Meeting of the Parliament

Meeting date: Thursday, March 30, 2017

Official Report 892KB pdf

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Mental Health Strategy

The next item of business is a statement by Maureen Watt on the mental health strategy. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.

As the Scottish Government’s first dedicated Minister for Mental Health, I have been driven by a simple principle: we must prevent and treat mental health problems with the same commitment, passion and drive as we do physical health problems. That principle is shared across this chamber and beyond, which is why it is at the heart of our new strategy.

Everyone has mental health: for all of us, our health has both mental and physical aspects, but they are not always thought of in the same way. We want to create a Scotland where stigma related to poor mental health is eradicated and where prevention and early intervention are central. We want to be a nation where mental health care is person-centred, recognising the life-changing benefits of fast, evidence-based treatment.

In the past decade, mental health services have changed dramatically. There has been excellent work from the national health service, local authorities and third sector organisations. Staff in all those organisations, at all levels, make life-changing and life-saving interventions every day. However, we all have a mutual ambition to go further. Today’s strategy and its 40 actions set out our starting point.

The strategy has been fundamentally shaped by views and feedback from organisations and service users across Scotland. We received almost 600 responses to our engagement paper and we held public events and meetings. The volume and the content of the responses and discussion demonstrated passion and commitment for change.

In late 2016, the Health and Sport Committee carried out an inquiry into mental health. The committee’s findings were thoughtful and constructive and gave added impetus to the issues that we were developing. The committee raised the importance of child and adolescent mental health, including rejected referrals, early intervention, treatment, and the need for multiple services, such as health, education and local authorities, to work together. The overarching message to us from the engagement was simple: be more ambitious and recognise mental health as an essential part of all health and social wellbeing.

As this is the first national strategy since the integration of health and social care, we have worked closely with the Convention of Scottish Local Authorities in developing it. We will continue to work closely with COSLA as we implement the strategy nationally and locally.

Intrinsic to the strategy—and to implementing the actions and the vision—is a human rights-based approach. A concrete way to do this is to use the principles of participation, accountability, non-discrimination and equality, empowerment and legality—PANEL. The reality of implementing the actions and the development of future actions must continue to keep human rights at the core.

I suspect that we all share the Scottish mental health partnership’s vision of

“a Scotland where people can get the right help at the right time, expect recovery, and fully enjoy their rights, free from discrimination and stigma.”

I want mental and physical health to have parity of esteem in practice. It is there in law already, but people’s lived experience and our data suggest that there is a way to go. Achieving parity will not be easy, but it is vital. We estimate that only one in three people who would benefit from treatment for a mental illness currently receive that treatment. We also know that people with lifelong mental illness can die 15 to 20 years prematurely. That is a major health inequality and I cannot accept it.

To achieve parity of esteem over the 10 years of the strategy we must see and be able to measure: equal access to the most effective and safest care and treatment; equal efforts to improve the quality of care; allocation of time, effort and resources on a basis commensurate with need; equal status within healthcare education and practice; equally high aspirations for service users; and equal status in the measurement of health outcomes.

Improving mental health services and care is not solely the preserve of the health portfolio or the NHS. To tackle the causes of poor mental health, action is required across Government, including in the education, housing, justice, environment and economy portfolios. That is also true of agencies and organisations outwith the Scottish Government. There must be work across all public services to harness the widest range of opportunities to improve the population’s mental health. Without doubt, poverty is the single biggest driver of poor mental health. The fairer Scotland action plan sets out how we will help to tackle poverty, reduce inequality and build a fairer and more inclusive Scotland.

The broader implementation of mental health law must promote a human rights-based approach. We will ensure that that is made clear in statutory guidance. We will also commission a review of current legislation to see whether—and what—further reforms are necessary so that the needs of people with learning disabilities and autism are properly taken into account.

That is not the only legislation that we propose to consider. We will reform the adults with incapacity legislation so that it fully reflects the requirements of the United Nations Convention on the Rights of Persons with Disabilities. In that reform, we propose a particular emphasis on the provision of supported decision making.

