Meeting date: Wednesday, November 27, 2019
Meeting of the Parliament 27 November 2019
Agenda: Portfolio Question Time, Mental Health, Business Motion, Parliamentary Bureau Motions, Decision Time, Gender-based Violence
- Portfolio Question Time
- Mental Health
- Business Motion
- Parliamentary Bureau Motions
- Decision Time
- Gender-based Violence
The next item of business is a Scottish Liberal Democrat debate on motion S5M-03438, in the name of Willie Rennie, on mental health.14:39
What I am about to tell the chamber is quite shocking; it should shake the Government to the core. I am disappointed that Humza Yousaf, the Cabinet Secretary for Justice, is not in the chamber, because some of the content of my speech should shake him to the core.
The state of Scotland’s police is deeply worrying. People across Scotland are struggling with their mental health. When they seek help, often it is not there or it arrives far too late. In the absence of enough support, problems that start small can become big. This week, I came into possession of the findings of new, unpublished, expert academic research into the health of police officers. It shows that many of Scotland’s police officers are struggling with their mental health and are being let down by those at the top and by the Scottish Government.
The scale of the problem is horrifying. Here are just a few examples: 21 per cent of police officers reported high levels of depressed mood; one in 10 reported drinking alcohol or taking prescription drugs as a coping mechanism; and almost half suffer from exhaustion. Most devastating of all, 35 per cent of officers reported going to work while mentally unwell. The officers who keep us safe in our communities are turning up to work while they are unwell with a mental illness. I will let that sink in.
The evidence shows that police officers do not get enough support. Some 57 per cent reported that a lack of resources caused them a high degree of stress. Only 3 per cent agreed that the national force cared about their wellbeing. I repeat: only 3 per cent thought that Police Scotland cared about them. Officers are exhausted, depressed and being pushed into dangerous coping mechanisms.
I know that it is a tough job, but it should not be making people unwell on anything like that scale. The conditions that our police are working in are fundamentally unsafe. That cannot be dismissed.
The research covered six policing divisions, including my own patch in North East Fife. The research team was led by world-renowned expert Professor Linda Duxbury, who was brought over from Canada at the request of the Scottish Police Authority, Police Scotland, the Scottish Police Federation and the other unions. The research could not be any more up to date—I received it just this week.
When I challenged the First Minister on the matter earlier this month, I knew that officer and staff absences had increased by 11 per cent and 25 per cent respectively. The First Minister's solution was that we should just carry on as we are. However, carrying on with the status quo—making no change—will not repair the damage.
I was astonished to see the Cabinet Secretary for Justice say that he was
“very satisfied the support structures are in place for those officers for their mental wellbeing to be addressed.”
So 35 per cent of officers—more than a third—are turning up to work mentally unwell and only 3 per cent of them think that Police Scotland cares, yet the justice secretary is satisfied. He should be ashamed of such an out-of-touch and dismissive remark.
On the subject of being ashamed, is Willie Rennie ashamed that the last time that the Liberal Democrats were in power, they oversaw huge budget cuts to mental health trusts, with almost a third of all national health service mental health beds lost and mental health nurse posts slashed? Does he want to apologise for that?
Police officers across the country will be listening to the deputy leader of the Scottish National Party. They will be furious that he has ignored every word that I have just said about the state of their mental health—they will be astonished. He should be ashamed of ignoring their needs and demands. It is outrageous that he is acting in that way.
Calum Steele made it clear that Humza Yousaf’s level of satisfaction was
“not shared by the officers and as such it is difficult to understand the basis upon which Mr Yousaf was able to derive that satisfaction”.
We should listen to Calum Steele. He speaks for the country’s police officers, and he said that he is dissatisfied with Humza Yousaf’s response.
Will Willie Rennie give way?
I will in a second.
Only 3 per cent of officers think that Police Scotland cares, and 35 per cent turn up for work mentally unwell. The Government should be shaken to its core and worried about the state of our police.
When they turn up at work, those very same officers have to deal with increasing numbers of mental health cases in their duties every day. The officers I was out with over the summer told me that that is one of the biggest issues that they face. They said that they need mental health officers in the police force, working alongside them to address that.
Neil Findlay is very much in touch with what is happening. He understands the pressures that our police officers are under, which is exactly what I am about to come on to.
Police officers are not the only ones who are going to work despite being mentally unwell. That is happening around the country in the public and private sectors. What choice do people have when they can wait up to two years to get the treatment that they need? It is tough and there is a serious cost, because waiting an age for help causes people’s health to deteriorate further.
Colleagues in England are rightly complaining about adults waiting for up to 176 days for psychological therapy, which is obviously not acceptable. I do not wish such a wait on anyone, but that is well short of what is being experienced here in Scotland. I long for the day when people can be treated within 176 days, because adults in this country, under this Government, are waiting for 700 days.
The 2017 mental health strategy was supposed to bring all that to an end. Scotland is so far behind that it is frightening, which is why we want a transformation in Scotland’s mental health services.
Will Willie Rennie take an intervention?
I will in a second.
I have spoken before about how the strategy was 15 months late, which delayed critical investment. Today, I want to talk about progress in the years since, particularly against action 15 in the strategy. I will read it out to remind members precisely what it says, which is that the Scottish Government would
“Increase the workforce to give access to dedicated mental health professionals to all A&Es, all GP practices, every police station custody suite, and to our prisons.”
My party asked for that and we had discussions about it with Shona Robison and Maureen Watt when they were ministers. In the end, we were promised 800 additional mental health workers in those key settings. Although we disagreed with the figure of 800, we thought that it was at least a start.
However, the Government has now diluted that commitment. The evidence is in the Cabinet Secretary for Health and Sport’s amendment to today’s motion. The First Minister told me explicitly that the Government had made a commitment and is delivering it, but that is not what was promised. The 800 mental health workers are now going to “a range of” places that merely include
“A&E departments, GP practices, police stations and prisons”,
and the target covers something called “other settings”.
Will Willie Rennie give way?
In a second.
A third of the staff hired so far have been diverted to those “other settings”. The Scottish Association for Mental Health wants clarification and we want clarification. Will the cabinet secretary give us clarification?
Notwithstanding Willie Rennie’s point about psychological therapies, which I do not dismiss, eight out of 10 patients are seen within the 18-week period that is our target for those therapies. There is a great deal more to do, but it is important that we are accurate in our depiction of the overall situation in Scotland.
With regard to the commitment to 800 mental health workers, I am sure that Willie Rennie will recall and agree that we take the lead from our integration joint boards, which understand local needs. “Other settings” incorporates the work that takes place where people need additional help and support. We will give more detail on that later in the debate.
That is fine, but it is not what the Government promised. The Government promised that the personnel would go to
“A&E departments, GP practices, police stations and prisons”,
but so far, we have had a miserly seven and a half personnel for the police. Just think of the number of police stations and custody suites across the country, yet only seven and a half personnel have been placed there so far. That is exactly what Neil Findlay was talking about.
What on earth are we doing to support the police on the front line? What are we doing to support general practices, prisons—we had a report just this week on that very subject—or A and Es? It is all very well and fine for the cabinet secretary to come up with statistics to rebut my statistics, but until the Government recognises and accepts that it is not delivering on the strategy that it promised and that people are crying out for help, we will not move one step forward.
That the Parliament recognises that there is a mental health crisis in Scotland; considers that mental health is not currently being treated equally to physical health, but that it deserves to be treated with the same urgency; believes that this requires the creation of new services, operating 24 hours a day, seven days a week; recalls that action 15 of the Mental Health Strategy stated that 800 additional mental health workers would be added to the workforce in A&E departments, GP practices, police station custody suites and prisons; believes that this is an insufficient quantity to meet the huge unmet demand that exists, and regrets that the commitment has since been diluted, with the latest update showing that more than a third of the staff added to the workforce so far have been attributed to “other settings”, meaning that the police, A&E departments, GP practices and prisons will not get the benefits of the full contingent of additional mental health workers expected; notes recent reports of the increasing stress and mental ill-health being experienced by police officers and staff, and urges the Scottish Government to coordinate a new emergency package of support to increase and upgrade the services available to both them and staff in other public services, and further calls on the Scottish Government to publish the final allocation of staff that each key setting is currently expected to receive, and for it to set a new target for the number of mental health workers it will add in each of these settings, elevating the ambition of its 10-year strategy and getting people the treatment they need fast.14:50
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. Instead, mental health is a significant challenge across the globe and we in Scotland are determined to respond in an ambitious and systematic manner.
Together with our partners in local government, the NHS, the third sector and the wider mental health community, we are focusing on an approach to mental health that encompasses prevention, early intervention and clinical services. We are doing that against a backdrop of a decade of austerity, which has impacted negatively on public services and directly on people across Scotland who rely on public services. The welfare reforms that the current and previous United Kingdom Governments have imposed on some of Scotland’s most vulnerable people and communities have had a particularly detrimental impact on the mental health of the people who often need the most support.
This Government has a strong record of mitigating the worst impacts of austerity, and continues to do so. However, it is not realistic to argue that austerity, which was imposed on Scotland, has had no impact on the quality of life and therefore on the mental wellbeing of people in Scotland.
Will the minister take an intervention on that point?
I would like to make a little progress first, and then I will see whether I have time.
The Government is taking a long-term, wide-ranging approach to mental health issues. We are working with delivery partners and service users to put in place meaningful responses to changing demands and expectations. In 2017-18, our total investment in mental health services exceeded £1 billion for the first time, and in 2018-19 it reached £1.1 billion.
Mental health services will remain a funding priority for the Government in the future. That includes providing targeted funding, such as last year’s commitment to fund an additional 80 child and adolescent mental health services staff, and a package worth £54 million over the past four years to support access to CAMHS and psychological therapies. Mental health services were one of the key priority areas that the Government laid down as part of this year’s NHS board annual operating plan process. Boards were asked to provide their plans to meet waiting time standards for mental health services alongside those for key aspects of physical health services. That work will be intensified in the year ahead.
It is important that we maintain our focus on clinical services, and we will always do so. However, we must also recognise that a clinical response is not always the most appropriate one. For many people, earlier support that focuses on returning to good mental health quickly is the right approach, and the Government continues to build on that. In the two years since we made our commitment to funding an additional 800 mental health workers, integration authorities have been working to ensure that those new resources support early intervention and, where possible, a preventative approach to mental health problems. It is important that those 800 workers are placed where they are—
I notice that the Government’s amendment attempts to delete the word “crisis” from the Liberal Democrats’ motion. Recently, the Royal College of Psychiatrists in Scotland has said that this country is facing a “workforce crisis”—why does the minister think that it has done so?
Through the policies that it is putting in place, the Scottish Government is making stringent efforts to improve the situation. There is a huge contrast between our actions to bring mental health services into line with those for physical health and what is happening—or not happening—elsewhere in the UK. Clearly, a huge Barnett consequential follows from that. Innovative and creative examples are happening locally across Scotland and I welcome the partnership approach that is being taken in prioritising that commitment.
Will the member take an intervention?
I will cover some of the points that Mr Rennie made earlier.
As of October, more than 320 full-time equivalent mental health workers have been recruited and we are on target, with our partners, to recruit all 800. It is important that the Government discusses its policies with partners and it is appropriate that those 800 recruits are in the places where they will make a difference to people.
We are heavily committed to a range of early intervention and preventative services for young people. In partnership with our colleagues in local government, we are investing in school counselling in all secondary schools and expanding the availability of school nurses. We are also investing in counselling across our colleges and universities. The Labour Party supported that but, when it came to the money, it voted against the funding for those provisions.
Through the work of the children and young people’s mental health and wellbeing programme, which is jointly chaired with the Convention of Scottish Local Authorities, we are implementing some of the key recommendations from the Coia task force, the youth commission on mental health and the SAMH audit of rejected referrals. The programme board will oversee the emergence of new community mental health and wellbeing services and support across Scotland. It will also oversee the development of a new crisis service for young people in the year ahead.
The distress brief intervention pilot programme recently won the care for mental health award at the Scottish health awards in recognition of an innovative approach that is providing an “ask once, get help fast” early intervention for people who present in distress and do not need emergency medical treatment.
Will the member take an intervention?
Time is tight and I want to cover one of the main areas that Willie Rennie covered.
Through a strong collaborative approach across different services, the programme now provides support to well over 4,500 people and it has been extended to young people aged under 18.
