Meeting of the Parliament

Meeting date: Tuesday, September 25, 2018

Official Report 1175KB pdf

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Mental Health Strategy: 2018 Annual Report

The next item of business is a statement by Clare Haughey, the Minister for Mental Health, on the mental health strategy 2018 annual report. The minister will, of course, take questions at the end of the statement.

14:24  

Our 10-year mental health strategy, from 2017 to 2027, paints a clear picture of the kind of Scotland in which I want to live: a Scotland where people can get the right help at the right time, expect recovery and fully enjoy their rights, free from discrimination and stigma.

The strategy’s guiding ambition is that we must prevent and treat mental health problems with the same commitment, passion and drive as we do physical health problems. I was honoured in June to be appointed as Minister for Mental Health to build on the work of my predecessor, Maureen Watt. Although I have been in post for only a short time, I know from my experience as a mental health nurse the commitment and dedication of the people who make a difference in mental health care every day across Scotland.

Today sees the publication of “Mental Health Strategy: 2017-2027—1st Progress Report”. In the strategy’s first period, many of its actions have already been implemented: of 40 actions in the strategy, 13 are complete or nearly complete, and 26 are in progress. Only one action remains, which is to carry out a progress review of the strategy in 2022, which for obvious reasons is yet to get under way.

I will single out for attention three actions in the strategy. Under action 16 of the strategy, we invested £175,000 to establish a perinatal mental health managed clinical network. Its expertise and diligent work has directly informed a commitment in our 2018 programme for Government to deliver a stronger network of care and support for the one in five new mothers who experiences mental health problems during and after pregnancy. That equates to 11,000 women per year. We will invest £50 million in perinatal and infant mental health over the next five years.

More than 1,000 people in Aberdeen, Lanarkshire, the Borders and the Highlands have already received distress brief interventions. The intervention programme is funded by £3.4 million from the Scottish Government in order to provide the offer of next-day contact with a trained worker from a third sector background to anyone who presents in distress to accident and emergency departments, police and ambulance services and primary care. We announced in the programme for Government that the initiative will, in 2019, be rolled out to under-18s.

Last month, on 29 August, I had the pleasure of launching our new “Transition Care Planning—Action 21—Principles of Transition”, which will help young people to move more smoothly from child and adolescent mental health services to adult mental health services. The transition care plans have been designed entirely by young people in dialogue with clinicians, and are a shining example of what can happen when we listen to the views of our young people and act accordingly.

Those are just three of the headline achievements that are summarised in the report. They are examples of specific actions in the strategy that are already making real and tangible differences to people’s lives.

It is important to say that the 40 actions in the strategy will not in themselves completely deliver our central vision. They will act as valuable and necessary levers to create the changes that we want to see, but getting to our ultimate vision and achieving our ambitions will require work beyond that set of commitments. I want, therefore, to mention five pieces of work that are all fundamentally important.

Firstly, there is the children and young people’s mental health task force, which is chaired by Dame Denise Coia and supported by £5 million of additional funding. Dame Denise Coia has dedicated her summer to talking with children and young people and their families, services, agencies and practitioners. Earlier this month, she published her initial “Children and Young People’s Mental Health Task Force—Preliminary View and Recommendations from the Chair” on our whole-systems approach to mental health services, and her work will help to implement the recommendations in “Rejected Referrals to Child and Adolescent Mental Health Services (CAMHS): A Qualitative and Quantitative Audit” that was published earlier this year.

Dame Denise Coia has already started work on a blueprint for how services can better meet the rapidly changing need that we see across Scotland. The task force will convene its first meeting next month.

Secondly, there is the youth commission on mental health. Young people are spending 15 months on an in-depth investigation of child and adolescent mental health services. They will do their own research, identify issues that are important to them and speak to experts, policy makers and service providers about the solutions. The youth commissioners have been invited by Dame Denise Coia to be co-chairs of the task force. That is an inspired move that will keep the voices of children and young people at the centre of that work.

