address long waits, supporting mental health in primary care settings, as well as nearly £10 million to speed up treatment for adults waiting for psychological therapies.”15:44
I agree with Alex Cole-Hamilton and others that we face a mental health crisis in Scotland. We faced that crisis before the pandemic, with exceptionally long waiting lists for mental health support and therapy, and chronic workforce pressures. Most tragically of all, recorded suicides have increased year on year since 2017, despite the promise that was made by the Scottish Government in its 2018 “Scotland’s Suicide Prevention Action Plan” to reduce suicides by a fifth by 2022.
Then we come to Covid-19. We are just one month away from the one-year milestone from when the whole country went into its first lockdown. We now know more about Covid-19 as a virus, but we also know more about its impact on society. The Royal College of Psychiatrists has highlighted data that shows that
“high levels of psychological distress … have doubled during the Covid-19 pandemic”.
The impact of the pandemic is being felt far and wide. Inclusion Scotland stated that its research
“throughout the periods of lockdown uncovered a mental health emergency for disabled people in Scotland who told us in no uncertain terms that they were being ‘pushed to the brink’.”
Covid-19 has tested everyone, but there are many people for whom it has just been too much to cope with. Although there is light on the horizon with vaccines being rolled out, cases and infections falling and the prospect of a slow return to some normality, we know that this event will have lasting effects on many people in our society.
It is right to note that in November 2019 we debated this same issue and the Scottish National Party Government appeared to be in a state of denial about the extent of the crisis that we face. Fast forward to today and the crisis has been exacerbated, with waiting lists stretched and people waiting months for treatment. It is completely unacceptable for the SNP to blame the United Kingdom Government for that, as it does in its amendment today, in a blatant attempt to shift the blame for where we now are.
The crisis has been long in the making and the Scottish Government has been in power for 14 years—the crisis is its responsibility and its alone. The fact is that the Government has taken its eye completely off the ball; we can see how that has impacted on mental health services across Scotland. Inclusion Scotland has highlighted that for the quarter ending September 2020, just 60 per cent of children and young people were seen within 18 weeks, as opposed to the 90 per cent that should have been seen as per Government targets. That is six in 10, when it should be nine in 10.
According to the latest child and adolescent mental health services data, almost 1,000 children and young people have waited more than a year to begin vital treatment, and of the near 23,600 patients who were waiting for mental health treatment in September 2020, around 3,800 had been waiting more than a year.
All those figures paint a picture of vulnerable people waiting to receive vital treatment and services that are completely unable to cope with demand. That not surprising, given that there have been warnings about workforce pressures for many years. The Royal College of Psychiatrists has said that nearly one in 10 consultant psychiatry posts was vacant in its last census in 2019, which was a year-on-year increase of nearly a third, and there is a one in six consultant vacancy rate in CAMHS.
Before the pandemic, the Government pledged to recruit 800 mental health workers by April 2021, but we know that as at July 2020—the most recent figures available—it had fallen far short of that target. It is clear that we need to invest drastically in our mental health workforce in order to clear the growing backlog of patients who are waiting. Only then will we be able to deliver a mental health service that meets the needs of the people of Scotland, especially our young people.
The Scottish Government is still failing to recognise the challenges that we face on mental health, and the Covid-19 pandemic has heightened many of those challenges. We need a Government that will focus on tackling the mental health crisis head-on, rather than burying its head in the sand. We support the motion today and encourage others to support our amendment.
I move amendment S5M-24138.2, to insert at end:
“; notes with concern the potential for an unsustainable increase in demand for CAMHS and other mental health services, many of which already experience unacceptably long waiting times; recognises the need for both improved access to NHS mental health services and greater support for third sector organisations to reduce waiting times and deliver urgently needed care; considers that maintaining good mental health is as important as maintaining good physical health, and believes that further efforts are required to promote self-care for mental health.”15:49
I begin in the same way that I began the debate that is referenced in the motion—by thanking the Liberal Democrats for bringing the debate. I also indicate our support for the Liberal Democrat motion and the Conservative amendment.
I appreciate every opportunity to discuss mental health because doing so helps us better understand and enhance the mental health of our country. A lot has taken place since the previous debate on mental health. If we agreed—as we did—that there was a mental health crisis in November 2019, we can be assured that the crisis is far worse today. It could be said that we are nearing the point of a mental health emergency.