Mr Rennie spent some time talking about the police and I, too, want to touch on the emergency services. Our emergency services staff work hard every day to keep people across Scotland safe, and their welfare is crucial. They face challenging and at times dangerous situations that can have an impact on their mental wellbeing. The Scottish Government is committing £180,000 to extend the lifelines Scotland wellbeing programme to blue-light responders. Extending the programme is very important for the resilience and wellbeing of first responders in the blue-light services and will ensure that they feel supported, informed and valued.
Mr Rennie mentioned the research that was commissioned by Police Scotland. That research indicates an employer that is taking the mental health of its staff seriously. It is good practice that Police Scotland wants to understand what needs to be done, and we look forward to analysing that research when it is published.
We have in place a 10-year mental health strategy that emphasises the importance of good mental health alongside good physical health. Yesterday, we published an update on the strategy that presented a comprehensive range of work that is being taken forward across Scotland to deliver on and, indeed, move beyond the original scope of the strategy. We will work with partners including members from across the chamber to take an organised and systematic approach to meeting Scotland’s mental health needs, now and in the future.
I move amendment S5M-20035.4, to leave out from “there is a mental health crisis” to end and insert:
“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; believes that this requires the creation of new services to both meet mental health service provision and empower prevention activities that support broader mental wellbeing; recognises the commitment and contribution of those working across Scotland to improve services, implement change and ensure that mental health is given the focus that it rightly deserves; commends the vital role of police officers and staff in keeping communities safe and supports initiatives being undertaken by Police Scotland to create a safe, positive and healthy working environment; further supports the Lifelines project, which works with blue light services to provide trauma support; welcomes that £60 million of investment in additional school counselling services across all of Scotland that is being taken forward in partnership with local government; notes that recruitment, through integration joint boards, is on track for 800 dedicated mental health professional in a range of key settings, including A&E departments, GP practices, police stations and prisons; further notes the steps outlined in the second annual report on the implementation of the Mental Health Strategy, but seeks greater pace in addressing the recommendations of the audit of rejected referrals and the report by the Youth Commission on Mental Health Services; believes 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, and continuing right up to this year with the changes to Pension Credit, and further believes it is clear that Scotland’s example should be followed and that future UK Government social security policies must deliver the same standards of dignity, respect and fairness as Scotland’s policies.”14:58
I thank the Liberal Democrats for bringing this important debate to the chamber. No one in the chamber can deny the growing recognition in Scotland of the need to embark on a step change in mental health support. A staggering one in three Scots are estimated to experience mental health problems, sometimes with knock-on effects on physical health, personal relationships and work.
The Scottish Conservatives believe that it is vital that we move towards parity of esteem between mental and physical health. We need to start valuing mental health as much as we value other kinds of health. We cannot let it be seen as something that can be overlooked. It cannot take a back seat.
We have come a long way in how we value mental health, but there is still much further to go. Scotland could be a world leader in the area, but it is clear that, right now, we are not—nowhere near it. Last year, the mental health themed programme for government promised
“Speedier access to specialist care for all those who need it”,
yet, in that time and under this Government, nearly one quarter of adults wait too long for psychological therapy. That is not good enough. The Government has made a habit of making grand promises and not delivering on them. Mental health is just another area in which the Government’s words are not matched by its actions.
That is particularly a problem among young patients, with the latest CAMHS statistics revealing that almost a third of vulnerable children are waiting too long for mental health treatment. Last year, an Audit Scotland report stated that mental health services for children were too “complex and fragmented”. Even the Scottish Government's own children and young people’s mental health task force published recommendations earlier this year calling for transformational change to mental health services for young people.
Urgent improvements to access to services must be made to ensure that all children get a speedy and appropriate diagnosis. Anything less will fail children and their families. We should be trying to tackle mental health problems as soon as they occur and at the earliest possible age. Instead, issues are going untreated and, in many cases, getting much worse.
The latest figures also show a high number of vacancies for mental health services. The vacancy rate of 8.6 per cent across psychological services is the highest rate ever reported for the month of June. The Royal College of Psychiatrists has warned that psychiatric services in Scotland are facing a workforce crisis and child services are once again in the firing line, with the college warning that data from its 2019 census reveals that one in six consultant posts in the service are unfilled.
We welcomed the Scottish Government's announcement that it would provide funding to support the employment of 800 additional mental health workers by 2021-22. However, progress has moved at a glacial pace. More than two years since that pledge was made, the Government’s figures show that only 327 whole-time equivalent posts have been filled. In addition, only 112 of the 250 link workers that the Government pledged have been recruited so far, which is less than half the promised number. Those targets must be met.
Does Ms Wells accept that, as we are halfway through the period, having half the number of community link workers that was committed to is a reasonable position to be in? Does she accept that it is a collaborative effort with integration joint boards and local authorities?
We have one year left in which to recruit. We have seen the number move at such a slow pace. I just want to make sure that the targets are met, so I am looking for a commitment from the Government. If the targets are not met, it will have a detrimental impact not only on vulnerable patients but on hard-working staff on overstretched wards. We cannot expect staff to be able to fully help their patients when they have far too much on their plate.
As I said, the Scottish Conservatives believe that a step change is required in mental health support. We can be a world leader if we take the right actions now rather than in five or 10 years’ time. In the past, we have called for colleges and universities to appoint mental health champions for students, for plans to have specialist mental health support in every GP practice or hub and for work to ensure that mental health support is provided in every A and E department on a 24/7 basis.
Research has shown that having a mental health problem can increase a person’s chance of feeling lonely. That is why, this year, the Scottish Conservatives launched our loneliness action plan, which includes an increased focus on youth loneliness, improvements to social prescribing, work on connecting communities and implementation of a national awareness campaign. Loneliness is a problem that can have significant side effects regardless of age. It can be linked to a lack of permanence or a lack of a sense of belonging. It affects young people, who often do not feel connected to their local community in this digital world, just as much as it affects the elderly. Particularly as we get close to Christmas, we must remember that many people simply do not have access to the company of others, or they feel isolated despite the many people around them.
Ultimately, the Scottish Conservatives believe that there must be parity of esteem between mental and physical health. That must not be just a phrase; it must be met with action that delivers for patients and staff.
A theme that will come up time and again in the debate is change. We need change in the waiting time targets and change in the workforce numbers. The Scottish Government’s task force is calling for transformational change. In the interests of too many Scots, and particularly our young people, that change must happen now.
I move amendment S5M-20035.2, to insert at end:
“; recognises the workforce crisis across mental health services and that children’s services are among the worst affected, and calls on the Scottish Government to address the concerning number of rejected referrals within the CAMHS service as a matter of urgency.”
I thank the Liberal Democrats for lodging today’s motion on mental health. I associate myself with what has been said about the frankly shocking statistics on police mental health, which Willie Rennie so eloquently covered in his opening speech. It is worth reminding ourselves that the police are more often than not first responders at an increasing number of incidents, and are dealing with ever-more alarming and distressing circumstances. It is imperative that we adequately support our police force in that regard.
We all have mental health. How we look after and treat mental health has rightly become a higher priority across society.
Will the member take an intervention?
I would like to make some progress, please.
Despite the higher profile of mental health, it is still not discussed as much as, and treated on a par with, physical health.
The Liberal Democrat motion raises many important points, simply because there are so many concerns around mental health across the board. It is right to say that there is a mental health crisis, although our colleagues on the Government benches might not agree with that. Although not all the causes may lie with the Scottish Government, it is only right that it should bear the ultimate responsibility for that crisis. Waiting times for CAMHS, underinvestment in services, a lack of staff and a scaling back of commitments are just some of the major issues, as the motion highlights, and more should be done to invest in mental health to create a parity between physical and mental health.
The most recent release of statistics on child and adolescent mental health services shows that three in 10 children and young people are not being seen within the 18-week target. In fact, the waiting time target has not been met during the First Minister’s time in office. In 2018-19, more than 5,000 children and young people waited longer than 18 weeks to access services and support, and a further 7,000 were rejected for referrals to CAMHS, with little by way of alternatives or treatment options being available to those who were rejected.
Those children and young people are being let down now, and the consequences could follow them well into adulthood. The transition from CAMHS to adult services is a quagmire to navigate for many people, which adds to their stress and furthers the trauma, not only for the young person but for the family. That is why Scottish Labour lodged its amendment, which has a special focus on children and young people.
The First Minister’s announcement in 2018 that every school would have a mental health counsellor was welcomed by Scottish Labour, and it remains welcome today. Sadly, however, as Annie Wells highlighted, the pace of implementation means that hundreds of schoolchildren are missing out now on vital access to a school counsellor. There has been a reannouncement of that commitment 14 months after it was made and just days before this debate. Access to a school counsellor who can provide the right level of support at a very early stage has the potential to fundamentally change a young person’s long-term mental health and wellbeing. Surely that is the kind of transformational change that we all want to see.
Returning to the motion, we agree that serious questions need to be answered on mental health worker recruitment. The Scottish Government promised an extra 800 mental health staff by March 2022 in A and E, GP settings, prisons and custody suites. The period for delivering on that is now 50 per cent of the way through, but only 40 per cent of the staff promised are in place. In fact, the promise has been watered down, because a third of the new staff delivered are in “other settings”, rather than in the places where the original commitment guaranteed they would be.
Prisons, in particular, need access to more mental health staff, because we know that the prison population has greater levels of poor mental health. Given my long-standing work on supporting prisoners and their families, I find it disappointing that the announcement appears to have been watered down. Properly supporting offenders and their families is crucial if we are to break the cycle of reoffending—I have seen all too often the impact of failure to support offenders who have poor mental health. It is vital that the proper support and help are available to all offenders. More important, that support must be tailored to meet need.
Mary Fee knows that I share her commitment to the quality of work that is done with offenders. Does she accept that the approach has to be collaborative? If it is not, I will simply direct where any one of those 800 workers goes. I do not think that she would like me to do that.
I agree with the cabinet secretary. I will come on to that kind of approach.
We need to move the initiative along as quickly as we possibly can—the longer we delay, the more people we fail. That holistic, joined-up approach, with good community support, is crucial, as the point of release—I am sure that the cabinet secretary will agree—is often the point of crisis for many offenders.
Our amendment also addresses the unfortunate and tragic rise in the number of people dying by suicide. It is regrettable that we have the highest rate of suicide in the UK. If we do not deliver and fund the wide range of support services efficiently and effectively, before the point of crisis, we will not see any reverse in the number of people dying by suicide. Over a year on since the Parliament debated the suicide prevention strategy, it is imperative that we reaffirm the commitment on suicide prevention that was made in September 2018 by backing the Labour amendment today.
The causes of poor mental health are wide ranging. Inequalities such as poverty can often exacerbate the mental health problems of the most disadvantaged. Only by ending austerity and properly investing in mental health services for all can we create a country that supports and treats the mental health of people and ensures the parity that we all wish to see between physical and mental health.
I move amendment S5M-20035.1, to insert at end:
“; regrets the increase in the number of deaths by suicide, including among young people aged under 25; notes with concern the ongoing long waiting times for access to CAMHS and the lack of support for patients moving between CAMHS and adult services; maintains that reform is needed in specialist mental health services for young people, and believes that investment is needed to transform crisis support, improve early intervention and ensure a joined-up approach is achieved across services, particularly over the festive period.”15:12
My thoughts are with all those who have been affected by suicide and by mental ill health. I thank the people in our front-line services who work so hard to tackle what seems to be a fast-growing epidemic.
Willie Rennie focused on the impact of mental ill health on those who serve in our police service. Earlier this year, Calum Steele, the general secretary of the Scottish Police Federation said that Scotland was in the midst of an “acute mental health crisis”. That is very much how it feels for those who are working on the front line, and they need our support in tackling it. I welcome the opportunity to debate the subject this afternoon.
No one in the chamber would deny that the CAMHS figures and the figures for youth suicides are completely unacceptable, not to mention extremely distressing. Since the audit of rejected referrals was published, CAMHS has refused help for 7,518—one in every five—children and young people who asked for mental health support, and child suicide rates were recently reported to have risen by 160 per cent in Scotland.
The Scottish Greens support a preventative approach. We back calls for teachers to receive mental health training, because teachers are a constant and stable presence in children and young people’s formative years. However, research that was conducted last year by the Mental Health Foundation Scotland revealed that many teachers lack the training and confidence to help them to address mental health concerns with their pupils. I appreciate that the Scottish Government has committed to ensuring that all secondary schools across Scotland have a counsellor from 2020 onwards, but it is absolutely clear that that requires a whole-school approach. Giving teachers mental health training could aid early intervention while helping them to address their own wellbeing, improve retention and lower levels of burn-out. However, the training absolutely must be properly resourced. It must not be yet another responsibility that is piled on to overburdened teachers.
