Meeting date: Wednesday, June 17, 2020
Meeting of the Parliament (Hybrid) 17 June 2020
Agenda: First Minister’s Question Time, Provisional Outturn 2019-20, Justice Sector Response, Recovery and Renewal, Mental Health Transition and Recovery, Business Motion, Animals and Wildlife (Penalties, Protections and Powers) (Scotland) Bill: Stage 3, Animals and Wildlife (Penalties, Protections and Powers) (Scotland) Bill, Domestic Abuse Bill, Private International Law (Implementation of Agreements) Bill , Business Motion, Parliamentary Bureau Motions, Decision Time
- First Minister’s Question Time
- Provisional Outturn 2019-20
- Justice Sector Response, Recovery and Renewal
- Mental Health Transition and Recovery
- Business Motion
- Animals and Wildlife (Penalties, Protections and Powers) (Scotland) Bill: Stage 3
- Animals and Wildlife (Penalties, Protections and Powers) (Scotland) Bill
- Domestic Abuse Bill
- Private International Law (Implementation of Agreements) Bill
- Business Motion
- Parliamentary Bureau Motions
- Decision Time
Mental Health Transition and Recovery
[Interruption.] Sorry, this is just like being at home, cleaning the bunker—although nobody knows what a bunker is, do they?
The next item of business is a statement by Clare Haughey on mental health transition and recovery. The minister will take questions at the end of her statement.15:31
The mental health impacts of the Covid-19 pandemic have brought new and significant challenges as we all continue to adapt to this unprecedented situation. Many of us will feel excitement and relief about the opportunity to move more freely outside our homes and to meet our friends and loved ones again. However, that may be accompanied by anxiety about the spread of infection.
As we work towards transition and recovery, we need to ensure that the importance of looking after our mental health is just as widely understood as the importance of protecting our physical health. Since the beginning of the pandemic, the Government has taken significant action to help support the mental health and wellbeing of the people of Scotland. We have invested a total of £6 million of additional funding to support the population’s mental health.
We launched the national clear your head campaign in April. Through television, radio and online resources, we have shared practical tips on how people can look after their mental health and wellbeing. We have set in train a number of initiatives to increase the capacity of existing services, both now and in the future. For example, in March, I announced an additional £2.6 million of funding to increase the capacity of NHS 24’s mental health telephone and online services. We have invested a further £1 million to roll out the Distress Brief Intervention programme on a national basis. The programme provides an “ask once, get help fast” intervention for people in distress. We have made mental health support and advice available to parents and carers through Parent Club. We have provided £105,000 to support Young Scot to develop enhanced digital content and resources on mental wellbeing during Covid-19.
I can announce today that we are providing nearly £43,000 to Beat, the United Kingdom’s eating disorder charity, to support its online and telephone support services. That funding will enable Beat to reach 3,000 people with an eating disorder over the next 12 months.
We recognise that people with autism, together with their parents and carers, may find changes to routine particularly challenging, so we have provided an additional £200,000 for Scottish Autism and the National Autistic Society, enabling the expansion of their telephone helplines and online services.
We have also worked with the Scottish Commission for People with Learning Disabilities, which has provided excellent easy-read versions of all key Covid-19 messages over this critical time, ensuring that the advice is accessible to everyone.
We are indebted at this time to our amazing health and social care workforce. As part of our efforts to care for those who care for us, we have launched the national wellbeing hub, PRoMIS, to provide a range of practical support, both now and in the future. Working alongside boards and the workforce wellbeing champion network, we are keen to build on the support that the hub provides. In particular, we plan to offer a national listening service for people across the health and social care workforces. We are also developing services for those who may need more specialist support.
I take this opportunity to recognise once again the contribution of our workforce. They have gone above and beyond, every single day, and their contribution has been truly extraordinary.
We understand that Covid-19 will have long-lasting impacts well beyond the initial crisis response stage. As such, we will continue to build on the success of those actions to meet changing mental health need. As we move through the phases of recovery, we will anticipate on-going challenges. There will be an increased need to provide different support for newly emerging mental health issues, which will be on top of the typical demands on mental health services. An intensive response will be required, which will need to be flexible and innovative. That is why we have identified the remobilisation of mental health services as one of our top priorities.