We will ensure that improving mental health and wellbeing is central in all new public health priorities. We will challenge the NHS to prioritise the physical health of people with mental health problems and remove barriers to people accessing services. I visited Maryhill health and care centre in Glasgow this Tuesday, and the mental health information station in Edinburgh this morning, and heard first-hand about those challenges. We will focus on prevention and early intervention for children, young people and adults, to help to prevent the development of mental health problems and to step in promptly where they develop. We have already agreed to fund a managed clinical network for perinatal mental health. It is the first MCN in Scotland for mental health and is a significant step forward in achieving parity.

We have made considerable progress in improving access to specialist child and adolescent mental health services, but demand continues to increase. We have listened to concerns about rejected referrals to CAMHS and will commission an audit of those services. Sometimes CAMHS is the right route for young people and, at other times, an alternative would be better. We will look at the whole system—we recognise the importance of not only specialist services but early interventions at tiers 1 and 2. That could be of particular importance to looked-after children.

We will complete the roll-out of targeted parenting programmes to ensure availability across Scotland. We will commission the development of a matrix of evidence-based interventions that can improve the mental health and wellbeing of children and young people. We will also develop a new, separate, 10-year child and adolescent health and wellbeing strategy, which will cover physical and mental wellbeing.

Schools are one of the key places to ensure that the children of Scotland have the care and support they need. That is why we will soon commission a review of personal and social education, the role of pastoral guidance, and counselling services in Scotland. Our aim in that review is simple: to ensure that every child has appropriate access to emotional and mental wellbeing support in school.

We will facilitate work with Police Scotland to ensure that people who have mental health problems who are in contact with the police, or who are in distress, get the help and support that they need. That will include work through our refreshed justice strategy and our distress brief intervention programme. We will also work with the Scottish Prison Service and partners to improve the mental health of prisoners, including young offenders.

We aim to create a social security system in Scotland that is based on dignity, fairness, and respect, and which supports people with mental health problems. Not securing employment is the biggest inequality that people with mental health problems can face. Utilising our new employability powers, we will work across services to support people to stay in, or return to, work. That includes being committed to working with employers to support the mental wellbeing of their employees.

As I mentioned earlier, the physical wellbeing of people with mental illness is of major concern to me. I am committed to ensuring that services such as screening and smoking cessation are supported to help to improve participation rates for those with mental health problems. That will be the start of tackling the 15 to 20-year premature mortality. Other work will be needed and I believe that I can count on the support of many in taking the right steps to address this significant health inequality.

Through our twin programme of investment and reform, we are working to shift the balance of care across health and social care. In the coming year, we project that NHS spending on mental health will exceed £1 billion for the first time. In each year of this parliamentary session, we are committed to increasing that investment, with mental health receiving an increasing share of front-line NHS investment.

None of the improvements to mental health services will be realised without having the right staff in the right place. We will work to give access to dedicated mental health professionals in all accident and emergency departments, all general practices, every police station custody suite, and all our prisons. Over the next five years, that will mean making an additional investment of £35 million for 800 additional mental health workers in those key settings. That increased investment through the NHS for that workforce will be in addition to the £150 million already set out for improvement and innovation. I can therefore confirm today that over the next five years, the total Scottish Government direct investment in mental health will be more than £300 million, which will support implementation of the strategy.

In primary care, we are developing new multidisciplinary models of supporting mental health. That will help to achieve the “ask once, get help fast” principle and better equip people to manage their own health and encourage recovery.

Presiding Officer, as I hope I have made clear, the strategy is not the end of the process—it is just the beginning. The voices of stakeholders and service users have been key to the development of the strategy, and I am determined that they will also be key to its implementation. That is why, to help me to steer the strategy, I will be convening a biannual forum of stakeholders. In that forum, I want to hear stakeholders’ views and get their help—now, and in the future.

To ensure that we learn from what the actions laid out so far have achieved, we will carry out a full review at the halfway point of the strategy. I hope that members across the chamber will be able to see reflected in the strategy the ambitions that they and others have promoted. I believe that the strategy can be built on and developed in the years to come. I believe that, together, we can deliver the mental health support, care and services that the people of Scotland deserve.

Thank you, minister.

The minister will now take questions on the issues raised in her statement. I can allow around 30 minutes for questions and then we will have to move on. I remind everyone that there is a lot of business to get through this afternoon so brevity would be very much appreciated.

I thank the minister for advance sight of her statement.

I begin by expressing my concern, which I know is shared across the chamber, that the Scottish Government has allocated only 45 minutes for Parliament to question the Government on the new mental health strategy.