On adult mental health issues, it is clear that employers have an important role to play in prevention. This week’s “Unison Week” reported that mental health issues cause more than 70 million working days to be lost every year, and 300,000 people who have a long-term mental health problem lose their jobs every year in the UK. In 2018, more than 870,000 people in Scotland were prescribed antidepressants.
That makes it clear that the issue affects every workplace, and that it requires a collective, holistic response. As employers—all MSPs are employers—we can be part of that response. Employers need to foster an open and supportive workplace culture by making it clear that mental ill health will be treated the same as physical ill health, and by embedding and normalising discussions about mental wellbeing into everyday work conversations. I am sure that none of us would hesitate to tell our colleagues that we have a stinking cold or a sore throat, but in too many cases there is a reluctance to discuss our mental wellbeing.
A preventative approach must be taken. It is clear that the Scottish Government is not entirely responsible for the devastating impact that UK welfare reform has had on the mental health of too many people in Scotland. Earlier this afternoon, I chaired a meeting with Menu for Change and that issue came up time and time again. We were discussing the fact that we want to see an end to the need for food banks in this country, and the point about the impact of food and work insecurity, as well as poverty in general, on people’s mental wellbeing was made over and over again. When people do not know where their next meal is coming from, it is very hard to have robust, good mental health.
We know that universal credit is having a terrible impact. Earlier this year, SAMH told us that universal credit is not working for people who have mental health problems. A report that SAMH produced highlighted that work capability assessments are not appropriate for people with mental health problems because they do not adequately gauge the impact of those problems and of other conditions that may fluctuate. Many assessors do not have the understanding of mental health and wellbeing that would make them fit to carry out those assessments. The stress that the process causes does nothing to help people who have mental health problems. It is important that Social Security Scotland staff who interact with people who have mental health problems are given the training to ensure that they do so with compassion; I appreciate that work is being done to ensure that.
The Scottish Government has spent about £100 million every year on mitigating the cost of the welfare-imposed austerity of the UK Tory Government. Does Alison Johnstone agree that it would be better for the money to be spent on public services, rather than on mitigating Tory welfare-imposed austerity?
Absolutely. Any social security system that is worthy of that name should be taking a remarkably different approach from the one that we have seen.
We all have mental health, as members have mentioned, and helping people to identify warning signs, triggers and stressors and to develop coping mechanisms can help to grant some autonomy over our mental wellbeing. Mind, the mental health charity, is clear that resilience can change over time and that elements that build it can be introduced into everyday life. However, as I have said before, it is hard to feel resilient when day-to-day life is such a struggle. It is clear that any preventative approach to good mental health must address the link between mental health and inequality and poverty. A Money and Mental Health Policy Institute report has revealed that 86 per cent of respondents said that their financial situation and mental health were closely interlinked. People with mental health problems are often trapped in a self-perpetuating circle and are unable to access the support that they need while we have a punitive welfare system.
I am running out of time. We need to do all that we can as a nation to make it easier for people to initiate conversations about their mental health to get the support that they require.
We move to the open debate. I have let the opening speeches run on a little because of interventions. I ask members to keep to six minutes, please. I call Liam McArthur, to be followed by James Dornan.15:19
The Liberal Democrats have chosen to use our time today to give Parliament a chance to debate what can be described only as a crisis that is facing mental health services. It is right that we do so, and it is consistent with the priority that our party has attached to mental health issues for a number of years—in keeping mental health at the top of the political agenda, in holding the SNP Government to account on its record and in demanding the transformative change that we need in an area that has been overlooked and underresourced for too long. As Alison Johnstone did, I pay tribute to all the people who work in the sector.
As Willie Rennie rightly reminded Parliament, people across Scotland are struggling. Often, when they turn for help with their mental health, that help it is not available or it arrives too late, by which point manageable problems have turned into full-blown crises. I see that locally, in the lack of available psychiatric input and in a child and adolescent mental health service that is stretched to breaking point and is trying to cope with the demand for help and support.
On that last point, I welcome the specific focus of Mary Fee’s amendment on the problems that face CAMHS teams across the country. Annie Wells was right to remind us that one third of children and young people are waiting too long for the support that they need. Alison Johnstone highlighted the fairly shocking statistics on suicide among young people.
It is not just people who experience poor mental health who are being let down. Earlier this week, I was contacted by a constituent who described her experience of caring for a family member who is dealing with mental health and addiction issues. She said:
“I went to the doctor .. they told me that my feelings of complete despair ... was completely normal. That they see this time and again as part of families dealing with addiction. Not once at any of the appointments or admittance to A&E ... did they offer me support or ask me if I was coping, in fact they put the onus back onto me”.
As a direct result of the lack of initial help and support, my constituent and two other family members found themselves needing eight additional visits to the doctor, two prescriptions for long-term antidepressants, one five-day stay in hospital, an ambulance call-out, and two referrals to the mental health teams. That cannot be right on any level. It shows a lack of joined-up thinking, services struggling to cope and a situation being made far worse by its not being addressed in a timely fashion.
However, the Government’s amendment gives no sense that ministers grasp either the scale or the urgency of what needs to be done to address the crisis. That is perhaps best illustrated by the complacent dismissal of concerns regarding the welfare and wellbeing of our police officers and staff. The findings of the new report and academic research that were referred to by Willie Rennie must surely have acted as a wake-up call for ministers. They confirm what earlier surveys, as well as a wealth of anecdotal evidence, have been telling us for some time: police officers and staff are struggling with their mental health and are being let down by those at the top and by this Government.
The full report will be shared with the Justice Sub-Committee on Policing, in due course. However, the details that have been provided by the Scottish Police Federation so far, in response to Willie Rennie’s inquiries, are alarming. They say that 35 per cent of officers reported having gone to work while mentally unwell, that 21 per cent reported high levels of depressed mood, that one in 10 reported drinking alcohol or taking prescription drugs as a coping mechanism, and that almost half of officers suffer from exhaustion.
In response, Jeane Freeman’s amendment asks us to support
“initiatives being undertaken by Police Scotland to create a safe, positive and healthy working environment”.
When 57 per cent of officers reported that a lack of resources to do their work has caused them a high degree of stress, and when only 3 per cent of officers agreed that the national force really cares about their wellbeing, that is not an adequate or appropriate response from the SNP Government.
Will the member give way?
No, thank you.
That response is becoming all too familiar and is very much of a piece with the response that was given by the Cabinet Secretary for Justice when he was confronted recently with evidence of a sharp rise in police officer and staff absences. If the justice secretary really feels comfortable that he is
“very satisfied the support structures are in place for those officers for their mental wellbeing to be addressed”,
that hardly conveys the impression that Mr Yousaf or the Government have grasped the scale, the seriousness or the urgency of the issue. I thought that Calum Steele showed remarkable self-restraint when he suggested that the justice secretary’s level of satisfaction is
“not shared by the officers and as such it is difficult to understand the basis upon which Mr Yousaf was able to derive that satisfaction”.
We ask our police officers and staff to do a difficult and often dangerous job on our behalf. Rewarding them with platitudes while dismissing their clear and consistent calls for more support is not good enough. It is a tough job; however, the job should not be making people unwell on such a scale. That is unsafe and cannot be dismissed, nor can ministers dismiss the findings of the research as being historical or as somehow having been overtaken by measures that they and police chiefs have put in place.
Professor Linda Duxbury’s research could not be more up to date. What is more, it could not underscore more powerfully why Police Scotland, the SPA and SNP ministers were wrong to reject our repeated calls for staff views to be surveyed well before now. Despite the Government, police chiefs and the SPA having dodged the issue for so long, Professor Duxbury’s report leaves them nowhere to hide. They must act, so I urge Parliament to support the motion in Willie Rennie’s name.15:25
I welcome the opportunity to take part in the debate, having been public about my own past mental health problems. I have huge sympathy for police officers who are similarly affected. On many occasions, I have come to work while suffering from poor mental health.
I would like some more detail on the scale of how unwell those police officers have been, because that can range hugely—from feeling stressed about a particular issue that they will face at work, right through to being so depressed, so out of it, that they feel as though they are going to commit suicide. I have experienced every single one of those stages, so I know that we cannot just say that such-and-such per cent feel unwell and that they are all the same. If there is a huge percentage at the top end of the range, we have a real crisis on our hands, but if we find that many are suffering from stress—as we all do, to be honest; I was stressed before I started this speech—the problem is not of the same magnitude.
Is James Dornan telling Parliament that police officers who are revealing their stress to researchers should just suck it up and get back to work?
You should listen to what I say, and then you should intervene based on what I have said, not on what you would like me to have said so that you could get your intervention in. That was absolute rubbish—
Members should remember to speak through the chair, please, and not directly to each other.
I am sorry, Presiding Officer.
It is clear that there is a lot to do. However, the Scottish Government has made incredible strides in mental health support in recent years. Over the current session of Parliament, investment in mental health will exceed £5 billion, and mental health staffing has increased by 76 per cent since the SNP came to office. Mental health is a priority for the Government, for me and—I am sure—for Parliament as a whole.
I am privileged to be one of the co-conveners of the Parliament’s cross-party group on mental health, alongside Emma Harper. We are currently looking into the Scottish Government’s ambitious “Mental Health Strategy: 2017-2027”, particularly the section on prevention and early intervention. As we know, the Scottish Government’s guiding ambition for mental health over the decade of the strategy is simple. The document says:
“we must prevent and treat mental health problems with the same commitment, passion and drive as we do with physical health problems.”
Other members have already mentioned that.
Before I get to the main section of my speech, I want to pay tribute to the cross-party group’s secretariat. The drive and commitment of Suzi Martin of SAMH are taking the cross-party group to new levels, and I think that Emma Harper will vouch for that.
As a co-convener of the cross-party group, I am well aware of the great work that the Government is doing to improve Scotland’s mental health services. It is fundamentally flawed for Opposition parties to claim that it is doing otherwise. We are at the start of a 10-year programme, but members are asking why the Government has not got it all done in the first six months or the first two years.
Since the new Cabinet Secretary for Health and Sport and the Minister for Mental Health took office, the Scottish Government has established a children and young people’s mental health task force—which is backed with £5 million of additional investment—to reshape and improve child and adolescent mental health services. It has published two annual reviews—one of which was released yesterday—of the mental health strategy. The reviews have shown that 19 of the 40 actions that have been laid out are complete, or nearly complete, and that 20 are in progress.
The Scottish Government has set up an independent review of mental health legislation, and has launched Scotland’s suicide prevention action plan. Among its various actions, the plan sets an ambitious target to reduce suicides by 20 per cent over five years. The Government has, as part of that, established the national suicide prevention leadership group. The Scottish Government’s vision of Scotland is one in which suicide is preventable and in which anyone who is contemplating suicide, or whose life has been touched by it, will receive the support that they need.
On top of all that, improving Scotland’s mental health was at the heart of last year’s programme for government. Within that programme are commitments to improve NHS 24’s breathing space service; the extension of online access to cognitive behavioural therapy; expansion of the perinatal support that is available to women; funding of an additional 80 counsellors to work across further and higher education; and additional school nursing and counselling services.
I am delighted by the recent announcement that Glasgow City Council will receive nearly £5 million over the next four years, including £1 million in this financial year alone, to ensure that every secondary school pupil who needs it will have access to professional counselling services by next year.
Those actions—it is not an exhaustive list—represent a transformational change in how our mental health services are delivered. Obviously, our mental health landscape has changed radically since 2017, and many of the changes will take time before results can be fully evidenced.
The Liberal Democrats, to their credit, have repeatedly championed improving mental health over the years. However, I believe that a little introspection from them is in order for today’s debate, because no matter how good our mental health policies are, health policy alone is not enough. The coalition Government, which was discussed earlier, presided over brutal cuts and austerity measures, and the effect on mental health that those have had across the UK cannot be ignored. Such policies have demonstrably had a disproportionate impact on people who are living in poverty, and people with health problems, including mental health problems, are overrepresented in that group.
A report that was published earlier this year revealed that, in about nine out of 10 NHS mental health trusts in England, bosses said that benefit changes in recent years have led to an increase in the number of people with anxiety, depression and other damaging conditions. Lack of money and lack of housing were also said to be contributing directly to increased demand for mental health support. To confirm that view, we need only look at the report of the United Nation’s special rapporteur, Philip Alston. It said:
“Living in poverty can also take a severe toll on physical and mental health. More than a quarter of working-age people in the poorest fifth of the population—roughly those in poverty—experience depression or anxiety.”