Thirdly, there is “Scotland’s Suicide Prevention Action Plan: Every Life Matters”, which we published on 9 August. It sets an ambitious target of reducing suicides by 20 per cent over five years. It contains 10 actions, and is backed by an additional £3 million. We have already established the national suicide prevention leadership group, which is chaired by Rose Fitzpatrick. That group will meet for the first time, tomorrow.

Fourthly, there is the see me national campaign, which was launched on 18 September. It is the biggest conversation that we have ever had with young people in Scotland about what mental wellbeing means to them. It harnesses the power of music to help people across the country to talk about how they feel. I am sure that the results will be especially valuable to Dame Denise Coia’s task force.

Lastly, our 2018 programme for government has mental health at its very heart. It contains a package of measures to support positive mental health and prevent mental ill health. Those new actions will build on the mental health strategy and will be backed by a quarter of a billion pounds of additional investment, which has a clear focus on child and adolescent mental health services, including school counselling.

All that is reflected in the report, which demonstrates progress on the strategy’s 40 actions and towards achieving our central vision. The framework that is set by the strategy has, with the other work that I have mentioned, helped to create the current sense of purpose and momentum on mental health that we see across Scotland.

Across society, we see a constantly evolving understanding of good mental health, mental distress, mental ill health and mental wellbeing. In the past, many people were unwilling or unable to discuss their mental ill health and to seek appropriate support and treatment. I am thankful that that is changing, but I want to go further in working to overcome the stigma that can be associated with poor mental health.

We need to ensure that the public’s understanding and expectation of mental health services are accurate and appropriate. The services that are delivered must also better reflect need. We know that there is a gap between how services are currently configured and some of the overall needs of the population. There is often too great a focus on crisis and specialist services. For adults and children, new models of support are needed that are less specialised, are available for more people, and are delivered across different settings and services.

We know that changing the location and nature of services and support requires development of the skills and capacity of the workforce who will deliver those services. That means giving staff across the health sector and other sectors the skills and confidence to ensure that they are sensitive and responsive to emerging need and ways of delivering services.

We also need to put in place preventative approaches, and to deliver early interventions where we can. That means ensuring that access to mental health professionals is straightforward and easy to navigate for the individual so that the right help is available at the right time.

On a related matter, we know that the workforce must grow. Through action 15 of the strategy, we are committing significant investment to delivering an additional 800 mental health professionals by 2021-22. We are doing that in partnership with integration authorities, health boards, local authorities and other key sectors, recognising the different services and settings in which people can present when they are in distress.

Finally, the role of data and information is another area in which there is significant scope for improvement. We need to move away from the current focus on waiting times and workforce statistics and instead to use evidence to identify areas for improvement—to identify what works and what has not worked. Measuring patient outcomes and experience will also be important. Action 38 of the strategy—the launch of a quality indicator profile and a mental health data framework—will be key to that.

As I said at the start of my statement, we have come a long way since March 2017, when the strategy was published. The report that has been laid before Parliament today summarises that progress, and does so by looking at what is happening across the whole system.

All of what the report describes is contributing to what will be a fundamental change. Ensuring parity of esteem between physical health and mental health, and meeting our vision for the strategy, will require us to work together to reduce stigma around mental health, to develop innovative and new ways of working and, in doing so, to ensure that Scotland’s mental health services are among the best in the world.

I commend the report to members and will be happy to take questions from them.

I thank the minister for advance sight of her statement.

I welcomed the Scottish Government’s commitments in its recent programme for government, because we all want mental health to receive the focus that it desperately needs. However, the statement misses the point somewhat. Since the strategy was introduced last year, CAMHS waiting times have been the worst on record; an audit into rejected referrals has highlighted a consistent rate of one in five children and young people being rejected for treatment; and an Audit Scotland report has described children’s mental health services as “complex and fragmented”.