That said, there are a number of areas within the new 10-year strategy that I welcome and, indeed, that the Scottish Conservatives called for in our mental wellbeing policy statement, which we published at the beginning of December.

The key message from all stakeholders who will be tasked with delivery of the strategy over the next decade in communities across Scotland is this: all the words in the world in a Government strategy will not make the difference if they are not backed up by real reforms and resources.

The previous mental health strategy contained 36 actions. Given that no report card on how those were delivered was ever compiled, will the minister tell Parliament how many of them were achieved?

The new mental health strategy aims to transform services and treatments over the next decade for those who have mental health problems. Will the minister outline to Parliament how progress will be monitored? Will the minister chair an advisory group to drive the strategy’s implementation forward? Will she commit today to provide an annual progress report to Parliament?

When I was elected to Parliament, I said in my maiden speech that mental health was the most pressing issue that our country faces. I am sorry to say that today feels like a missed opportunity. I welcome the fact that the minister said, in the last part of her statement, that the strategy is not the end of the process but just the beginning, because that has to be the case, and I hope that she will consider listening to organisations in the coming weeks and months as we hear concerns about the strategy.

As Miles Briggs will know, it is the Parliamentary Bureau, and not the Government, that determines the work programme in the chamber. The Health and Sport Committee will be able to scrutinise the strategy, which I am sure that it will want to do.

I am pleased that Miles Briggs recognises that the many asks in his party’s manifesto for last year’s election have been met in the strategy. As I said in my statement, we will be putting in place a governance structure to look at how the strategy is taken forward.

Updates on specific actions were, in fact, published online at various times throughout the previous strategy’s duration.

I am happy to give an annual report to Parliament if it wishes me to do so, but—as I said—I am sure that the Health and Sport Committee will want to scrutinise the strategy as it is set out further.

I, too, thank the minister for early sight of her statement. There are actions in the strategy that are to be welcomed, such as the managed clinical network for perinatal mental health; additional mental health professionals for our A and E departments, GP practices, police stations and prisons; and a commitment to young carers.

The publication of the 10-year mental health strategy was an opportunity for us to be bold and ambitious. I was hopeful that, when the Scottish Government delayed the strategy last year, it would listen to concerns that were raised by stakeholders and by the Health and Sport Committee, and that the final strategy would contain the transformative action that is required.

I am, therefore, disappointed that the Government is ignoring Scottish Labour’s plan for investment in school-based counselling and wraparound early intervention support in schools—a plan that was backed by Barnardo’s Scotland just last week—because we know that half of all mental health problems begin before the age of 15. Although it is welcome that the minister has committed to look at rejected referrals, the scope of that audit remains unclear. We are talking about 17,000 children over the past three years who have been referred to CAMHS and have waited for help, only to be turned away. Children and young people should have been at the very heart of the 10-year mental health strategy, but I see that we have to wait for a follow-up strategy on CAMHS.

You must come to a close, please.

Without a solid commitment to investment and action to support early intervention, how can the minister give assurances that the strategy will adequately improve the wellbeing of our children and young people?

With 40 actions in the strategy, it is indeed transformative, and I think that the member will find that most of the asks in her party’s manifesto have been met in full or partially. The audit of rejected referrals to CAMHS is precisely what Monica Lennon has been calling for.

On rejections of referrals to CAMHS, referrals to a range of physical services are also rejected for not being the appropriate action. That is why, in the strategy, we are beefing up the services available to young people and others at tiers 1 and 2. It is also precisely why I mentioned the real importance of education, with a review of personal and social education and of what education and schools can do. We all know that in the curriculum for excellence, all those involved in education are responsible for literacy, numeracy and health and wellbeing, which includes mental wellbeing. We are undertaking the review to ensure that that is happening.

I remind members that the main Opposition spokespeople are given some leeway in the length of their questions, but I ask for brevity in future questions, please.

I refer members to my entry in the register of interests as a registered mental health nurse.

I want to say, first, how much I welcome the strategy and the opportunities that it offers for improved care in mental health. What measures will the strategy put in place to improve equity of access to perinatal mental health services across the country?