It is clear that the impact of growing social and economic hardship in local communities, because of austerity, is devastating and is exacerbating mental health problems for many people.
With all the will in the world, it cannot be said that mental illness exists in a vacuum; politics and our health, especially our mental health, are intrinsically linked. As a Parliament, we should not be trying to score points on the issue; we should be working together to ensure that everybody gets the best mental health support that they can get. I urge members to think about that at 5 o’clock tonight.15:31
I, too, thank the Liberal Democrats for bringing the debate to the chamber and for allowing us to discuss mental health once again.
The fact that the Public Petitions Committee is carrying out a significant piece of work to combine several petitions that have mental health at their centre is an indication of the seriousness of the issue. We have taken evidence from a wide range of stakeholders. Recently, we took evidence at a teachers conference that was designed to allow us to specifically discuss the mental health of pupils and staff. The overwhelming ask was that we ensure that teachers have access to mental health training and support as part of their education. Alison Johnstone brought that point to the fore in her speech. When we are talking about teachers, we may as well throw in the police—Willie Rennie talked about them so eloquently—and people in our Ambulance Service and so on.
Gail Ross and I heard from secondary school pupils with lived experience of poor mental health. They highlighted an inability to recognise poor mental health in themselves and told us that, even if they could recognise it, there was no real plan of action if they should feel their mental health sliding.
I have always said in the chamber that education is a major solution to improving health and welfare, and I believe strongly that investment in education could go a long way in preventing mental health issues downstream. That could have a much reduced cost to the public purse, which would be over and above the most important outcome: our school pupils having much better health and wellbeing. Given that so many people’s slide into poor mental health began when they were at school age, surely education is an obvious area for investment.
I have often thought that if we really want to close the attainment gap, we need to focus on wellbeing. That view was backed up this morning, when I chaired a conference on additional support for learning in Scotland. The conference noted that additional support needs for pupils have increased significantly over the past seven years, with there having been a corresponding decline in the number of additional support needs teachers. The people at the conference said that the result is poorer mental health, as well as teaching staff being under increasing pressure. That will appear on a health balance sheet only further downstream, when the cost will be much greater.
Members will not be surprised to hear that the Health and Sport Committee has also taken up the issue. At one of our recent evidence sessions, social prescribing was highlighted, which is another major element of the solution. The committee has done an inquiry on that, and the report, which I think will be quite hard hitting, is due to be published soon. We had a great round-table discussion, but it only backed up everything that we already know: a more connected social prescribing model would make great inroads into preventing health issues, such as poor mental health, and could be used as an alternative to continually medicalising the problem.
On Monday night, in Perth, the committee heard from psychiatrists who suggested that such an approach would help to clear the way for those with significant and long-standing mental health problems to be seen much more timeously. The problem with providing that kind of support is that there is a lack of access to, and a huge lack of understanding of, social prescribing in the sector.
That brings me on to third sector organisations, because the non-clinical environment is a major part of the solution. We need to focus on service delivery rather than being hung up on keeping treatment within the bricks and mortar of NHS facilities.
Last night, I visited Tynecastle to see the changing room project, which is supported by SAMH, the SPFL Trust and the Big Hearts Community Trust. In that room were men who had stated that they were unable or unwilling to access traditional mental health services. In an environment that they understood, where there was no stigma attached, they were able to talk about and share their own mental health issues. As part of that programme, they can access physical activity. One gentleman described the men gathered in that room as his band of brothers. Two of them declared that they would have been suicide statistics had it not been for the group.
I could not agree more with everything that Mr Whittle has said so far. Does he agree that the allocation of a proportion of the 800 additional mental health workers that I mentioned earlier to what is designated as “other setting” includes some of the places that he is talking about right now?
That is the direction of travel that I am pushing for. I absolutely accept that there is investment in mental health, but I suggest that we should be looking at supporting other areas in the mental health arena that can deliver the kind of treatments that are required. The approach that I described, which involves taking services to those who need them in a non-clinical environment, constitutes effective mental health treatment. I should point out that Hibernian Football Club runs a similar project. We could do much more with the right kind of investment.
I have mentioned to the cabinet secretary on a previous occasion the support that is provided by Ayrshire Cancer Support through qualified therapists. Break the Silence, which provides qualified therapists, has suggested that it could carry quite a lot of the load if it was properly funded. The cabinet secretary will know very well the work of Yipworld and The Zone in Dalmellington. Both organisations work with the most disaffected youngsters in the surrounding areas, but they have lost out on a community funding programme, which has seriously impaired their ability to deliver services. What will happen to those who lose those services? They will undoubtedly appear downstream in health, justice or welfare, experiencing much poorer wellbeing and requiring intervention at a much higher cost.
The Parliament’s greatest failing is that, despite health and education being completely devolved to this place for the past 20 years, which has given it the opportunity to innovate and evolve in a different direction, it has continued to plough the same road, simply tinkering around the edges. The definition of madness is doing the same thing and expecting a different outcome. Money will always be an important part of the solution, but focusing only on that aspect means that the issue is just kicked down the road.
Every policy in this place—in health, education, planning, welfare and justice—should have health and wellbeing as its central objective. Only then will we effectively tackle the mental health crisis that is developing in this country.15:38
Almost every member who has spoken thus far has mentioned young people’s mental health, and it will not surprise members to learn that I intend to focus my remarks on that area. Brian Whittle and Alison Johnstone both mentioned the importance of teachers in supporting good mental health. My first members’ business debate, back in 2016, focused on that issue.
An eighth of the school curriculum content in Scotland is dedicated to health and wellbeing. In fact, if members are really interested, there is a whole page of curriculum content devoted to mental, emotional, social and physical wellbeing. That is before we reach CAMHS, which I will come on to in due course.
The “Youth Commission on Mental Health Services Report”, which was published last year, recommended that
“Mental Health should continue to be embedded within education from an early age in order to strengthen the knowledge and awareness of mental health.”
That is a real strength of our education system, because we prioritise literacy, numeracy and health and wellbeing.
The Government’s amendment rightly points to a reduction in the stigma around mental health. We also know that, at the same time, demand for mental health services has increased as people feel more able to discuss their feelings more openly. The Scottish Children’s Services Coalition has reported that
“20% of adolescents may experience a mental health problem in any given year. These problems disproportionately affect those children and young people from lower income households and areas of deprivation.”
At the Education and Skills Committee’s meeting this morning, we took evidence from the Cabinet Secretary for Education and Skills. There was a clear focus on exam passes and the number of subjects available, but none of us—and I include myself in this—asked a question about the mental health of our children and young people. That is quite a poignant point, when we consider the debate around education.
Willie Rennie will know that NHS Fife has previously struggled to meet the 18-week treatment time guarantee for child and adolescent mental health services, but I know that the Scottish Government is working with boards to deliver the improvements that are required.
What impact does the member think the very high number of rejected referrals to CAMHS has on children’s attainment?
I am not able to give the member a specific response to that intervention. However, I can speak from a professional perspective. In my experience, the front line of a child’s mental health is dealt with by a teacher before the CAMHS referral stage is reached. I will come on to that in due course. A lot can be done in the school community to protect and to build resilience in young people that we should not ignore when we talk about CAMHS waiting times.
On the investment that the Government has already committed to, there is £4 million in 2019-20 for 80 additional CAMHS staff. The number of CAMHS staff has risen by 4 per cent in the past year, and it is up by 76 per cent since September 2017, under this Government. The Government has committed to intervening where boards are falling short.
I will return to the point that I made to Mary Fee, which was about the opportunities that are presented to make interventions before a child reaches CAMHS. We should think back to the design of our school curriculum, which has health and wellbeing at its heart.
The Government amendment calls for a recognition of
“the commitment and contribution of those working across Scotland to improve services, implement change and ensure that mental health is given the focus that it rightly deserves”.
I therefore thank all the teachers working in my constituency who support young people in my community on a daily basis.
On that note, I want to share the story of a remarkable young woman who I met last year. She was excelling at her local high school in Glenrothes and was heading off to the University of St Andrews to study physics—she was a star pupil. However, something then happened: her mental health deteriorated and she had to be sectioned, through no fault of her own. She was desperate to please everyone around her and, as she said, to get back to “being normal”, whatever that was, but she just could not. Eventually, after a period in hospital, she made her way home and decided that she wanted to help others.
She designed something called a mental health distraction box, which contains a variety of items to help keep people’s minds active, such as colouring-in books and stress balls. She recently delivered the boxes to her old school in Glenrothes and to a number of other locations in the town. I pay tribute to Neve Stewart for her bravery in confronting her mental health challenges in a bid to help others.
The Liberal Democrat motion calls for mental health to be treated in the same way as physical health, but we all know that that does not happen for a variety of reasons. If you break your leg tomorrow, Presiding Officer, we will all know about it. We will see you in a stookie and we might see a pair of crutches. People will ask how you are. However, mental health issues are often hidden and below the surface. Because they are hidden, people often suffer in silence. That is wrong, which is why the Government amendment rightly calls for “parity of esteem”, and why that is also a focus for the Government’s “Mental Health Strategy: 2017-2027”.
A lot of the issue is cultural. Particularly in Scotland, the unfair stereotype of masculinity pervades and the strong and silent man is lauded. Suicide remains the biggest killer of men under 50 across the United Kingdom. The Scottish Government’s suicide prevention action plan aims to reduce the rate of suicide by 20 per cent by 2022, which is welcome news.
However, mental health is not just about culture. Between 2010 and 2015, when Willie Rennie’s bosses were in power in Downing Street, about a quarter of people on jobseekers allowance received at least one sanction. In the same period, rates of severe anxiety and depression among unemployed people increased by more than 50 per cent. The UK Council for Psychotherapy has said that the UK Government’s reforms to welfare payments were to blame and that sanctions have had a “toxic impact” on mental health across the United Kingdom.
Liberal Democrat members have come to the chamber today to politick about mental health. They talk about a crisis, but when people such as Neve Stewart are in crisis, they point the finger rather than reflect on their failings when they helped to prop up the Tories in Government. The Liberal Democrats are the enablers of a benefits regime that systematically harmed people’s mental health and wellbeing and that continues to do so to this day. They are the handmaidens of austerity, so shame on them.15:44
I declare an interest in that my wife and daughter work in the national health service and I am a member of Unite the union.
Without a doubt, there is a mental health crisis in the community. In my constituency work, I see more people seeking support to access services that they cannot access. Of course, there are many reasons behind the rise in mental ill-health, including material poverty, unemployment stress, substance abuse, violence, loneliness, low self-esteem and social pressures.
The extent of the problem can be seen in the number of antidepressants prescribed in our country. Information that I got in the summer from NHS Lothian tells me that in the previous 18 months, 900,000 items of antidepressants were prescribed. There are only 800,000 people living in the Lothian region. For the whole of Scotland, that figure was 1.2 million items of benzodiazepines prescribed and more than 3.5 million items of SSRI—selective serotonin reuptake inhibitor—antidepressants. I am not knocking the use of those drugs; I fully understand that they are exactly what some patients need, but those figures are absolutely extraordinary.
In 2018, 67 per cent of drug deaths were from street or prescribable benzos alone. I will give way to the minister if he will tell us what is being done about the huge level of deaths from prescribed and street benzos—792 people in 2018. Does the minister want to take that opportunity?
Thanks for the opportunity. There is a piece of work going on within the Scottish Government to look specifically at prescribing. In addition, on scripted benzos, there is work being done in the task force looking at the range of support that is provided to people in a clinical setting to make sure that it is appropriate.
How many times do we hear that there is a piece of work going on? How many times do we hear, “We are working at” something, yet we do not see any material change and there are people dying on the streets—three died in Dundee last night?
Does Neil Findlay agree that it is about time we had a debate in Government time on Scotland’s drug death emergency, to hear more about the strand of work being led by the task force?
Absolutely. Ministers should not hide from that; they should bring it forward. If they are positive about what is being done, let them bring a debate forward and we will engage with it.
Yesterday, I hosted a group of pupils and staff from Whitburn academy’s award-winning be herd group. They told me about their project, which addresses mental ill-health head on. They have changed the culture of the school so that pupils, staff, parents and anyone associated with the school can access support and a safe space in the school to talk and begin addressing a range of issues. I hope early next year to bring that project to a members’ business debate so we can all listen and learn from what is an amazing piece of work.