The impact of the pandemic has left no aspect of our daily lives unaffected and the full scale of the impact on mental health has not yet been fully realised. However, the official statistics released in the past year give us great cause for concern. Children and young people are missing out on and waiting longer to access CAMHS; there is increasing loneliness; more people are tragically dying by suicide; and more people are revealing that they have had suicidal thoughts, particularly between each wave of the pandemic.
A survey by the Royal College of Psychiatrists in Scotland reveals that one in four people think that the pandemic will have a negative impact on their mental health over the next year and 33 per cent of people with an existing mental health condition say that it has worsened since March 2020.
Two and a half years since the review into rejected CAMHS referrals, there has been a disappointing lack of meaningful reform and action in CAMHS. There are far too many young people waiting too long for access to CAMHS. The latest publication of CAMHS waiting times for the quarter ending September 2020 shows that four out of 10 children and young people were waiting longer than the 18-week target. That is a rise in the missed target compared with the previous quarter and the same quarter in 2019.
Scottish Labour wants to see an effective strategy that ensures that young people do not face unnecessary long waits and barriers to their transition to adult services. For far too long, young people have fallen behind as they move to adult services, putting at risk their long-term wellbeing. That issue, which is raised time and time again, is part of the focus of our amendment.
In the November 2019 debate, the Cabinet Secretary for Health and Sport recognised the need for transformational change. If there is to be transformational change—and there surely must be—in how we deliver mental health services and in creating parity between physical and mental health, now is the time to be serious about that and to rebuild mental health services to enable us to deal with this pandemic and future pandemics and crises.
However, that requires political will and capital. It is regrettable that recent budgets laid out by the Government and passed by this Parliament have failed to increase funding for mental health services in line with increases in overall health funding. When cabinet secretaries call for parity between physical and mental health, their actions do not match their rhetoric. We need action, and we need it now.
I move amendment S5M-24138.1, to insert at end:
“; notes with deep concern the further increase in the number of deaths by suicide in 2019 and the reported increase in suicidal thoughts throughout the COVID-19 pandemic; considers the continued excessive waits for access to CAMHS and high proportion of young people who still have their referral rejected to be unacceptable; is disappointed at the failure to implement an effective transitions strategy to support patients moving between services; acknowledges that mental health services cannot tackle the crisis without increased resources, and therefore believes it is regrettable that, in recent Scottish Budgets, funding for mental health services has failed to keep up with rises in overall health funding.”15:53
My thoughts are with all those who are affected by mental ill health and suicide, and I extend my sincere thanks to those who are working so hard in front-line services to help people experiencing mental distress. I, too, thank the Lib Dems for bringing the debate to the chamber this afternoon.
It is fair to say that we all acknowledge that the mental health of people of all ages across Scotland has been impacted by the pandemic. It has been a particularly distressing time for young people, who have been at risk of isolation and loneliness while being separated from their peers during lockdowns. A survey conducted by YoungMinds last summer found that
“80% of respondents agreed that the coronavirus pandemic had made their mental health worse.”
Meanwhile, it has become even more difficult for them to access mental health support, as Covid-19 led to a 55 per cent reduction in referrals to CAMHS.
However, we know that mental health provision for young people was poor even prior to the pandemic, because rejected referrals to CAMHS meant that too many were being left without treatment for too long. We must urgently improve CAMHS provision by delivering the resources and workforce that such services need, but we must also ensure that our young people are supported in the community while they await referral.
Local general practitioners’ surgeries will, of course, play an important role in addressing the current mental health crisis. GPs will be on the front line in any surge in mental health cases, as they are often our first port of call when we are unwell. The number of mental health clinicians who work in local surgeries must be bolstered to cope with such demand and to ensure that patients can access mental health support when they need it.
All too often, GPs are faced with either referring patients to specialist mental health support, knowing that a long waiting list or a rejected referral awaits them, or leaving them with no support at all. Community link workers can help to direct patients to support in the community, but they are often hampered by a lack of awareness of what provision is available and by the precarious nature of funding for voluntary and community organisations. The Government must undertake a mapping exercise so that we know what levels of community resources are available and can address any gaps in provision.