I thank Clare Haughey for her question; I recognise her experience in this area. As she said, I have already announced the new managed clinical network for perinatal mental health, which will bring together health professionals who work in the area of perinatal mental health. Expert leadership in that area will identify current gaps in perinatal care and pathways and develop and implement guidelines and best practice to ensure improved standards and that everyone gets the same high level of care, regardless of where they live.

Recruitment is under way for a lead clinician, who will be assisted by additional dedicated maternity nursing and infant mental health experts and managed support and should become operational later this year. The enthusiasm with which the announcement of the managed clinical network has been received is giving me great hope for that area.

The Scottish Government set a target for 90 per cent of adults and children whose GP refers them for treatment for mental health issues to begin treatment within 18 weeks. In December last year, national health service statistics revealed that 22.5 per cent—one in five—were not seen within that timeframe. In fact, the target has never been met since it was set by the Scottish Government in December 2014; between October and December last year, only two health boards were able to meet the 90 per cent target. The minister talked in her statement about getting the right help at the right time and about the ask once, get help fast approach. We welcome that, but what specific action will the Scottish Government take to make sure that those in need of mental health treatment are not subject to excessive waiting times?

Scotland was the first country to introduce waiting times for mental health services. I agree with Annie Wells. As I have said in the chamber many times, I am not content with too many health boards not meeting their targets, although we are seeing excellent progress in some areas—82.5 per cent of people do receive help within the 18 weeks and the median average waiting time across Scotland was nine weeks.

As the member will know, improvement teams have engaged with NHS Forth Valley, NHS Lothian, NHS Ayrshire and Arran and NHS Borders. In NHS Forth Valley, we have seen an over 40 per cent improvement in the health board meeting its waiting times.

Of course, there is so much more to do, which is why we are placing an emphasis on putting more workers into tiers 1 and 2, so that people can have help there and might not need to be referred to CAMHS or adult psychological services, so reducing the number of rejected referrals. The member will see from our summary of actions in the strategy that we intend to take steps in that area.

What provision will be made to ensure that in future young people who have exhibited suicidal tendencies or who have a history of suicide attempts are referred immediately for specialist treatment with no delay?

Every suicide is a tragedy. When a young person needs to be seen urgently by a clinician, that should happen—and it does happen on a daily basis. We are investing in access to CAMHS and we will engage with stakeholders later this year to publish a new suicide prevention action plan by early 2018, which will dovetail with the mental health strategy. It is unacceptable that people are not being seen as they require.

I note that the minister thanked COSLA in her statement. The reality is that this was meant to be a joint strategy from COSLA and the Scottish Government, for the obvious reason that implementing it will require work by the Scottish Government, councils and the integration joint boards. I am sure that the minister is disappointed by Councillor Peter Johnston’s note that was circulated to all councils last night, saying that COSLA was unable to endorse the mental health strategy that is being outlined by the Government today. I should say that Councillor Johnston is the health and wellbeing spokesperson for COSLA and the Scottish National Party group leader in West Lothian Council. Obviously, that is a disappointing start for the strategy.

Can we have a question, please, Mr Sarwar? [Interruption.]

Shona Robison is saying that we missed his welcome for the strategy, but the note says quite clearly that this was meant to be a joint strategy but COSLA is withholding its endorsement of it.

Can we have a question, please, Mr Sarwar?

What action will the Government take to alleviate the crisis that we have with COSLA, and how can we stop cuts to mental health budgets in IJBs?

We can sure rely on Anas Sarwar’s negativity.

As I said in my statement, we have worked very closely with COSLA in developing this strategy—joint work has been going on for months. Peter Johnston welcomed the strategy. We have put further ambitions in it and, of course, we will be working with COSLA and the integration joint boards, post their elections, on making sure that all this works.

How will the new mental health strategy support the development of positive mental health and wellbeing in schools and, in so doing, support young people’s resilience?

I recognise Jenny Gilruth’s experience in schools in this field. We will undertake a review of personal and social education in schools and make sure that all those involved with schoolchildren have the necessary qualifications and support structures to help children in schools. It is clear that upcoming problems with young children in schools are best identified along with parents. It is important that we give parents the tools to recognise that their children might be experiencing distress and to know precisely where to go, which might well be their GP. There is a great opportunity in schools to build our young people’s resilience to enable them to deal with whatever life throws at them.