I will raise some of the issues that those young people raised with me yesterday. They spoke about unacceptable waiting times for CAMHS, and about how they and their peers who are suffering from such things as eating disorders or self-harm, or who have had suicidal thoughts, have been left to wait for months or years for CAMHS support—and when they did get help, it was severely lacking. They told me that it was only when their condition got to the stage where they were at death’s door, or when they had penned a suicide note, that they got the support that they needed. Those are their words, not mine.
I say to the minister that desperate parents in my constituency and region tell me that kind of story time and again. This is an appalling state for our child mental health services to be in. If someone is in mental health crisis, they need help today, not in 10 months’ or a year’s time. The young people spoke about waits to see a psychiatrist or a psychologist. I have people in my caseload who have been waiting 10 or 12 months for a first appointment—so much for having a treatment time guarantee. Yesterday, I read this statement on the Care Opinion website about St John’s hospital general psychiatry:
“I have been in the mental health system for a long time. However I have not been seen by a psychiatrist in over a year. My appointment earlier this year was cancelled due to there being no psychs (not that I’ve ever seen the same one twice!). Today I attended an open clinic appointment, this is how they do things now”.
That individual had to wait for three hours and when they were finally called in, they saw a nurse, not a psychiatrist. They stated:
“It now looks like I’m going to be discharged from services without even being seen by a doctor”.
The person writing that is a nurse.
That is what is happening in our community. We have heard people today talking about parity of esteem. Those young people told me that they hear politicians talking about that all the time, but nothing moves on.
They spoke about the need for their project to be rolled out in every school, and most tellingly, about the need to address the issues of inequality, deprivation and poverty and the impact that those are having on their health and well-being and their family, friends and community.
There is an immediate crisis, and, for many people, there is nowhere to go other than A and E. Even then, when people are seen—I have recent experience of this myself—they get discharged from A and E back into the community with no idea where they will go. They have often left a stressful family situation and they are just fed back into another cycle of problems.
I know that a number of people have visited the Penumbra crisis centre in Leith, which takes people on a self-referral basis, keeps them safe for the night—or a few nights—and helps them to access services. That is the only service of its kind in Scotland. We need such services for emergency care for people in a crisis to be rolled out across the whole country
I was glad that Willie Rennie mentioned the police. As I said, I went out with the police in Livingston over the summer. All six cases that we dealt with that day had a mental health dimension—some more extreme than others. The police told me that they were not trained to deal with that.
You must close, please.
They were trying their best, but it was a sticking plaster approach. We need mental health teams embedded in our policing. I hope that the minister will raise some of those issues when he sums up.
Before I call Mr McDonald, I say that all parties have had extra time already. We are now running short of time, so please be stricter in your timings.15:51
I begin by giving credit to Willie Rennie and the Liberal Democrats, because it is often the case that when Opposition parties use their debating time they choose to split it between two subjects, and that can often lead to debates that are truncated and feel rushed. I pay tribute to the Liberal Democrats for spending their entire time debating an exceptionally important issue, which should allow for some deeper analysis.
On the debate that we have heard so far, one of the difficulties is that the term “crisis” is often used and misused in our public debate. There is no getting away from the fact that there are significant and serious issues within our society in relation to mental health and wellbeing. However, it would also be fair to say that progress is being made.
At the most recent NHS Grampian briefing for MSPs and MPs, we were told by Lynne Taylor, the clinical director for CAMHS in the north-east, that 91 per cent of Aberdeen city and shire patients are now waiting less than 18 weeks to be treated, although there are still some issues in the Moray area.
Mary Fee raised the issue of rejection of referrals. We were also told that although on paper it looks like 23 per cent of referrals are rejected, only 4 per cent of those rejections relate to a failure to meet the CAMHS criteria. Often it can be about the age of the patient who has been referred, or the fact that a person is seeking advice rather than treatment, which leads to a rejection of CAMHS treatment.
Will the member take an intervention?
I have a lot to get through, but I will take an intervention if it is brief.
I want to say first, however, that a lot sits below the headline statistics on these issues. That is not to take away from the need to tackle them, but it is important that we understand what sits below those headline statistics.
I agree with the member about the need for that deeper analysis, but one of the statistics that alarms me is the 160 per cent increase in suicide by those under 18 between 2014 and 2018. What does the member say about that?
I was about to come onto the issue of suicide, and discuss it in perhaps a slightly wider context than just young people. However, one suicide is a tragedy, let alone the number that we see on an annual basis.
As MSPs, we recently we had the opportunity to undertake suicide prevention training, which was provided by SAMH. I attended a session with Liam McArthur and Finlay Carson.
One of the key things that came across at that session, as we talked about people who reach out to us as MSPs or personally, was that the vast majority of such people do not actually want to kill themselves. However, they get to a stage at which they are unable to reach out to, or to find, anybody who is able to convince them that that is not the correct way to go.
What Monica Lennon said highlights the need for us not only to focus on services such as CAMHS and what I would describe as points of contact for people who are in a state of crisis. We also need to take a step back and look at what early interventions are necessary and where they are best placed. Jenny Gilruth made important points relating to that, such as how education, as a service, can be more attuned to the needs of young people.
We also need to think about peer and community support. Brian Whittle mentioned community charities and voluntary organisations, and I will highlight two examples from the north-east of Scotland. Man chat Aberdeen was established in June this year by local stand-up comedian Wray Thomson. We have heard the statistics on men and suicide, and Jenny Gilruth highlighted that men are more likely to close up about their mental health and wellbeing. The group was designed as a means to encourage more men in the north-east to open up about their mental health and wellbeing and to do so in a supportive environment, where they do not face the potential stigma of coming into contact with statutory services. The organisation has grown exponentially in terms of the number of men who are getting in touch with it, and it is having a positive impact on and real benefits for the men who attend the meetings.
For people at the other end of the age spectrum from those who Monica Lennon talked about, the positive impact of men’s sheds cannot be overstated. They tackle isolation and loneliness, which often feed mental ill health in older men.
Both man chat and men’s sheds are examples of community support that help people but that require funding in order to deliver that help. My question is, how do we ensure that funding filters down to such organisations, instead of simply focusing on how much money we spend on statutory services? Those are not the first point of contact for many people who are affected by mental ill health.
With that in mind, I also want to talk about physical health, which complements mental health. I have seen that at first hand through my involvement with jogscotland. I am a member of a jogscotland group in Bridge of Don in my constituency, and, on my mental health and wellbeing, I can say that there are days when the companionship and camaraderie of the group and the conversation that takes place during the jog can be uplifting and can help me get through days when I felt like I did not even want to get out of bed in the first place.
Finally, on the point that Alison Johnstone made about initiating conversations, we also need to reflect carefully on the type of society that we are creating for our children and young people to grow up in, not only in terms of social media—a subject that has been well rehearsed in various debates—but in terms of traditional media. When one of the main breakfast programmes in our country is fronted by a man who will mock men for being open about their emotions and will talk about people needing to “man up”, and when we have magazines that bombard women with negative messages about their body image, telling them that they are either too thin or too fat, we have to ask ourselves what impact that has on the mental resilience of young people who are subjected to those messages every day.
I once again remind everyone about the need for brevity.15:58
The fact that the cabinet secretary’s amendment to our motion begins by asking us to remove the words
“there is a mental health crisis in Scotland”
makes me concerned that the Scottish Government is failing to grasp the true severity of the mental health crisis that exists in Scotland. Therefore, I begin by underlining exactly why that statement is true, and why seeking to remove it should be a mark of shame on the Government’s record.
Mental wellbeing is plummeting in Scotland. I see evidence of that in my portfolio, beyond what has already been highlighted by my colleagues. A Mental Health Foundation survey reported that 51 per cent of teachers said that the pressures of their job had led them to develop a mental health problem such as depression or anxiety, or had exacerbated an existing problem. The same research found that 71 per cent of teachers said that they lack the right training to help them address mental health concerns with pupils, and that only 13 per cent have received mental health first aid training. That is even more unsettling when it is considered next to research undertaken by the National Union of Students in 2018, which showed that the number of students seeking counselling services had doubled since 2012-13. In April 2018, the Prince’s Trust indicated that the levels of young people’s happiness and confidence in their emotional health had dropped to the lowest levels ever recorded.
Let me be clear: the purpose of today’s debate is not to show that there are people in Scotland who struggle with their mental health, but to demonstrate how deficient our response has been so far. Waiting times for mental health services are too long, and the treatment targets for children and adults have never been met. People are waiting for up to two years for the help that they need, which for young people must feel like a lifetime. The CAMHS waiting time target is supposed to be met for 90 per cent of patients, but that has not been achieved since it was introduced in 2014.
The Government often says that things are getting better, but the latest statistics show that, in the space of a year, the number of children waiting for more than 12 months for treatment has soared. In September, reports showed that 735 children were waiting for more than a year to start their treatment; a year earlier, the figure was 208.
This summer, we discovered that some people in Shetland had waited for more than 600 days before starting to receive the treatment that they needed. Sixty-two Shetlanders had waited for more than a year to start their treatment, yet the Government’s target is 18 weeks. As a consequence of such a wait, a problem that might start as something small becomes much worse and, too often, ends in tragedy.
Waiting times are not just numbers that do not add up; they are evidence of individuals who have reached out, only to find that the support that they need is not there. For someone who is at their most vulnerable, that realisation must be crushing.
To be clear, fault in the crisis does not lie with the staff, who do their very best to work with what they have. They work around the clock to deliver the best service that they can. However, we do not have the systems or the staff in place to give mental health the attention that it needs. Based on what we know so far, I am not convinced that we are doing enough to change that.
That much is evident in the Government’s attitude to workforce planning, given the widespread vacancies and the conspicuous absence of an integrated workforce plan. I recognise that our health service is already working with a professional deficit, which of course will be made much worse if we allow any form of Brexit, and I recognise that increasing the workforce by the numbers that are needed will be a massive challenge. However, we will have been defeated by that challenge already if we do not even accept the basic premise of what the numbers show, which is that there is an emergency and that urgent action is needed to do something about it.
The cruel irony is that, by failing to provide basic interventions, we make everything so much worse. Too often, Government spending focuses on reactionary policies that only try to fix problems when they have already reached crisis point. Instead, the third sector often picks up the tab for preventative policies and, without certainty on funding, programmes can fall through and the people who need the services are left in limbo.
Spending time and money on our mental health services is an investment in our people. By investing in our people, we invest in our economy and our communities. What more evidence does the Government need to be convinced that there is a crisis? That recognition is crucial if there is any hope of turning the situation around.16:09
As a non-expert, I will say a couple of things about the underlying causes of mental ill health, the Scottish Government’s response to the related issues that we face and the Lib Dem motion. I do so with reference to two groups. Quite rightly, there has been a big emphasis in the debate on young people, but older people and armed forces veterans have not been mentioned so far, so some words about them would be useful.
Twenty years ago, I served on a council where a Labour councillor who said in public that he was suffering from something called seasonal affective disorder, or SAD, was roundly ridiculed for having said so. In the past 20 years, there has been a substantial change to the way in which the public perceives mental health issues. People are now aware that when days are shorter and we have long, dark winter nights, many people in Scotland struggle to cope with their mental health. For some—especially older people—loneliness and social isolation can feel most acute during the holiday season. Other people start to feel the pressure of paying higher heating bills and the stress of Christmas expenses.
We have to ask ourselves why so many more cases of mental ill health among veterans are being brought to light. I will give members my view, for what it is worth. Really broad sections of the population were involved in the first and second world wars, and when people returned from those conflicts, they were part of the mainstream, as many people shared the same experiences. In contrast, nowadays, people tend to be isolated when they come out of the armed forces and they have to cope on their own with what they have seen. That might account in part for the increase in the numbers of mental ill health cases. However, there are different reasons for that, and we should spend some time—perhaps not in a debate such as this one—looking at the underlying causes of the increased incidence of mental ill health in modern life.
I am pleased that the Government has recognised some of the additional pressures and is putting money into the pockets of those who need it most in winter: young families, those with additional needs, or those who have caring responsibilities. Those entitlements include the December advance payment of the carers allowance supplement, along with winter heating assistance. Together, they make up the most progressive welfare package anywhere in the UK, and they have helped to offset the crippling effects of UK welfare reforms since 2010, as Alison Johnstone and others have mentioned.
I think that the Government is doing a great deal, but there is no question but that more can be done. I accept that, and any Government has to be open to that charge and must constantly be challenged.