The Scottish Association for Mental Health is calling for an expanded network of psychological wellbeing supports, based within the third and voluntary sectors, which can be accessed quickly through self-referral, community-based triage or GP referral. I urge the cabinet secretary to give that proposal serious consideration.
The financial impact of Covid has also affected mental health services. In the debate referred to in Alex Cole-Hamilton’s motion, I spoke about the impact of the UK Government’s welfare reform on mental health. The minister was right also to refer to it in her amendment. The pandemic has highlighted the link between financial instability and poor mental health. The Mental Health Foundation says that
“groups affected by socioeconomic inequalities have been more likely to experience anxiety, panic, hopelessness, loneliness, and to report not coping well with the stress of the pandemic.”
Low income, unmanageable debt, unemployment, poor housing conditions and other socioeconomic factors all contribute to high suicide rates. We know that living in poverty takes a terrible toll on mental and physical wellbeing, so any preventative approach must address the link between mental health, inequality and poverty. If we fail to tackle the root causes of poor mental health, the challenge faced by mental health services will be insurmountable.
We must also recognise that not everyone has been equally affected by the pandemic. We need to improve our understanding of how people from ethnic minorities in Scotland have been affected by Covid if we are to avoid further worsening of existing health inequalities, including mental health ones, and to address the disproportionate impact of Covid on our black and minority ethnic communities.
We need to future proof our services and ensure that long-term workforce planning is taking place. Mental health services were overburdened and understaffed before the pandemic. The Parliament was debating waiting times and rejected referrals long before we had heard of Covid-19. We must act now to ensure that our mental health services can continue to support us now and for generations to come.
We move to the open debate. We are already over time so please be very tight with speeches, which should last no longer than four minutes.15:58
I am pleased to speak in the debate. Notwithstanding the challenges and criticisms that have been made by some members who have spoken, positive actions have also taken place. Just as the Royal College of Psychiatrists in Scotland has done, it is important that we recognise what has been achieved.
In 2017, the Scottish Government’s new 10-year mental health strategy was published. Crucially, its aim was to create parity between the treatment of physical and mental health services. The Scottish Government has also increased funding for mental health services. As we heard, only yesterday it announced another £120 million for the mental health budget line, in addition to what was announced by the Cabinet Secretary for Finance only a few weeks ago. The provision of £120 million for a mental health recovery and renewal fund will take next year’s Scottish mental health funding to £1.2 billion, which will be hugely beneficial for every community in Scotland. No previous Government has ever invested that level of resource in mental health services.
I welcome that additional resource and hope that in my Greenock and Inverclyde constituency the £120 million of funding can be made available to third sector organisations in addition to public sector bodies. Safe Harbour and Mind Mosaic are just two of the organisations that the minister has previously met and has an appreciation for. Barnardo’s and SAMH also undertake important work to help my constituents. I appreciate that the third sector is very much considered in the mental health transition and recovery plan.
The specialist work that Safe Harbour and Mind Mosaic undertake to help my constituents has a hugely positive effect and helps people to get their lives back. I know that the work that they deliver is appreciated by many, many people. Just as with addiction services, third sector organisations do a vast amount on mental health. They also have the opportunity to spend more time with individuals—time that public bodies do not always have.
The second point to highlight is that, at decision time on 27 November 2019, the Scottish Government’s amendment to the motion on mental health passed by 66 votes to 38. It replaced the words “mental health crisis” with the following:
“mental health and physical health must be treated with parity of esteem; further recognises that there is increased demand for mental health services as stigma has thankfully diminished”.—[Official Report, 27 November 2019; c 80.]
The Parliament voted to make the changes needed to make mental health equal to physical health. Society has changed. People not only want change; they quite rightly demand it.
It is also important to highlight that in the November 2019 publication of the annual report into the mental health strategy, two key aspects were highlighted. First, it highlighted that progress towards the actions in the mental health strategy was happening; 19 out of 40 actions were either complete or soon to be complete. Secondly, the Scottish Government responded positively to 99 out of 103 recommendations from the Youth Commission on Mental Health Services.
If the Scottish Government did not have a mental health strategy, I could accept the Opposition taking it to task; I would be doing the same. However, the strategy was prepared and published, it is being rolled out and it will prove to be beneficial for many people in our country.