We are working directly with national health service boards to ensure that people have access to the right services at the right time. Boards across Scotland must be able to meet demand in a safe, effective, sustainable and quality-focused way. Mental health services have continued to be provided throughout the pandemic, albeit with adjustments in timescales for delivery and to accommodate Covid-19 restrictions. Urgent and emergency cases continue to be prioritised.
We have worked closely with boards through the pandemic to ensure the integrity and quality of child and adolescent mental health services. It is vital that mental health remains a visible priority, particularly for our younger citizens.
We are undertaking specific work on the recovery of mental health services, including innovation in services and modelling future demand. That detail will inform a full recovery plan covering all boards and all phases of recovery over the coming weeks and months. To ensure that boards’ mobilisation plans are robust, we are also working directly with mental health leads to build a baseline of service provision, which includes detailed information about how services can be restarted safely. Where required, we will issue further guidance or directives to promote a consistent approach to remobilisation across Scotland.
During our engagement with boards, we have seen new evidence-led approaches across Scotland. The innovative use of technology has been a key feature, which we will be keen to learn from as services are redesigned to meet the needs of patients. There are also plenty of fantastic examples of local practice that we want to retain. For example, NHS Greater Glasgow and Clyde has established mental health assessment centres to provide help and support for patients who are experiencing a mental health crisis and ensure that they receive a more tailored approach. That example of best practice has been taken up by boards across Scotland, and 17 mental health assessment services are now operational across the country.
Although services are a crucial part of the picture, our work must go wider and focus on the importance of mental wellbeing. The promotion of mental health at a population level will be central to the Scottish Government’s long-term response. Human rights, equalities, the importance of reducing stigma and a focus on recovery will be foundational principles.
Throughout the pandemic, we have worked closely with stakeholders to shape our approach and to determine our longer-term ambitions for mental health and wellbeing in Scotland. That engagement has helped us to understand the current and emerging needs that are results of the pandemic. Some are new challenges, such as support for people who are shielding, and some are existing issues that have been brought into even sharper focus over the past few months. An example is the relationship between poverty, inequality and mental health, which is at the forefront of our thinking.
Key to those challenges will be the development of the new community mental health and wellbeing services for five to 25-year-olds. In March, we allocated £2 million of funding to local authorities to plan new supports for mental health and emotional wellbeing. In addition, we will make up to £15 million available each year for the delivery of those services. Despite the difficulties that are posed by the pandemic, I am confident that local authorities and their partners can have those vital services in place this financial year.
As well as concentrating on mental health services and the importance of wellbeing, we also want to ensure that robust support is in place for people who experience distress. The Distress Brief Intervention programme is a prime example. Fast, accurate and individualised signposting to sources of advice and support is also needed.
In that changing landscape, our policy response will remain fluid and adaptable and will be led by emerging evidence. The Scottish Government has commissioned the University of Glasgow, in collaboration with the Samaritans and the Scottish Association for Mental Health, to undertake a Scottish mental health and wellbeing tracker study.
That study will track mental health participants for the next year, and provide a Scotland-specific insight into the impact of the pandemic and lockdown restrictions on the population.
We have also established the mental health research advisory group, which includes academics and public health experts from across Scotland. The group, chaired by Professor Andrew Gumley, is helping us to identify emerging research to guide our policy response.
In the next phase of our recovery from Covid-19, mental health will continue to be to the fore. That is why we are committed to ensuring that the good mental health and wellbeing of the people of Scotland is one of this Government’s top priorities. Covid-19 has illustrated more than ever why that matters so much. We remain determined that everyone is able to access safe, person-centred, equitable, efficient, timely and effective mental health support, should they need it. We will continue to engage with and inform Parliament as we develop our response.