I question the basis of the Liberal Democrats’ motion. Given their shameful role as the midwife to Tory Government cuts, which Jenny Gilruth mentioned, it is surprising that the Liberal Democrats are today criticising the SNP’s pledge to increase investment in mental health services by claiming that the 800 additional mental health workers promised by the Scottish Government are insufficient.
Alex Cole-Hamilton rose—
I will not take an intervention.
The Liberal Democrats appear to forget the toxic policies that they enabled as willing coalition partners.
Will the member take an intervention?
I have already said that I will not take an intervention.
Those policies had a devastating effect on mental health services across the UK. When they were last in government, the Liberal Democrats oversaw mental health trusts being hammered by budget cuts, almost a third of all NHS mental health beds lost and mental health nursing posts slashed. I know that they do not want to hear it, but they have to take responsibility for the actions that they have taken.
Will the member take an intervention?
Mr Cole-Hamilton, I think that the member has made it quite clear that he is not taking your intervention.
We should celebrate the progress that has been made in tackling some of the issues around the stigma of mental ill health, which I mentioned earlier, so that people feel more comfortable about coming forward to seek professional help. It is a great injustice that, during a time in which demand for mental health services was increasing, the Liberal Democrats, in the coalition Government, were working to undercut provision. That is the contrast with what the SNP Government has tried to do. It has made strong commitments to—
Will the member take an intervention?
Does Keith Brown have anything to say to police officers in Scotland who are struggling as they currently are? In particular, does he have anything to say about the way that they feel about their bosses?
I have just said that I want to focus on the area of armed forces veterans, who suffer similar issues to police officers. I accept that someone who has a job in which they regularly see traumatic events will be subject to extraordinary mental pressures—that will be true of emergency workers across the piece.
As I also said earlier, there is always more that the Government can do. However, it is also important to take a balanced view and point to the measures that it has already put in place, which will help the very police officers that Willie Rennie has mentioned.
Such measures include providing intergenerational support for families and children to prevent and reduce the impact of adverse childhood experiences. As others have said, steps are being taken to improve mental health provision in secondary schools. In my area, the readiness for learning approach that Clackmannanshire Council is implementing as a way of supporting mental health and wellbeing has been extremely effective. The SNP Government’s attainment challenge funding has also been helpful. Under the latest programme for government, it also established the mental health collaborative to provide better support to adult mental health services throughout our public services, including the police.
The Scottish Government is delivering a fairer Scotland for those dealing with mental health issues at every stage of life—from children who have experienced trauma to older people living with dementia—through an approach that treats them with dignity and respect. If the Liberal Democrats’ motion had recognised that Scotland is leading the way on that across the UK, perhaps it would have been more effective. The Scottish Government is improving policy and practice and is focusing on prevention, early intervention and integrated care. When the Liberal Democrats call on the SNP Government to elevate its ambition, their hypocrisy is difficult to ignore, given their shameful history of aiding and abetting Tory austerity.
I believe that the Government’s approach can be trusted to deliver its vision for Scotland: a nation in which people can get the right help at all stages of their lives, expect recovery and fully enjoy their rights, free from discrimination and stigma.16:09
I associate myself with the remarks in many of the speeches in the debate, particularly those made by Annie Wells and Willie Rennie.
I will focus on the issue of post-natal depression and the effect that it can have on many people, not only women but men and families. Many of us will be aware that one in 10 women are affected by post-natal depression after the birth of their child. What surprised me when I looked into it further is that the same proportion of fathers can also experience post-natal depression in different ways.
Post-natal depression often comes on soon after the birth of a child, but it can go undiagnosed until a child is up to two years old. One of the issues is that we often think of it as the baby blues, occurring in the first few months, and we forget that it can continue to affect both fathers and mothers for months and years after the birth of a child.
There has been good movement within society over the past number of years. We now recognise post-natal depression as an illness and see it as something that can be treated and helped with, and both doctors and employers are far more sympathetic towards it. I asked permission from my wife to share the fact that she went through severe post-natal depression after the birth of our twins. Initially, she did not recognise the condition and neither did I. It was not until a friend pointed it out that she was able to get medical help.
That leads me to the first challenge that we face. I was interested that the Liberal Democrats mentioned GPs in their motion. For many people—particularly women but also men—it is important to get medication, but to do that they need an appointment with their GP. I am sure that all of us have been contacted by constituents who tell us how difficult it is to get that initial appointment, having either to phone up or to get to the surgery in time. We need a system that provides a quicker way for people to see their GP and get the medication that they need to help them.
Another thing that can help—it certainly did in our personal experience—is self-help groups. I will mention one in particular in Edinburgh called Juno, which was founded in 2015 by women who had experienced post-natal depression and wanted to support other women. They run a number of volunteer-led groups to which people can go to be listened to and to talk, and where they hope that people who have had a similar experience can relate to them. The former Minister for Mental Health, Maureen Watt, visited the project about a year ago and was very impressed by it.
The second challenge—not just for the Scottish Government but for local authorities—is that many such organisations are grass-roots organisations that are run by volunteers with no structure behind them. All they require is a small amount of money for some premises and for coffee and teabags. However, they are often the organisations that struggle most to get funding, because they do not have volunteers who are experts at filling out forms for charitable applications and they are often ignored by joint boards because they are too small.
A challenge for us all in the Parliament and the local authorities is how to fund those grass-roots charities. They need only a tiny amount of money, but with that money they can make such a big difference to many local communities. There is no easy answer to that, but it is something that we need to reflect on across the chamber. Of course we need to fund big charities and organisations, but how do we fund the small local groups—whether here in Lothian, in Ayrshire or up in the Highlands—that are helping individuals to turn their lives around and deal with mental health issues, whether that is post-natal depression or so many other things?
I welcome the debate, although I think that it has been more politicised than it needed to be. We all want the same thing; the challenge is to come together not just to score political points but to help those with mental illnesses to get better and to enjoy fulfilling lives.16:16
I, too, was able to go out on patrol with my local Police Scotland staff over the summer and I was very impressed by their work, as indeed I am by the work of all our blue-light emergency services staff across Scotland. They face numerous challenges with skill and courage and those challenges can have an impact on their mental health. The comprehensive extension of the lifelines Scotland programme, which assists police, firefighters and ambulance personnel, is very welcome.
Confirmation that the Government has committed to recruiting an additional 800 mental health workers across police custody, A and E, GP practices and prisons is also welcome, as is the news that nearly 400 of those workers have already been recruited.
According to NHS figures, at any given time, approximately one in six adults in Scotland experience a common mental health problem. Across the UK, mental health problems are a major risk factor for suicidal behaviour and are one of the major contributors to disability. However, mental health problems are not equally distributed across Scotland’s population. Adults living in the most deprived areas are approximately twice as likely to have common mental health problems as those living in the least deprived areas, and GPs are consulted about problems with anxiety twice as often in areas of deprivation as they are in the more affluent areas of Scotland.
There is an established link between social status and mental health, with problems thought to relate to the level, frequency and duration of stressful experiences and the extent to which social and individual resources and sources of support reduce their impact. The stressful experiences that have an adverse impact occur across life and include poverty, poor housing, family conflict, unemployment, childhood adversity and chronic health problems. Trauma that is experienced in childhood follows some individuals throughout their lives. The link between adverse childhood experiences and poorer life outcomes is well established, and it is incumbent on us all to work towards a society where protective factors are in place to offset that damage.
The Scottish Government is working hard across all five main areas of its mental health strategy to put in place protective factors that start at birth. In Scotland, we recognise that early intervention trumps crisis management, and we welcome the creation of the mother and baby unit centres of expertise in NHS Lothian and NHS Greater Glasgow and Clyde and the community perinatal mental health services across Scotland.
I am pleased that the Government is listening to what young people say about their mental health needs. Scotland’s youth commission on mental health reported in May this year that young people need mental health support from everyone who is involved in their lives and not just from specialist services. The commission, which is the first of its kind, is made up of young people, and they have recommended change not just to mental health services but to the entire system. Young people are asking for standardised frameworks, a person-centred approach, reduced waiting times and a focus on prevention, with schools and communities embracing enhanced roles and responsibilities so that it is possible for each child and young person to access the right service at the right time. That is another strand of getting it right for every child.
The Scottish Government has listened and responded in key areas of provision for young people, including on a national 24/7 crisis support service and self-referral community wellbeing services. It will invest £60 million in additional school counselling services across Scotland over the next four years. In Dumfries and Galloway, which is one of the areas that I serve, that means an increase in spending of £1.9 million. In the Borders, the increase is £1.2 million. About 7 per cent of the funding is to be distributed to schools that are located in rural areas, which is good news for South Scotland and other rural regions.
By September 2020, all secondary school pupils in Scotland who need it will have access to professional counselling services, including during the school holidays, which will ensure continuity of care. The Scottish Government has already committed £20 million to increase the number of college and university student counsellors. Funding to increase the number of professionals working in child and adolescent mental health services has grown by more than 50 per cent under the SNP.
Most of the additional £250 million that has been invested in mental health over the next five years will be spent on services for children and young people. The children who need CAMHS are often at the sharp end of public service provision in Scotland. They include children with the most acute needs and sometimes they are looked-after children who are caught up in children’s hearings. Whatever the route to the CAMHS door, they are our children and young people and they deserve a prompt, effective, well-resourced service. No such child should be turned away or have to endure a long wait. By investing in them, we are investing in the future of our country.
In Dumfries and Galloway, which is part of the South Scotland region that I represent, more than 96 per cent of young people are seen by CAMHS within the target times, but that success is not replicated across Scotland. The service is rightly under close review, and the youth commission on mental health has recommended that the target time between referral and being seen be reduced to eight weeks.
The 2019-20 programme for government includes a clear focus on how the reduced waiting times for CAMHS and psychological therapies will be achieved. For the first time, NHS boards will have to address trajectories in their annual operational plans so that funding is tied to performance. Reassurance should be taken from the fact that the Scottish Government has stated that it will intervene if boards fall short of delivering what is promised. Children and young people in Scotland deserve no less. Their rights must be observed and I am pleased that the SNP Government is demonstrating its absolute commitment to that obligation.16:22
Yesterday, the Health and Sport Committee took evidence from senior management of NHS Tayside. On Monday evening we met members of the public and people who work in healthcare in Tayside to find out what they think about local services. Lots of critical issues came up at those meetings, but the issue that stood out above all others was the crisis in mental health. It is not confined to Tayside, but it is urgent in a region in which there are exceptional levels of drug and alcohol dependence, suicide risk and mental illness.
When crisis point was reached, NHS Tayside asked Dr David Strang to carry out an independent inquiry into mental health services in the region. His interim recommendation was that the board should call a halt to its planned centralisation of services until the whole way in which services were delivered had been properly reviewed.
Despite that recommendation, the board has pressed on with its planned changes. The chief executive, Grant Archibald, told the Health and Sport Committee yesterday that the board had no choice: if it did not make drastic and immediate changes, its ability to deliver training in the relevant disciplines would be jeopardised, and a far worse crisis would ensue. He also told the committee that there was simply no way of filling all of Tayside’s vacancies for consultants in psychiatry, and that the board therefore intends to set aside 10 of those vacant posts and instead seek to recruit 10 nurse consultants.
If the chief executive of NHS Tayside is right in his analysis, there could hardly be a starker example of urgent and fundamental service redesign under the pressure of events being the only way for a broken service to continue to deliver at all. That means, by implication, that the people of Tayside have been let down over an extended period by an operating model of mental health services that was no longer fit for purpose—if it ever had been.
Looking forward, David Strang’s final report in the new year will be critical to what happens next. His recommendations must surely carry weight, not just with NHS Tayside but with Government ministers.
The case for reform of delivery of services is also clear from child and adolescent mental health services in NHS Grampian, which was mentioned by Mark McDonald. Eighteen months ago, only 27 per cent of young people in Grampian were being seen within the 18-week target, which is significantly less than in other areas and in other services.
One of the causes of that has been addressed in the course of this year. Mental health services for young people in and around Aberdeen used to be spread across three locations on two sites. Children and young people might have needed two or three appointments just to access services, and mental health staff spent far too long travelling between sites, when they could have spent the time seeing more patients. It is no wonder that waiting lists were so long.
The whole service is now together on one site, which used to be the site of the City hospital in Aberdeen—as the cabinet secretary knows from her visit there. It is a custom-built and user-friendly unit that has been designed in part by young people. I visited the new Links unit this past month, on the day on which Jeane Freeman opened it. The change in how services are being delivered is clearly already making a real difference.