I will finish by commending Amy Shearer of the Greenock Telegraph. Amy is a reporter and she was the genesis behind the recent time to talk day that the newspaper ran in print and online. The purpose was simple: it was to help break the stigma around mental ill health. Amy’s story of being bullied in school was awful, but I thank her for having the bravery to talk about it. Members can check the Greenock Telegraph Twitter feed for the short videos that were also posted.
The fact that Amy needed to tell that story tells us that there is still a vast amount of work to do. With societal change and political change, I believe that we can make leaps forward in helping to deal with the mental health problems that many people in our constituencies have. We still need to deal with the stigma, but that issue is being addressed, bit by bit.16:02
The Covid-19 pandemic has brought many challenges to the world and, in some cases, it has shone a light on the existing issues, including the mental health issues that are prevalent in Scotland. Rises in loneliness, anxiety, depression or suicidal feelings are common. Our mental health has never been more challenged than it is now, and, frankly, our systems are struggling to cope.
The facts speak for themselves. One in five children referred to specialist mental health services are being turned away; a quarter of those referred for psychological therapies wait at least four months to be seen; and deaths by suicide have risen over the past two years. I suspect that those are just the tip of the iceberg.
In NHS Highland, our mental health professionals are doing everything that they can to help those in need, but they are not being helped by the SNP Government or by their own health board. In the past four years, mental health provision has been downgraded. New Craigs hospital in Inverness has seen a reduction in beds and staff, and it has not been immune from the devastating impact of staff bullying, which has taken its toll on our mental health professionals, too.
New Craigs now has just two recovery teams and can only hope to help people when they reach a crisis. For some, that help comes too late. Help needs to come far sooner—more lives will be lost if we continue with a mental health system that only helps when people hit breaking point. At a time when highlanders need more and more help from mental health services, the Government is giving them less and less. The consequences of years of underfunding and underresourcing our mental health teams are stark.
In Caithness and Sutherland, we have reached a situation of increased reliance on the police to be the first line of defence in the community in helping those who are struggling with suicidal thoughts. Officers will see it as their duty to step in and help, but that is not their primary job and they are not trained to do it. Our young officers are being exposed to incredible stresses, some of which they cannot cope with.
We have a mental health crisis in the Highlands, and our mental health system is clearly not fit for purpose. The model is broken and needs to change urgently. First, we need mental health professionals to be embedded in our GP practices. Secondly, we need more collaboration between NHS Highland and mental health charities and support groups. The likes of James Support Group and Mikeysline, which are charities that do much to help highlanders who are impacted by mental health issues, must be part of the solution.
More needs to be done to raise public awareness of what support is available. How many people who need support know where and how to access it? The process must be made easier. We need to introduce effective online portals for mental health support so that people can be signposted to appropriate services and help groups in their area. That information should be handed over the first time that a patient presents themselves to their GP.
As lockdown restrictions are relaxed, we need in-person sessions to return. The reassuring physical presence of a therapist or members of a support group is vital to improving mental health. Video calls will always be a poor substitute.
The Highlands need a Scottish Government that is fully focused on improving mental health services. The Government that we have had for the past 14 years has not had such a focus; it is time for a Government that has.16:06
I have recently taken a strong interest in young people’s mental health services. In a previous debate, I spoke about what the system needs to do to adapt.
Changes to the system should be considered. I am a relative newcomer to the such debates, but I will give my observations. I spoke previously about my constituent’s poor experience in Glasgow after a suicide attempt. It took several complaints to get her to the right place. Six months on, she still does not have access to a consultant psychiatrist, which she desperately needs. Waiting times are a major feature of the system that needs to be addressed.
Another constituent who I contacted today to find out how she is doing said that she is contacted quite regularly to find out whether she still wants to see a consultant psychiatrist. She said that nothing has changed.
I whole-heartedly welcome the additional funding for mental health services, but I make the plea that the debate is not simply about funding—we need to scrutinise waiting times, the availability of the right treatment, the diversity of treatment and the pathways to the right support. We know that individuals can be permanently damaged if they fail to get the right treatment.
As SAMH has previously suggested, CAMHS should be extended to people up to the age of 25, and I have always agreed with that. We should plan for that now. For young people, the jump from leaving the children’s service at 18, when between then and the age of 24 or 25 will be the most important period of their life, is a major design feature that needs to be addressed urgently.