I doubt that there is a single one of us who has not thought about our own mental health at some point over the past few months. In many ways, the pandemic has destigmatised, and shown us that it is okay not to feel okay. More people have been asking each other how they are doing. Those things really matter. The importance of good mental health is clear.
As we move into the next phase of recovery, there will be new challenges for us all to face, but we will face them together. There is no right emotional response to the national trauma that we have faced. Some of us have adapted quickly and will continue to do so. Some will find it more of a struggle, and that is okay. The community spirit and togetherness that has been shown every day across Scotland has been amazing. We must hold on to that.
The people of Scotland can be assured that mental health will continue to be an absolute priority for the Government. Thank you.
I thank the minister for advance sight of her statement. The latest waiting times figures show that fewer than two thirds of children and young people who are accessing CAMHS services were treated within the Scottish Government’s 18-week target, but the number of children who are waiting for more than a year for mental health services increased by almost 300 by the end of March. It is clear that, before the crisis, our services were not delivering for our young people.
Will the minister agree to look at three key asks and report back to Parliament? The first is to establish mental wellbeing support resources for parents over the summer holidays. The second is to make available a peer-to-peer wellbeing support network in all secondary schools, hopefully when they return in August. The third is to develop new mental health training for teachers, not just mental health first aid.
I thank Mr Briggs for his question. I have said on many occasions that our position has been that long waits for mental health treatment are unacceptable and it is encouraging to see that more people are able to access psychological therapies compared to the same quarter last year in the statistics that he referenced. However, it is disappointing to see a drop in performance at this time.
Our investments have contributed to a substantial increase in the CAMHS and psychological therapies workforce. However, we recognise that the impact on performance has been slower and less comprehensive than we expect and require. We are keen to build on some of the learning that we have done during this time and to see how recent developments in the use of technology, for example, can help boards to address some of the longstanding issues around access and, crucially, quality of services.
Mr Briggs had three specific asks. If he will indulge me, I will write to him on them. It might also be helpful for him to know about some of the things that we have done that I have not mentioned already today. For example, the Solihull approach looks at relationships and child development and covers from the antenatal period right through to age 19. The Distress Brief Intervention programme is accessible nationwide for anyone who is over the age of 16. The Parent Club website provides advice and support for parents, carers and children on aspects of mental health.
I thank the minister for advance sight of her statement.
I was pleased to hear confirmation that there are now 17 emergency mental health assessment centres. That is welcome. I know that the Royal College of Emergency Medicine has recently endorsed their continued use in the future. Can the minister guarantee that the changes will be made permanent, as the NHS is remobilised?
Finally, I did not hear an awful lot in the statement directly about bereavement support. Constituents have been in touch with me who have suffered loss and trauma because of Covid-19, and who have struggled to find access to groups for support, although they know about the helplines. I wonder whether—perhaps after today—the minister and the Government could signpost people to support. If there is not yet enough specific information and advice for people who have suffered a loss because of Covid-19, could that be rolled out for the future?
Monica Lennon has raised the pertinent issue of bereavement support. Anyone who has been bereaved during the pandemic has had a bereavement like none that any of us has ever experienced, with access to the rituals and support that we would normally have being denied us. I send my sincere condolences to anyone who has been bereaved through Covid-19—as my family has, so I feel that I can say that with sincerity and empathy.
We have invested in the services that Cruse Bereavement Care can provide. I appreciate that it is currently difficult for people to access group sessions, which can be extremely powerful in supporting people. I hope that we will, as we progress through the pandemic, be able to look at more innovative ways of providing group therapy in the national health service and in third sector organisations.
I am delighted that we have so many emergency mental health centres up and running across the country. They provide a good service to people who are in mental health crises by giving them direct access to mental health professionals and directing them away from the less appropriate environment of accident and emergency departments in acute hospitals. I will certainly be working with health boards on how they plan to continue the services, and will encourage them to do so.
We will also look at all the innovative services that have been developed across mental health, of which there is quite a range. We will consider their value, the quality of care that they provide to patients, their outcomes and whether they are providing good-quality evidence-based services. We will encourage health boards to continue with those innovations.