We have heard many warm words—particularly about early intervention and prevention—but things do not seem to be moving in the right direction. When I have asked about additional mental health workers, community link workers, school counsellors and nurses, I have got nowhere fast. Detail seems to be lacking.

It is interesting that the minister said that we need to move away from the focus on waiting times and workforce statistics, but surely those figures are necessary to know that the strategy is heading in the right direction.

What does the minister suggest as an alternative measure of progress? When will we see the delivery plan for the recruitment of additional school nurses and counsellors? Does she truly believe that the commitments that were made in the programme for government will produce a step change, particularly in early intervention and prevention?

It is rather disappointing that Annie Wells could not welcome the progress that has been made in 18 months. Stakeholders that have been involved in ensuring that progress include national health service staff, social care workers and third sector organisations.

Annie Wells did not really listen to my statement. On CAMHS, she will be aware that we have set up a task force under Dame Denise Coia that has been working over the summer and will meet next month. The task force will look at wholesale changes in CAMHS.

I thank the minister for advance sight of her statement.

Everyone wants mental health to be on an equal footing with physical health. However, the reality is that the Scottish Government is nowhere near achieving that parity, regardless of its warm words. We welcome the appointment of Dame Denise Coia as the chair of the children and young people’s mental health task force, but Audit Scotland’s recently published report “Children and young people’s mental health” told us that services for young people are “complex and fragmented”.

CAMHS features heavily in the programme for government. Will the minister assure the Parliament that funding for mental health workers in our schools will not come from existing mental health or education budgets? Will she also assure us about how transition care plans will be monitored, given the existing problems with CAMHS?

We welcome the distress brief intervention treatment that 1,000 people have received in Aberdeen, Lanarkshire, the Borders and Highland. The programme tackles the mental health of drug and alcohol abusers. There have been cuts to alcohol and drug treatment in the past decade, so when will the distress brief intervention programme be rolled out across Scotland? Will funding be increased year on year to tackle areas with high levels of deprivation and poverty, which result in higher levels of drug and alcohol addiction?

I hope that I will be able to answer most of Mary Fee’s questions. It was additional funding that was announced in the programme for government. I am pleased that she welcomes the transition care plans, which were launched last month. They were the result of a piece of work that young people did, with clinicians’ support. At the launch of the plans, young people said that they were extremely proud of the work that they did. I have written to all health boards to express my expectation that they will use the plans in the transition period from CAMHS to adult mental health services, although the plans can be used at other transition points, too.

We will evaluate the distress brief intervention programme, which has been extremely warmly welcomed—my local police force has spoken to me several times about how well received the programme has been in Lanarkshire. As Mary Fee is aware, we will also roll out the programme to under-18s. More than 1,000 people have benefited from the interventions, and we have collected extremely positive feedback. Once the programme has been evaluated, we will look at how to take it forward.

I thank the minister for advance sight of her statement.

The minister spoke about the delivery of an additional 800 mental health professionals to support A and E departments, general practices, police station custody suites and prisons. However, have the number of training places been increased to allow for the further 430 counsellors that have now been committed to for schools, colleges and universities? Is the commitment to provide a further 250 school nurses also being reflected in the extension of the number of training places?

We have made a commitment to the additional mental health workers, and we are working with the chief officers of the integration authorities on developing that commitment. That work includes obtaining detailed workforce plans that will provide information on workforce allocation, the location of the workforce in 2018-19 and details of the trajectory towards the total of 800 additional mental health professionals by 2021-22. We expect to receive those plans for further analysis by the October recess.

The integration authorities have devolved responsibility for health and social care in their areas. Therefore, it is key that they play their part in the plans, taking into account local needs. We are working in collaboration with other relevant partners to ensure the best use of the workforce. Local plans need to be made to meet the needs of local populations, and we will work effectively with partners to ensure that the workers are in place.

We have increased the number of nurse training places. As part of a wider package of measures to accelerate the supply of newly qualified nurses and midwives, there will be an additional 2,600 nursing and midwifery training places over the next four years. We are focusing on priority areas, including mental health and maternal and child health, and on remote areas, particularly in the north of Scotland.