Waiting lists are long, and 1,000 young people are waiting on the CAMHS register. For reasons that I do not fully understand, 20 per cent of applications for treatment are rejected.
I agree with Mary Fee and others that we are in the middle of a mental health crisis. Young people in different stages of their lives are suffering in different ways. The lockdown has been tough on young people not just because they are learning from home but because their social development is being affected.
I asked my 12-year-old niece, Maia, what question I should ask the First Minister after yesterday’s statement. Maia said that she would like me to ask the First Minister why she cannot see her friends, which is probably what most children would say in the pandemic.
The crisis was brewing before we got here. That is clear from the Scottish Government’s latest wellbeing statistics, which show that 38 per cent of young people reported that they had very poor mental health before the pandemic.
One in six children are now thought to have a mental health problem. Not being in school and lacking contact with friends are damaging children and particularly the poorest children. That is why I am inclined to support a national approach to education in the lockdown. Many children are being left behind because the system is not catching up with them.
We do not know what the real impact of the pandemic will be. Some people might bounce back in time, while others will not. It is important that our mental health system is fit for purpose and able to identify the differences that exist so that, in time, people will be able to get back to their normal lives and to think in the way that they would want to think once we get back to normality, as we hope that we will do towards the end of the year.
Our mental health service must be fit for purpose, but we must ensure that, with the additional funding, we are heading in the right direction, reducing the waiting times and ensuring that the right treatment is provided at the right time. If we do that, we will have done a service to young people in this country.
The final contribution in the open debate comes from Emma Harper.16:10
Thank you, Presiding Officer. The year 2020 was consumed by the pandemic, which has affected everyone and changed all aspects of our lives. It has caused much stress, loneliness and grief—to many people. However, it has brought people and communities closer together, and there is now a greater emphasis on supporting local businesses, helping one another, being supportive and demonstrating kindness.
I remind the chamber that I am the co-convener of the cross-party group on mental health and deputy convener of the Health and Sport Committee. During the first lockdown, as a volunteer, I phoned people who were isolating and isolated.
The impact of the pandemic on mental health has been highlighted well in the Scottish Government’s mental health tracker study, which was published on Monday this week. Although the report makes for tough reading, it is important to remember that behind each number is a person—a loved one, a friend and a family member.
I will support the minister’s amendment, which focuses on proactive approaches to dealing with the national trauma that we face. Yesterday, during the Health and Sport Committee’s budget scrutiny, the Cabinet Secretary for Health and Sport covered in detail the interventions that the Government is implementing to support many mental health actions. In response to the challenges, the Scottish Government has increased the support that is available to people who need it most. Children and young people, people who face redundancy, those with long-term physical health conditions and people with disabilities are among the key groups that the support focuses on.
An important example of that support is the distress brief intervention programme, which is an innovative programme that provides vital support to people who are experiencing emotional distress. If someone presents as being in distress to the emergency services or in a primary care setting, the distress brief intervention programme can offer them a call from a trained operator within 24 hours. They will then be provided with up to two weeks of one-to-one support to help them to address issues that might be contributing to their distress. As part of the response to the coronavirus pandemic, a new pathway to the DBI service was created through NHS 24’s mental health hub, and it has been used by more than 12,800 people, which is welcome.
Last year, I raised with the minister the issue of support for our front-line workers, including our NHS staff. As part of NHS Dumfries and Galloway’s vaccination team, I have heard directly from health and care staff about the extent to which they are coping—or not coping—with their mental health at this time. I am pleased that, since the beginning of the pandemic, the Scottish Government has provided more than £18 million, which has included support for our front-line workers. Extra capacity for computerised cognitive behavioural therapy, which has been a lifeline for many front-line and NHS workers, has been supported through the provision of £1.2 million. I encourage the minister to ensure that those services continue to be available, and to be expanded as the need arises.
I have also raised the issue of support for people in areas of rural Scotland, such as Dumfries and Galloway, where social isolation and loneliness have worsened during the pandemic. I thank Support in Mind and RSABI for their fantastic work in combating rural isolation and supporting mental health. I would be grateful if the minister could outline specifically what support is available for people in rural areas.
I want to highlight the work of Fixing Us, which grew out of the fixing dad organisation. It is an excellent example of how to build a healthier Scotland, both physically and mentally, through a social prescribing approach.