Before I call Emma Harper, I remind members to press their request-to-speak button if they want to ask a question. I ask for succinct questions and, although I know that this is a very important and sensitive issue, succinct answers. I am trying to get everybody in.
Will the minister provide an update on what mental health services have been paused or stopped altogether during Covid-19, such as CAMHS physical attendance in Dumfries and Galloway? Will she also provide an outline of what impact that has had on the people who need the services?
Provision of mental health services has continued throughout the pandemic, albeit with adjustments to accommodate Covid-19 restrictions and to timescales for delivery. As I said earlier, urgent and emergency cases continue to be prioritised.
That said, certain aspects of service delivery have necessarily been paused over the period due to restrictions that have been imposed through Covid-19 related limitations, such as physical distancing. Those aspects include group work, day and respite services, assessment and review for dementia, autistic spectrum disorder and neurodevelopmental assessments, medication reviews for attention deficit hyperactivity disorder, and some inpatient detox services. Where that has happened, we have been assured by boards that efforts are being made to support patients and their families by other means—for example, through telephone contact or domiciliary visits, when they are essential.
Health boards are also working with each other and with the Scottish Government to find safe and effective ways to deliver group interventions—which I referenced in my answer to Monica Lennon—and neurological assessments remotely.
I know that the minister is aware of the huge contribution that the third sector makes in tackling mental ill health, through organisations that offer specific mental health interventions and others that simply offer opportunities to be included. The minister will know that many organisations are struggling in the current crisis, and that if they disappear the burden will fall on NHS services that are already under extreme pressure. What work is the minister doing, in conjunction with the Cabinet Secretary for Communities and Local Government, to make sure that the third sector will still be there when we need it most?
Over the course of the pandemic, as previously, we have acknowledged the work of the third sector. Mental health services are about much more than a national health service response.
We value the work that the third sector does for our communities across Scotland. We have invested in various third sector organisations during the pandemic period and before it—for example, in perinatal mental health services; in Young Scot, so that it can examine the effect of lockdown on our children and young people; and in Cruse Bereavement Care, which I have mentioned.
The mental health delivery board has continued to meet during the pandemic. The third sector plays a key role on that board, so its voice is certainly very much at the table in planning for mental health services once we come out of the pandemic, and during it.
Ten minutes remain, and 10 members want to ask questions, so we might have to get a bit swifter at this.
How will the Scottish Government ensure that parents and carers are made aware of the mental health support that is available for children, and what specific mental health provision will be made available for children who have additional support needs?
The Scottish Government is working with a range of partners to support children and families, in order to mitigate the impact of the Covid-19 pandemic on their mental health.
We have made available support and advice on mental health for parents, carers and their children, on the Parent Club website. That support includes free access to the Solihull Approach online course, which is a resource that helps parents and carers to understand better their child’s emotional development, and supports development of healthy relationships.
Schools remain a key link for parents and carers in supporting the mental health and wellbeing of children and young people, including those who have additional support needs. They will continue to be available for discussion of concerns about a child’s mental health with guidance staff or senior management.
Education Scotland and the national autism implementation team have been working with a range of stakeholders to consider how teachers and teaching staff can be supported in their role of supporting autistic learners back to school.
A time will come when we will debate how prepared we were for this pandemic, but we must now prepare for the pandemic that we know is coming. Isolation, shielding, loss of loved ones, financial insecurity, the pressures of home schooling and the emotional toll of it all have impacted on mental health. Eighty-three per cent of young people say that their mental health has got worse, and other research shows stark increases in the number of adults with mental ill health. There will be no excuses. Will we be ready for the mental health pandemic?
We have been working very closely with NHS boards and others, as I have said, through the mental health delivery board, to ensure that we monitor the impact of Covid-19 on demand and capacity.
We wrote to NHS boards on 14 May, highlighting mental health as a clinical priority. We asked them to set out their plans for reinstating services, and to work with partners to estimate the anticipated rise in mental health needs in their populations and to determine their responses.
I will continue to work with boards and others to ensure that the people of Scotland get the services that they require, post pandemic.