I, too, am grateful for early sight of the minister’s statement.

Liberal Democrats are grateful to see the 800 mental health workers begin to be recruited. Can the minister specify exactly what roles they will fulfil? Will they be talking therapists or will they signpost people to interventions? Will the minister also tell Parliament how she intends her Government to respond to the call by Sir Harry Burns, in his review of NHS targets, that we should routinely capture adverse childhood experiences, so that we can direct support to those children?

As I said in my answer to Alison Johnstone, we are working with the chief officers of the integration authorities in delivering our commitment. We are making detailed work plans that will include where the workforce will be. It is important that we work to local plans, because we are not taking a one-size-fits-all approach.

On adverse childhood experiences, the Government is investing in perinatal mental health services as well as infant mental health services in order to support families so that we reduce the risk to children. We have also rolled out the family nurse partnership, which works with vulnerable families to reduce the risk of ACEs.

I welcome the minister’s statement. Can she give a commitment that the Scottish Government will continue to engage with organisations such as the national rural mental health forum and the Royal Scottish Agricultural Benevolent Institution to ensure that we can further explore the options to tackle social isolation and loneliness in rural parts of Scotland?

The national rural mental health forum has been established to help people in rural areas maintain good health and wellbeing. The forum will help to develop connections between communities across rural Scotland so that isolated people can receive support when and where they need it. The forum has been provided with £50,000 of funding in this financial year—funding that was jointly provided by the mental health and rural portfolios, which demonstrates the cross-cutting nature of the forum’s work. Since 2016, membership of the forum has grown from 16 to 60.

The forum has agreed to deliver three outcomes: a much-improved understanding of the unmet need for mental health support in rural Scotland; evidence of how to better overcome barriers to accessing and seeking support, therefore enhancing people’s mental wellbeing in rural Scotland; and better-informed rural and health policy due to specific evidence and support from forum members.

Recent figures show that, in the past year, over a fifth of CAMHS patients in the Highlands and Islands region have not been seen within the 18-week target. Given the issues with mental health provision in rural Scotland, what more can be done to improve on such dire statistics in that region?

As I said earlier, the Scottish Government recognises that it is not acceptable for people to wait for a long time to be seen by mental health services. That is why it took action to set up the task force that is chaired by Dame Denise Coia, whose initial recommendations were published last week. Her task force will meet next month, when it will look at how we might revise CAMHS provision so that people can more quickly access the services that they need, and so that those who need specialist services can be fast tracked to be seen by them.

This week, we have been given more stark reminders about the devastating impact that bullying—often of our young people—can have on lives, families and communities. Let us be clear: bullying in any form, whether in person or online, is not acceptable. Will the minister outline what support is being given to schools to enable them to recognise and support young people whose mental health is being impacted by bullying?

I agree entirely with Fulton MacGregor that bullying of any kind is totally unacceptable and must be dealt with quickly, whenever and wherever it happens.

Education authorities and all those who work in our schools have a responsibility to identify issues and to support and develop the mental wellbeing of pupils, with decisions on how to provide such support being taken on the basis of local circumstances and need. Local authorities will use a range of approaches and resources to support children and young people in their mental and emotional wellbeing, in line with local needs and circumstances.

Since 2014, the Scottish Government has provided £6,000 per year to NHS Education Scotland to roll out to local authorities children and young people’s mental health first-aid training. The aim is to train staff in secondary school communities in order to increase their confidence in approaching pupils who they think might be struggling with mental health problems. Such training will complement the range of mental health strategies that are already in place in local authorities.

Unbelievably, the Minister for Mental Health said in her statement that we need

“to move away from the current focus on waiting times and workforce statistics”.

That is in the face of the worst CAMHS waiting times on record, the highest suicide rate in the United Kingdom, a sky-high vacancy rate and a desperate need to recruit hundreds more staff. Does the minister not understand that the way to move that focus is to meet the standard, treat patients on time and employ more staff?