I welcome the steps that the Government is taking, and I reiterate that we need to continue to ensure that folk are supported as much as possible during this extremely challenging time.
We move to the closing speeches. We are still a little bit over our time.16:14
This has been an excellent debate, albeit too brief, with thoughtful and well-argued contributions from across the political divide. I, too, congratulate Alex Cole-Hamilton and the Liberal Democrats on their initiative in securing this afternoon’s debate.
Many speakers, including Mary Fee and Pauline McNeill, referenced the pandemic and said that the measures that have been necessary to keep it under control have had significant impacts on Scotland’s mental health, with many people experiencing and reporting loneliness, isolation and worsening mental health.
Of course, as many speakers have testified, Scotland was already experiencing a mental health crisis prior to Covid-19. Too many people were burdened with acute emotional trauma and the perceived stigma of mental health issues and were failing to access the help and support that they needed.
It is important not to underestimate the stigma effect on individuals, their families and their friends. I remember a health education poster that I had on my office wall as a young front-line social worker in the early 1980s—I was young once, Presiding Officer. It said, “Six months after Alice had her nervous breakdown, her friends are stilI recovering”.
Our amendment seeks to add to the motion:
“notes with deep concern the further increase in the number of deaths by suicide in 2019”.
The ISD Scotland report in 2016 said that the suicide rate appeared to be higher in Scotland than in England and Wales. It noted that suicide was three times more likely among those in the most deprived areas than among those in the least deprived areas, that three quarters of those who died were men and that nearly 50 per cent were under 54.
Labour has questioned the effectiveness of the Scottish Government’s action plan. Mary Fee said that, if there is to be transformational change, now is the time to be serious about it and rebuild mental health services to enable us to deal with the pandemic. Alex Cole-Hamilton, in a passionate speech, said that the mental health statistics are shocking and that he is deeply concerned. He said that we need local direction with an expansion of the mental health workforce, noting that those with mental health issues are facing the longest queue in the NHS.
The minister spoke about the new and significant challenges across Scotland and said that now is a time of national trauma. Donald Cameron and Alison Johnstone made similar points, saying that we are facing a mental health crisis and expressing their concern about the number of recorded suicides going up.
I will conclude, because I know that time is tight. I agree with Inclusion Scotland that Covid has pushed people to the brink, and particularly those with disabilities and pre-existing mental health issues. Those with a disability who are digitally excluded face a double whammy of disadvantage.
As the battle against Covid-19 seems to be succeeding, which is of course good news, we face conflict on a new front—a mental health pandemic. The curse of loneliness, isolation and despair, mixed with the ever-present stigma of seeking help, is a crucial dilemma. As Michelle Obama said,
“At the root of this dilemma is the way we view mental health in this country ... Whether an illness affects your heart, your leg or your brain, it’s still an illness, and there should be no distinction.”16:18
I welcome the opportunity to close in this debate on behalf of the Scottish Conservatives. I am grateful to the Liberal Democrats for allocating some of their time to this crucial topic. I wish that we had all afternoon to discuss it.
Donald Cameron opened his speech by pointing out that there was a mental health crisis in Scotland long before the Covid pandemic, with unacceptably long waiting times for mental health treatments, as well as chronic workforce pressures. This debate is nothing new and the issues have been rehearsed in the chamber many times. Of course, the Covid pandemic has exacerbated the crisis hugely.
I heard a child and adolescent psychiatrist claim that the number of young people who are seeking help with their mental health has “skyrocketed”. Dr Omer Moghraby has reported seeing young people presenting to accident and emergency after having taken overdoses or cut themselves severely. Some have changed their eating patterns so severely that they have lost a lot of weight, and medical colleagues have had to take measures to save their lives. He said:
“The closure of schools, the lack of contact with friends and stopping all sports activities is having a particularly damaging effect on children.
One can only say the major factor across it all is pandemic - the lack of activities, the lack of schooling, the lack of opportunities for these young people and probably a deterioration of wellbeing of their parents not being able to cope.”
I thought that that last phrase, “the deterioration of wellbeing” of parents was very powerful, and we have to consider that as a contributory factor to a child’s mental health.