NHS Grampian, of course, faces a different challenge from that of NHS Tayside. Funding per head of population and staffing levels in mental health services in NHS Grampian are barely half what they are in NHS Tayside, and the young people’s mental health service in NHS Grampian remains the lowest staffed in Scotland.
However, although NHS Grampian services faces such fundamental challenges, service redesign has clearly made a huge difference in only a few months. Percentages can fluctuate from month to month; the latest figure that I have seen is that 70.8 per cent of young people across Grampian now access services within 18 weeks, which is more than twice as many as in 2017. That is real progress, but more needs to be done in NHS Grampian and elsewhere.
I also acknowledge a remarkable example of a contribution by young people to the improvement of mental health services. For their 10th birthdays in 2017, Jago and Carmen, from Banchory, got to see Ariana Grande at the Manchester Arena. They were not injured in the terrorist atrocity that happened that night—at least, not in any physical sense—but how they view the world was, of course, changed forever. They resolved to turn their traumatic experience to the benefit of other people of their age. Together with their friends, they set up the #kidsforcamhs campaign to raise funds for kids’ mental health services in and around Aberdeen. They have already raised £14,000 and have been recognised for their efforts as finalists in the Scottish health awards in Edinburgh earlier this month. That was a fantastic achievement for a group of youngsters who are between nine and 12 years old. They are determined to raise even more money next year. For those young people, as well as for the NHS across Scotland and the Scottish Government, there is still a lot more to do.
In different ways, NHS Grampian and NHS Tayside demonstrate the urgent need for reform, and local leaders who make change happen deserve support. That leadership needs to be national as well as local, and that urgency must inform the whole approach to mental health services across the country in the future.16:28
I am pleased to be taking part in today’s debate, and I join Mark McDonald in commending the Liberal Democrats for putting one subject up for the whole afternoon. It makes for a more satisfactory debate.
I agree that mental health needs to be taken as seriously as physical health. In fact, as members have said, we cannot separate physical and mental health—we are complete human beings so we need to look at ourselves and each other holistically. I throw in the point that our spiritual health is also important.
Just as there are many varieties of physical ill health, there are many varieties of mental ill health. In both cases, a simple problem might be easily sorted, but multiple factors are often involved, and it takes time to deal with them properly.
A range of problems can lead to mental ill health. As Alison Johnstone and the Greens and Keith Brown have said, poverty, inequality, and insecure work can all be factors. Loneliness and isolation were issues that we looked at when, in the previous session, I was on the Equal Opportunities Committee, of which—if I remember rightly—Mary Fee was the convener.
The public sector is not always best placed to deal with issues like loneliness. Rather, that is often done by family, friends and neighbours, and by the third sector, which has the time and the capacity, through use of volunteers, to befriend and spend time with someone who is lonely. The public sector absolutely has a part to play in improving the nation’s mental health, but we should not think that it can deal with the problem all on its own.
In Parliament, we are talking about mental health much more than we used to, and the public are talking about it. That is good, but it probably raises expectations of what we can do to improve things.
Men, in particular, are talking more than they used to about their mental health. That is especially thanks to the openness of some high-profile footballers and other sportsmen. Traditionally, men have not been as good as women at opening up about their feelings—except, perhaps, after consuming serious quantities of alcohol—and there seems to be a gender aspect to mental health issues. In the NHS Greater Glasgow and Clyde area, depression has been shown to be 144 per cent higher among women. Conversely, anxiety is higher among men. Perhaps unsurprisingly, mental health related drug deaths are 65 per cent higher in men, and mental health related alcohol deaths are 71 per cent higher.
Resources are also an issue. Financial resources have to come from somewhere—primarily from more tax or from reallocating resources from elsewhere. I do not see any mention of that in the Lib Dem motion. Asking for improved services or more spending is all very well, and I accept that it is one of the roles of Opposition parties, but a responsible Opposition party will also be willing and able to state where such resources should come from.
Will the member take an intervention?
I was expecting an intervention from the Lib Dems, but I will take one from Brian Whittle.
I am a bit quicker than Willie Rennie. Obviously, finance is hugely important, but surely how that finance is spent is of equal importance. That is what I was trying to allude to in my speech.
I accept that point. How we spend money is important, and there is always room for improvement on that, but we are constrained by our total resources—of both money and people.
If I read the motion correctly, the Lib Dems are asking for more than 800 extra mental health workers. It is worth remembering that we are near full employment in the country, so we need immigration rules to be relaxed if we want to increase the labour force, for that and other reasons. Beatrice Wishart touched on that point. I accept that the Lib Dems want us to remain in Europe, and that they want freedom of movement and therefore more workers to be able to come into the country. Other parties have not been quite so honest about that.
During the summer, I was out with the police, as other members were in their areas. A major theme that came across to me from speaking to police officers was the amount of time that they are having to spend with folk who have mental health issues. They include very serious cases in which individuals threaten, or have attempted, to commit suicide. Social work and health service staff might not be able to attend quickly, so police officers are required to stay for hours with a person who has a serious mental health problem. If the police take a person to the NHS—for example, to A and E—that person cannot just be left there: the police must wait until the person is seen, which might take hours.
I was taken aback by the suggestion that between 20 and 40 per cent of police time can involve incidents that have a mental health element. It has been reported that in one year—I think that it was 2016—there were 57,000 mental health entries on the police database. Calum Steele of the Scottish Police Federation said that it is a “fundamental failure” of the system that the Scottish Ambulance Service can
“step back knowing that the police service will be there”
I do not think that that is a criticism of the Ambulance Service, social work services or hospital A and E services, but it seems to be strange that other services can say that they are overstretched but the police cannot say no. There has to be a better way to deal with such cases than tying up so much police time.
I agree that mental health is hugely important. It deserves a huge amount of our attention and a commitment of our resources.
We move to the winding-up speeches. I call Monica Lennon to speak on behalf of the Labour Party.16:33
I am grateful to Willie Rennie and the Liberal Democrats for bringing this debate on the worrying mental health crisis and the urgent action that needs to be taken to best support all our constituents. Several members have rightly spoken about the impact of austerity, poverty, inequality and universal credit. Mary Fee, Beatrice Wishart, Annie Wells and others have talked about the pressures on our public services and workforces, including teachers and, of course, the police, as set out by Willie Rennie.
Others, such as Jeremy Balfour, James Dornan and Mark McDonald, talked about their personal experience, directly or in their family, which reminds us that we all have mental health, and that perhaps we have more in common than we realise.
In opening for Scottish Labour, Mary Fee set out why we support today’s motion and why our amendment focuses on issues regarding young people, including the worrying increase in death by suicide among Scotland’s young people, the pressures on CAMHS and the need to boost crisis support, especially over the forthcoming festive period.
As I said to Mark McDonald, suicide in young people who are under the age of 18 has steadily increased—there has been a 160 per cent increase since 2014. All of our thoughts are with everyone who has been affected by suicide. I will touch briefly on Lanarkshire, where I live. Communities have been saddened by the tragic loss of young lives to suicide recently, including in my daughter’s school, which brings it very close to home.
I recently told the First Minister about my young constituent, Kyle, who completed suicide earlier this year, aged just 14. Kyle and his mum went to their GP, but crisis support was not made available, and he was told about long waiting times for specialist CAMHS services. Devastatingly for his friends and family, he died just a few days later. Kyle’s brave mum feels that, still, not enough is being done to help young people and their families when they experience poor mental health.
We have all talked about CAMHS services being under increasing pressure. I know that in Lanarkshire, there have been significant increases in the number of referrals and urgent referrals. Other members talked about the impact on education and the role that teachers often play by being there on the front line and picking up the pieces. I was looking today at the submission from the Educational Institute of Scotland, which says that 76 per cent of education professionals describe themselves as being stressed frequently or all of the time.
We heard about some encouraging developments. The minister talked about the distress brief intervention scheme, which was piloted in NHS Lanarkshire. It has been very successful, and the extension to 16 and 17-year-olds is welcome. I join Joe FitzPatrick in commending the board and the staff who picked up their recent award at the Scottish health awards. The minister will be aware that SAMH is calling for the national roll-out of DBI for those who are aged 16 or over. I would be grateful if he could give a commitment to that today.
Ministers know that Government investment in school-based counselling has long been an ask of Scottish Labour and others, and that North Ayrshire Council has led the way on that. We all desperately want to see that rolled out in all schools without any further delay.
The minister said at the beginning of the debate that the Government has made a number of meaningful responses. However, I say gently that warm words—which, often, end up being just warm words—are meaningless to families who continue to fall through the cracks of services that do not have enough of the right resources, such as youth services, education and the NHS. All of us know families who have struggled to access crisis support. Too often, people are given the poor choice of having to turn to either a busy and noisy A and E or the police. We have heard today some really harrowing testimony, from Willie Rennie and others, about the impact on our police officers.
We know that mental health crises do not happen just within nine-to-five hours. Our community mental health teams need to be better equipped to offer a truly 24/7 response, and to provide a trauma-informed response. My brave constituent, Karen McKeown, has publicly spoken out about the barriers that she faced prior to her partner, Luke, completing suicide between Christmas and new year two years ago. Karen and Luke were passed from pillar to post; they were turned away from mental health services, partly because of previous substance misuse, only to be told by addiction services that they would have to seek separate help for mental health. There should be no wrong door.
Karen gave compelling evidence to the Public Petitions Committee on the need for change. I see Brian Whittle nodding, and I note that he was in tears that day. I share Karen’s disappointment at both the Scottish Government’s response to the committee and the fact that her petition was closed last week. I urge the Government to listen more carefully to people such as Karen—who has already met the Minister for Mental Health—and to take urgent action.
I will try to finish quickly.
Several members have spoken about staff. A member of staff shared with me their experience of the lack of support that is available in community mental health teams. They said:
“Staff are feeling not listened to and unable to provide the patient care they feel they could if they had the right facilities ... There are often no rooms available to see patients who have been assessed as higher risk, who are often mentally distressed and under the influence of substances.”
That is what is happening on the ground. Scotland is facing a mental health crisis. I urge the Scottish Government to redouble its efforts to end the long waiting times and the unnecessary barriers that too many Scots are forced to endure.16:40
I am pleased to close the debate for the Scottish Conservatives, and I welcome the opportunity for the Parliament to debate mental health. Willie Rennie and Liam McArthur outlined the importance of mental health for so many individuals and families across Scotland. I have always supported the call for mental health and physical health to enjoy parity of esteem and I welcome cross-party support for that, but as Neil Findlay has outlined, at the core of this debate, that means nothing if it is not backed up by services when people need them.
We have heard about the extent of the Scottish Government’s failings across the range of mental health services—in adult mental health services and especially in CAMHS, as Annie Wells rightly highlighted in our amendment.
I have to say to SNP ministers that their attempt to delete the word “crisis” from the Lib Dem motion is cause for concern, because for many members—as has been outlined in the debate today—when people come to speak to us at our surgeries, we see the crisis in mental health services that so many people and families face across our country today.
On the key points that have been made about our public sector, it is important to note what has been said about the police service and about the people who work in our NHS. They are often at the forefront of the crisis for many of our fellow Scots. We have seen some progress in trauma-trained emergency services. That is welcome, but it is also a response to that crisis, and we need to see the preventative side being brought forward. That is something about which we have not heard from ministers.
Mary Fee talked about young people in her contribution. I welcome that, and it is really important to mention The Scottish Sun’s mind the future campaign in the debate.
Almost a third of children are waiting too long for mental health treatment in Scotland. The most recent figures show that more than 30 per cent of children are not being seen within the 18-week waiting time target. I have heard ministers say that they agree that that is unacceptable. It is also deeply concerning, given that all of us know about the importance of early and swift treatment of children’s mental health problems. Such interventions can make a difference in preventing less serious issues from developing into much more serious ones that can last into adult life, a point that Barnardo’s Scotland made in its helpful briefing for the debate. The number of referrals for treatment that are rejected by CAMHS is a huge concern. Too many families are being left to cope on their own.
Audit Scotland has warned that it is “not clear” how SNP ministers will meet the crisis in mental health services. Ministers should take that warning on board.
We have heard that workforce planning is not fit for purpose. The Royal College of Psychiatrists has talked about a “workforce crisis”, with children’s service provision being among the worst affected. Indeed, the college’s 2019 census revealed that more than one in six consultant posts in children’s mental health services in Scotland is unfilled. That is causing the excessive waiting times that too many of our fellow Scots continue to face.