Delivery of maternity services has necessarily been altered; for example, there are restrictions on who can attend scans and appointments. There is an increased risk of social isolation for women who are beginning motherhood during lockdown. What actions are being taken for the mental wellbeing of pregnant women and new mothers, to prevent an upsurge in postnatal depression?
In August last year, as Alison Johnstone might remember, we invested £225,000 in third sector organisations to support families and mums in the postnatal period. We have extended that funding to August 2020, when the national perinatal and infant mental health fund will come online. Organisations are actively offering help and support to women and their families during Covid-19.
We also need to remember that health visitors and general practitioners are good sources of advice and support for pregnant women and new mums who feel that they are struggling. Up-to-date information can be found on NHS Inform’s “Ready Steady Baby!” web page, and on the Parent Club and Clear Your Head websites. It would be remiss of me not to mention the excellent care—physical and psychological—that midwives provide to women throughout pregnancy.
Earlier this month, we learned of the extent of waits for child and adolescent mental health services in the year up to the start of lockdown. The official statistics showed that a record 1,253 children had waited more than a year for treatment. We now know how bad the situation was at the outset of the crisis, but experts are warning of a fresh avalanche of need for the services. We also know how damaging grief, removal of freedom, loss of contact and disruption can be.
What is the Scottish Government’s plan for the recovery of CAMHS to meet existing and heightened demand? How does it differ from the existing strategy? Three years into it—
—we had more children waiting over a year than ever before.
Point made. I call the minister.
As I have said in my answers to other members’ questions, we anticipate increased demand for mental health support as we move through the phases of recovery. That is why we have identified mental health as a key priority for the recovery process and for health boards in the remobilisation of services.
Over the coming weeks and months, we will be working directly with NHS boards to develop a recovery plan for mental health services that covers all boards and all phases of recovery, and we will continue to work with them thereafter to monitor their plans and the impact of Covid-19 on the demand for NHS services.
The minister mentioned the national wellbeing unit. Will she provide an update on use of the unit and say how she sees it, going forward?
I do not think that the minister heard that. Will you repeat the question, Mr Dornan? I am sorry.
Yes, I will do so happily. The minister mentioned the national wellbeing unit. Will she provide an update on use of the unit and say how she sees it, going forward?
We heard that.
The national wellbeing service that we have developed for our health and social care staff, third sector staff and unpaid carers is a resource to provide them with the best and most up-to-date information, and to support their mental health and wellbeing. Since it was launched last month, it has been overwhelmingly well received; feedback from people who have used the service has been very encouraging.
The service will develop as we go forward and have more evidence-based information on support for our health, social care and third sector staff. We are monitoring its use. The most recent statistics that I have seen show that the resource is being used by staff and their families from across the country and from across the NHS, social care and the third sector.
Will specific services be designed for people, especially the elderly, who are required to continue shielding or are self-isolating?
Annie Wells raises a really important point. We have asked people to do something that is quite extraordinary. We have asked them, essentially, to lock themselves away from their friends and family, to stop going out and to stop accessing their usual support services, and to do all that at a time when they are, no doubt, overwhelmed and worried about the pandemic.
The letter that the chief medical officer issued in March to people who are shielding provided advice on what they could do to keep themselves mentally active, and to look after their mental wellbeing while shielding. It also signposted additional advice and support from NHS Inform and the Breathing Space website. The Clear Your Head campaign has practical tips on what people can do to make themselves feel better while they continue to stay at home, and there is also a support helpline for people who are shielding.
I ask Fulton MacGregor to be brief.
Will the minister provide an update on the distress brief interventions? Will she outline the roll-out of the programme and say how it is being delivered and what the impact has been?
Please be brief, minister.
The expansion of the programme went live for callers across Scotland on 8 June. The key element in the expansion is that anyone who phones the NHS 24 mental health hub from anywhere in Scotland can be referred to the DBI programme for further support, when that is possible. The expansion is testament to the dedication, hard work and cross-sector co-operation of all the organisations that are involved in the DBI programme.