In Dr Moghraby’s considerations, we see the lack of physical activity as a significant contributor to poor mental health. For me, that highlights two aspects of how the crisis must be tackled: timely interventions for those caught in a state of poor mental health, and, of course, how we prevent people from falling into poor mental health in the first place—how we ensure that people have a coping mechanism. The latter aspect is why music, sport, art and drama are so important as a conduit into social interaction. Opportunity to participate has been eroded over the years, especially in less affluent areas, and that has been exacerbated by the Covid lockdown. I do not apologise for once again highlighting the need to focus on prevention.
The importance of the third sector is always underestimated and underresourced by the Government. There are so many fantastic organisations with specific skills that are under extreme financial pressure. All the while, CAMHS are under intolerable pressure, which has led to more than 1,000 children in desperate need of help waiting more than a year.
Mental health is an acute health issue, and we need to understand how investment finally gets to the third sector. The Health and Sport Committee reported that it is difficult to track progress of individual integration authorities’ spending on mental health, which creates difficulty in tracking progress against the Scottish Government’s commitment to mental health support services. Although the extra finance is very welcome, we must be able to track where that investment goes and measure that against outcomes.
There is so much that we could discuss and debate regarding a real solution. In the Government’s amendment, we see the reason why so little progress has been made by the SNP during its time in office. Instead of accepting that there is a mental health crisis and tackling it head on, the SNP instead tries to shift blame yet again on to the UK Government. To the Scottish Government, that is the job done. It has no ability to take responsibility for a crisis that has been a long time in the making. It is a crisis that, in my view, is linked to drug-related deaths, of which Scotland has the worst number in Europe. That is what happens when the SNP does not have the eye on the ball and all its focus is elsewhere.
As we emerge, I hope, from the Covid crisis, mental health services will be ever more crucial. Nothing that I have heard from the SNP tells me that it has a plan with which it will be able to tackle the enormity of the crisis.16:23
I thank members across the chamber for their input. The debate is especially timely, given our announcement yesterday of an additional £120 million of funding for our mental health recovery and renewal fund. The mental health of Scotland’s population remains a top priority for the Government.
The impact of Covid on the whole population is wide ranging, and our understanding of it will evolve as the pandemic progresses. We already know that the pandemic has exacerbated underlying inequalities, particularly for those with pre-existing mental illness.
The mental health transition and recovery plan and the investments that I outlined in my opening speech give a sense of the Government’s priorities. We are entirely focused on meeting the pandemic’s substantial challenges to mental health and wellbeing for both those with pre-existing mental illness and those who are experiencing mental health problems for the first time.
We must act now. We must ensure that appropriate, timely and effective support is available to all who need it. In particular, we must ensure that the best possible mental health care and support is in place for Scotland’s children and young people—Scotland’s future generations.
As members know, the actions that are set out in our transition and recovery plan summarise the range of our response to Covid-19. We know that there will be impacts in terms of inequalities, employability, relationships, people having pre-existing mental health conditions and people needing specialist help. Our recovery and renewal fund will ensure the delivery of the plan.
Many important points have been raised during the debate, and I will address some of them. Donald Cameron and Brian Whittle accused me and the Scottish Government of Westminster blaming. However, we know that poverty is among the biggest drivers of poor mental health and that cutting people’s benefits and imposing rape clauses are among the biggest drivers of poor mental health and poverty. They need to own that. [Interruption.] No, I will not take an intervention.
Donald Cameron accused the Scottish Government of not being on track to deliver the 800 mental health workers mentioned in action 15 of the strategy. I assure Mr Cameron that we are on track to have 800 mental health workers in place by the end of the 2022 financial year.
Mary Fee called for action, and that is precisely what the Government has taken in expanding services throughout the pandemic and laying out a clear plan for the recovery of mental health services.
I ask Pauline McNeill to read the transition and recovery plan. I acknowledge that she is new to this particular area of mental health, and that might address some of the concerns that she raised in her speech.
Alison Johnstone referred to several types of mental health need, including in employment. She also spoke about economic instability and the disproportionate impact of the pandemic on various groups of people. The transition and recovery plan covers those needs and lays out our response to the mental health impacts of the pandemic on a wide range of groups.
Over the past year, mental health has been talked about more than ever before. We continue to check in on our family, our loved ones and our colleagues as much as possible, and we have learned that self-care is key, as is continued access to specialist support for those who need it. There are no positives to what we have all been through over the past year, but Covid-19 has shone a light on mental health and the Government is rising to the challenge of ensuring that the right help is available in the right place and at the right time for those who need it.16:27
As other members have acknowledged, this has been a very worthwhile debate, with valuable contributions across the chamber.