Neil Findlay talked about Lothian, which is also my region. Parents regularly contact me about the horrendous delays that their children are experiencing. They are told to come back when their children get worse. That is not on, and we need to see action. We see our health services letting down some of the most vulnerable children and young people in my constituency, and that is simply not acceptable.
The Cabinet Secretary for Education and Skills has joined us. I welcome the fact that he has been in attendance, because we need a cross-portfolio approach.
Last week, Tommy Sheppard and I attended a student round-table meeting at the University of Edinburgh. That university is doing a lot of good work in setting up support groups to look out for vulnerable students. I praise it for that. Many students at the University of Edinburgh are international students, and support is needed out of term time. It is telling that the volunteer support group of peers warned us that they now need support, because they have taken on so much of their fellow students’ concerns. That support is not there for them. I think and hope that there is an opportunity there. I intend to write to the cabinet secretary about those student’s proposals, and I hope that we will be able to bring forward solutions.
I am proud of the fact that, over the past few years, Scottish Conservatives have worked closely with mental health organisations and have argued for a range of new policies to improve mental health services, including boosting social prescribing, increasing awareness and tackling some of the underlying issues, such as loneliness, that often lead to many Scots having poor mental wellbeing. Many brilliant health charities are working across Scotland to try to turn the situation around. We should be supporting them and expanding the services that they provide.
Jeremy Balfour made a most excellent speech. He talked about the need to provide family-centred and person-centred support. I hope that we will look at how we fund smaller community-focused groups, which often need only a small amount of funding to sustain or start up a service.
Lewis Macdonald and Jenny Gilruth spoke about the positive work that young people are undertaking. Young people were in the public gallery at the start of the debate, and I hope that they understand that the Parliament will listen and take forward these issues.
More action is needed from ministers in order to achieve what we want and to build best practice. Building anything other than the best crisis service in the world is simply not good enough for our fellow Scots. If anything comes out of today’s debate, I hope that it will be that ministers understand that not everything is fine in Scotland. Many of us have real concerns about where our mental health services are going, and I hope that ministers will work with parties from across the chamber when we bring forward suggestions. At the moment, it feels as though we are not taking the action that is needed. That is not good enough for Scots who need services now.
I hope that ministers will take the debate as a warning call. The Scottish Government has admitted that we have a public health emergency in relation to drug deaths and, increasingly, it looks as though our mental health services are in crisis. We need to see action, and I hope that the Government will take that on board.16:47
Let me start by responding to Mr Briggs. The Government is taking action. People might disagree about whether it is enough and about whether things are being done quickly enough, but I do not think that people can deny that we have taken significant steps, some of which I will cover.
I will try to cover why the pace of what is being done is not as fast as members might want—or, indeed, as fast as I might want. We have a choice between collaborating with partners, which means that we might go at a slightly slower pace than we might want, or trusting me to direct things. If that is what members want me to do, I will happily do it.
Forgive me if I have got this wrong, but I think that Ms Lennon asked me about the associate programme on distress brief interventions. I am happy to let her know that that associate programme for health and social care partnerships is now available. People can use the tools and resources from the distress brief intervention programme to embed connected and compassionate support. If I have not entirely covered the points that Ms Lennon raised, I ask her to let me know and I will get back to her.
Improving mental health by providing the right support in the right place is a priority for the Government and for members across the chamber. I join others in thanking the Liberal Democrats for giving the full amount of their time for the debate; they made an important choice.
Across the chamber, we share the intention that there be parity between physical and mental health, in practice as well as in our attitudinal approach. As the task force that we set up said, that will require transformational change. However, transformational change, by its very nature, does not happen instantly or quickly. That is why we need not only to have a fair debate in which we recognise the steps that have been taken, as Lewis Macdonald said, but to look critically at what more we need to do.
I will set out the steps that we have taken. We are on track to meet the commitment of providing 800 additional mental health workers. We have not diluted that commitment in any respect. Some of what Mr Whittle said points precisely at other settings where the support of mental health workers is important. In part, such provision needs to be led by what local bodies and organisations—including our IJBs, which have responsibility in that regard—tell us about where in their area it would make most sense. As we publish the future projections—
Will the cabinet secretary give way?
I have a lot to get through, but I will try to take an intervention later.
I am happy to give members some information on the projections for where those additional 800 mental health workers—or rather, the 400 or so that we have still to recruit—will be placed.
There is a £60 million investment in school counsellors. I share Mary Fee’s concerns on that—I wish that we could have implemented that commitment as soon as it was announced. However, it involves channelling money and resources through our local authorities to ensure that schools can add value to what they already do, and that takes time to work out. That is why the announcement of the actual amount of money, how it will be disbursed and what will happen with it was made yesterday.
There is additional investment in school nurses; investment in further and higher education counselling services; and mandatory mental health and suicide prevention training in the NHS, which I am happy to report is also offered to teachers in schools. Significant progress has been made in setting up community mental health and wellbeing services. However, as I have said, that is primarily a collaborative piece of work with our local authorities.
I turn to the points that Brian Whittle, Lewis Macdonald, Jeremy Balfour and a number of other members made about the third sector. They made important and powerful points about the range of services that can be made available to help people in areas of their life where they are experiencing mental distress. A lot of that work, if it is done early—which is partly why we have school counsellors, although it also depends on what the third sector can offer us—is critical in preventing those distressing periods from becoming a crisis.
Members made an important point about how that support is funded. Recently, we have invested £0.25 million in third sector organisations of varying sizes to support counselling and befriending support services. However, we need to do more in order to support the small organisations that are doing really good work. As Jeremy Balfour said, they may need only a room from which to work, or even just a kettle or enough coffee—whatever—in order to make their provision work. Nevertheless, some of the organisations that we fund fall below that level.
Brian Whittle rose—
Forgive me, Mr Whittle—I will be happy to sit with you and other members and work out how we might do that as an additional strand of our work. It is critical in relation not only to mental health but to social prescribing specifically.
Will the cabinet secretary give way?
I need to make progress.
As members have said, the number of workers in CAMHS has increased by 76 per cent since 2017, and the number of posts in psychiatry has increased in the past five years. Issues around rejected referrals and transition work—which Mary Fee raised—are very important, and we need to increase the pace in that area.
Lewis Macdonald made an important point about what he described—and what I have seen—in Aberdeen: the real importance of service redesign in which users are involved. That will make a significant difference to the speed of service and the delivery of the right service in the right place, which includes bringing in nutritionists and others. Redesign is critical.
Willie Rennie rose—
Ms Freeman needs to conclude.
I will make two final points, if I may. Context is all, which is why it is important—
Will the cabinet secretary take an intervention?
No, I cannot—I am afraid that I do not have time.
That is why it is important to hear what Alison Johnstone and others are saying about the impact of another Government’s policies on the quality of people’s lives in a way that produces mental stresses and the additional impact on their mental health. We cannot shake our heads and ignore that—it matters. For those reasons, we are happy to support Mary Fee’s amendment, and we ask members to support the Government’s amendment.16:54
In his opening remarks, Willie Rennie revealed to members in the chamber the full extent of the mental health crisis in our police force. I was very dismayed that the cabinet secretary singularly failed even to acknowledge that crisis in her closing remarks. That a third of our police officers are going to work while they are mentally unwell is a worrying indictment of how we in society watch out for those whom we pay to watch out for us. That many are resorting to self-medicating with alcohol and barbiturates, just to get through, is very troubling. That almost half are exhausted should give us all real concern. The situation is made all the harder by the increase in mental health cases that they have to deal with while on shift.
That malaise is not confined to our police service. Ambulance workers repeatedly report high levels of stress and depression. Much of the mental ill health in all our emergency services is triggered by unresolved trauma and stress at work, which is often caused by what those workers have to bear witness to.
Andy Cunningham is my constituent. He is a paramedic at the national risk and resilience centre in west Edinburgh. In a letter to me, which he has allowed me to share, he described the moment that he realised he needed support and was not coping as well as he thought he should. Andy was called to the scene of the suicide of a young woman in Edinburgh. He wrote:
“My feelings whilst trying to retrieve a young deceased female from Leith docks? Nothing. No feeling at all at the time other than I nearly lost her while trying to hook the body in. That night I reflected on why I’d become so numb to death. I had seen 100s of dead people, at the time I’d lost my father, 2 close friends and a cousin to suicide.
I knew what I was feeling wasn’t right. I felt so numb, so alone and it didn’t feel good. I knew it wasn’t normal for one human to feel nothing for another and that’s when I knew I needed to speak to someone. I was lucky, in that I took some time off, found a counsellor that listened and helped with my perspective that in time I was able to return to work. I still see that young girl’s body every day and will do for the rest of my life. Others aren’t so lucky. They are so traumatised by what they see, they are broken. They are broken for life but the lucky ones survive.”
I am grateful to Andy for his courage in sharing that story with me. He describes himself as lucky, and he is in many ways. He found a pathway to support, but there is no bespoke pathway for emergency workers who are experiencing post-traumatic stress. That was represented with crystal clarity in the devastating research that was passed to the Scottish Liberal Democrats, which revealed that only 3 per cent of police officers agreed that the national force cares about their wellbeing.
I am proud to be working alongside Andy Cunningham and other relevant stakeholders in the blue-light service to press the Government to develop a national first-responder trauma recovery strategy.
We need to do much more, however, and not just for blue-light workers. Many members have rightly pointed to the fact that Scotland’s mental health crisis reaches every aspect of our society. As Beatrice Wishart pointed out, the Government amendment removes the word “crisis” from our motion. However, at the start of the debate, Annie Wells demonstrated the depth of the crisis in the workforce. For want of staff, children are consistently being turned away from acute in-patient care at a time of crisis for them—if that is not a crisis, I do not know what is.
The plight of children seeking help was taken up by other members such as Mary Fee and Jenny Gilruth. Mary Fee rightly pointed to the fact that 5,000 children have waited more than 18 weeks for care. There is undoubtedly a correlation between that number and the very worrying and devastating uptick in child and adolescent suicide, which Alison Johnstone, Liam McArthur and Monica Lennon touched on. We are in a crisis.
I must say that I found Keith Brown’s remarks at best indecorous. He used his time almost exclusively to attack my party. There will come a day when he finds something else in the tank to come at us with, but that day is not today. I challenge him to explain to the parents in my constituency whose kids are self-harming and are waiting a year for treatment why they should be satisfied with his cheap attacks on other parties when he refuses to explain his Government’s failure or even acknowledge its extent.
Will the member take an intervention?
I do not have time.
The Government’s response to all that has been nothing short of dreadful. Neil Findlay covered that point with passion. The national mental health strategy was 15 months late and the suicide strategy was later still. If any one of us was struck with appendicitis, we would be in surgery by the end of the day but, if we went to a GP with anxiety, depression or self-harming behaviour, we would join the longest queue in our national health service.
Our services are buckling, and that is nowhere more evident than in Tayside. This morning, I spoke with Gillian Murray, the niece of David Ramsay, who took his own life after being turned away from the Carseview centre. She is still reeling from the fact that the service and the health board have not learned the lessons or taken on the recommendations from the independent review that has been carried out.
The Liberal Democrats have fought and fought again for increased mental health provision. We finally won some sort of commitment when the Government agreed to put 800 workers in a range of settings. However, what are those workers actually doing? Are they even mental health practitioners? We asked the health secretary; she could not tell us. The level of detail, she said, was “varied”. In fact, all the signs are that the Government could not tell us even if it knew, because we have had to ask the Scottish Information Commissioner to intervene. The Scottish Government has refused repeatedly to tell us how the 800 staff will be shared out. We know one thing: the police service has a miserable 7.5 new workers in total so far. How many will it get in the end? Nobody knows. There is no good reason for the secrecy. If there are robust plans, the Government should be able to show us them today; instead, we are told that they need to be kept secret so that that policy can be developed.
The purpose of the debate is to shine a spotlight on the deeply worrying state of our police and their morale; to draw attention to the Scottish Government’s secrecy on the roll-out of the 800 additional personnel for mental health; and to express concern that the personnel may not be mental health professionals but are being diverted to other settings and away from A and E departments, GP practices, prisons and the police. Liberal Democrats want a step change; we want services to really operate 24 hours a day, seven days a week. That would be truly transformational and would get people the help they need and get it fast. There is no reason for the Government to oppose the motion today: it is reasonable and realistic. Only a complacent and out-of-touch Government would object to what we propose and I urge members to support our motion.