I recognise—as does the Government—that mental health services are not good enough for our young people. That is why we have set up a task force under Dame Denise Coia, as I have already said. The previous Minister for Mental Health met a number of NHS boards whose current delivery against standards continues to fall short. The latest statistics show that five of those boards show some signs of improvement, but we need to go further.

Our mental health strategy is investing £150 million in services over five years, and it sets out clearly how we can reshape service delivery to benefit patients. That figure includes £54 million to help boards to improve their performance against waiting time targets by investing in workforce development, recruitment and retention, and service improvement support. We are already funding Health Improvement Scotland’s work with boards on improvement, with Information Services Division analysts being embedded in the boards, and through NHS Education Scotland’s programme of investment in workforce capacity building.

Some people with mental health issues find it quite difficult to ask for support face to face with their general practitioner. Can the minister say whether there are other ways in which they can access such services?

There are various ways in which people can access services. Breathing space, for example, is a confidential phone line that is run by NHS 24. People can also access services online, and we have rolled out a computerised cognitive behavioural therapy programme to all NHS boards.

There are also a great many third sector organisations, such as Samaritans, through which people can access help if they feel that they are in mental health difficulties but do not feel able to approach their GP. However, I encourage anyone who feels like that to try to go to their GP because their GP is best placed to signpost them to local services.

I think, similar to the suicide prevention strategy, the Scottish Government seems to be focused on trying to deliver a service to people who are caught in a spiral of poor mental health. Vital though that is, does the minister recognise that the system will ultimately crash unless a whole-system approach to health is adopted, which looks at the root causes of poor mental health including poor nutrition, inactivity, chronic pain, obesity, isolation and alcohol and drug addiction, and which considers all the evidence from the Scottish Association for Mental Health?

It is interesting that Mr Whittle left poverty off that list, considering what the United Kingdom Tory Government is doing in rolling out universal credit and putting a lot of people into debt and poverty. People are having to access food via food banks. He chose not to mention poverty.

The mental health strategy looks at physical health—at smoking cessation, screening and physical activity levels. Programmes have been set up under the mental health strategy that are committed to improving physical health inequalities among people with mental health problems. On smoking cessation, for example, NHS Lothian has a tobacco control action plan that it launched on 20 June. The plan contains commitments to raise awareness among medical professionals and healthcare staff of the significant impact that smoking can have on mental health medications.

Two projects are running on screening. The first is run by NHS Dumfries and Galloway and is to improve, through gaining an understanding of the barriers to uptake, the uptake of breast, cervical and bowel screening among people who are experiencing homelessness or who have mental health problems. NHS Lanarkshire is reviewing options to increase uptake of cervical, bowel, and breast screening services for the homeless population in Lanarkshire.

The active living becomes achievable—ALBA—project is a new and unique behaviour-change project that links in with existing physical activity provisions to enhance sustainable individual physical activity engagement through behaviour change. The aim is to increase physical activity levels for people living with mental and/or physical health conditions in order to improve their mental and physical health and wellbeing. The results of the ALBA intervention will be available in September 2019.

Can the minister provide an update on action 33 of the mental health strategy, which relates to the needs of people with learning disabilities and autism?

Yes, I can. The review to consider

“whether the provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003 ... fulfil the needs of people with learning disabilities and autism,”

which is chaired by Andy Rome, is under way. There is a strong emphasis on reaching a broad range of stakeholders and seldom-heard groups so that the real issues can be fleshed out and considered. That will mean several stages of engagement, and provision of the right support for people so that a range of views and experiences can be recorded, thereby making the review truly accessible. It is crucial that the review is truly inclusive and that its work is open and transparent. We want people to see, understand and participate in the work of the review. The first of the three public engagement phases commences this month.

Thank you very much. I apologise to Mr Stewart and Mr Lyle as we have no time to call more members.