At the start of the debate, Alex Cole-Hamilton reminded us that the motion asks only that Parliament accept the simple but important fact that
“there is a mental health crisis in Scotland.”
Those who are involved in the sector—I pay tribute to each and every one of them—recognise that, and those who are in need of support, whose numbers grow by the hour, certainly recognise it. Even the Scottish Government, given the welcome and surely coincidental funding announcement that was made by Kate Forbes yesterday, appears, at least implicitly, to recognise it. So why cannot ministers bring themselves to acknowledge the crisis for what it is? How can it possibly serve the interests of those who are desperately in need of support or those who are trying their best to provide support that ministers stubbornly refuse to acknowledge the crisis? For what reason is the Government so determined to avoid acknowledging the crisis that it seeks to airbrush it out of the motion, as it did when the Parliament debated a similar motion 15 months ago? In that debate, we heard from MSPs across the chamber painful testimony of the experiences endured by their constituents. We have heard the same again today.
Alex Cole-Hamilton talked about the effects of isolation, and Donald Cameron and David Stewart drew attention to the rising suicide rate. Mary Fee rightly warned that, as bad as things have got in recent months, we are far from seeing the worst of it. Alison Johnstone and Pauline McNeill focused on the particular stresses in relation to CAMHS. Stuart McMillan talked about the continuing issue of stigma, and Emma Harper highlighted the rural dimension to the issue, which was welcome.
However, the crisis in mental health predates the pandemic. In March last year, children’s mental health waiting times reached record highs. Some adults were waiting two years for treatment. Indeed, the Government’s own waiting times target has not been met since it was introduced, in 2014. Services are overwhelmed and we know that our police are far too often left to pick up the pieces, as Edward Mountain said. Officers not only attend individuals in distress; they can be asked to spend entire shifts accompanying those who are in crisis to safe emergency treatments through A and E. That is not sensible or safe. There should be help on hand from trained professionals for anyone who needs it.
As everyone has acknowledged this afternoon, all those problems have been pushed to the extreme over the past year. Last week, my colleague Beatrice Wishart revealed that research had found that children and young people in Shetland have waited, collectively, 1,300 days beyond the 18-week target in the year so far. That is a 4,500 per cent increase compared with the previous year. Those are not just numbers; they are evidence of people having taken the difficult step of reaching out only to find that the support that they need is not there.
That is not the fault of the staff, who are stretched to their limit and doing their best. Neither does it diminish the additional resource that ministers have committed—which is still not enough, although it is considerably more than it would have been had we simply accepted the Government’s previous arguments that it was doing all that it could. That evidence is, though, an argument for saying that, as we begin the process of rebuilding from the pandemic, we must learn from past mistakes.
That will require honesty about the scale of the challenge that we face and about the extent of the crisis that exists. Clare Haughey argued that nothing is to be gained by describing what is happening in mental health as a crisis. Why, then, has the Scottish Government accepted that we face a climate and nature crisis? Why, after 14 years of ministers sticking their heads in the sand while pointing the finger at Westminster, has the First Minister finally accepted that we face a drugs death crisis in Scotland?
In the same way, we now need the Scottish Government to accept the evidence and acknowledge that we face a mental health crisis. We need the treatment of mental and physical ill health to be put on the same statutory footing. We need a third sector that is fully engaged and involved in the delivery of joined-up services. We need appropriate expertise to be available when and where it is needed, no matter where in the country someone lives. We need resources beyond what the finance secretary has announced, welcome though those are. Finally, we need strategies on mental health and suicide prevention to be updated in a timely fashion and informed by the expertise of those who work in the sector and those with lived experience. We need all of that and more, but we also need the Scottish Government to face the fact that Scotland has a mental health crisis.
Given what we have heard today, what we know from our constituencies and regions, and what we hear consistently from experts and those who are desperate for help, more of the same simply is not good enough. Parliament passed up an opportunity to declare a mental health crisis 15 months ago. To do so again, in the face of all the evidence, would be negligent in the extreme. I urge Parliament to support the motion in Alex Cole-Hamilton’s name.