What provisions are in the strategy to tackle rising levels of self-harm among children and young people in Scotland, and how will we make sure that young people presenting with self-harm are never met with a stigmatising response?

Self-harm is clearly a demonstration of mental distress. I have visited services in Perth, where, in schools at lunch time, there is groupwork with children who have presented with self-harm. That is another area where schools can help. In addition, peer support can be of real benefit in helping children who demonstrate self-harm.

In the chamber, we have previously discussed concerns over children or young people with mental health problems being admitted to non-specialist wards, not least in relation to the issues that the Mental Welfare Commission for Scotland raised last year. Will the minister outline how she intends to address the matter through the strategy?

I advise those in the chamber that I am the parliamentary liaison officer to the health secretary.

With a sore throat.

Yes. [Laughter.]

We have seen improvements in 2016, as reported by the Mental Welfare Commission for Scotland, with fewer incidents of young people being admitted to non-specialist wards. In 2015-16 there were 135 admissions involving 118 young people, but in the previous year, there had been 207 admissions involving 175 young people.

The Mental Welfare Commission for Scotland’s report made six recommendations, many of which were for NHS boards—and NHS boards should address the issues that were raised. One recommendation was for the Royal College of Psychiatrists to address. We are working on that recommendation with the RCP’s representative and CAMHS lead clinicians to review standards and help adult mental health wards demonstrate their ability to provide safe and appropriate care for under-18s who require admission. That measure is set out in action 19 in our strategy. We are also taking action to scope highly specialist mental health in-patient services for young people, looking at forensic CAMHS.

I thank the minister for advance sight of her statement. Despite what she said, there is no commitment to the scale of resources required to deliver the desperately needed step change in services. The Government statement is carefully worded. The minister said:

“We will work to give access to dedicated mental health professionals in all accident and emergency departments, all general practices, every police station custody suite, and all our prisons.”

That is not the same as providing dedicated, trained professionals in all those locations. The Liberal Democrats proposed that measure in our budget negotiations; the Government is pretending to take it. Would it not be more honest to make the difference clear?

There will be 800 extra mental health workers—those are 800 real people, who will be available to be accessed. The Liberal Democrats seemed to imply when we started the budget negotiations that there is a pot of money and that we can have people sitting around doing nothing. We are not in that position. We are making sure that all those areas, including A and E units and policy custody suites, have access to a mental health support worker as quickly as possible.

I welcome today’s statement. The strategy sets out opportunities to pilot improved arrangements for dual diagnosis for people with problem substance misuse and mental health issues. Will the minister outline how the pilots will be identified and whether lessons from them will be implemented nationally?

I think that we all know that mental health problems and substance misuse commonly co-occur and that there are opportunities to optimise how specialist services work together. Those opportunities will be explored in discussion with the integration authorities and NHS boards and by identifying examples and opportunities that can be used to inform national guidance and good practice.

Our pilot work on the distress brief intervention scheme and on transforming primary care also provide opportunities to improve the service response to people with mental health and substance misuse issues. The evaluation of the pilots will provide lessons about outcomes, which will inform future national models.

We also know that having a comorbidity policy in a service is a recognised protective factor in reducing suicide levels. Healthcare Improvement Scotland is working with NHS boards to implement a suicide prevention framework that allows teams to consider comorbidity policies, and to take action to create such policies if they do not have them.

There is a mountain of expert evidence highlighting the importance of inclusivity and physical activity as major tools in the treatment and prevention of poor mental health. If members visit the Combat Stress stand that is currently in the members’ lobby, the people there will tell them how they are using activity to tackle mental health issues. The minister’s statement suggests that she will challenge the NHS to prioritise the physical health of people with mental health problems. However, as we know, the Government is withdrawing funding for jogscotland from 1 April, with the Scottish Association for Mental Health helping to pick up the Government’s tab, so much does it believe in the importance of being active to the mental health agenda. Given the evidence, how can the Government possibly claim that the strategy tackles preventable poor mental health when its actions do exactly the opposite of what expert opinion says?

The Minister for Public Health and Sport and sportscotland are working together on a way forward for jogscotland.

The member makes the very valid point, which I highlighted in my statement, that it is really important for people with mental health problems to have good physical health. That is precisely what I said with regard to the actions in that respect. Those with mental health problems often have poor physical health, and it is important that they get the screening and the tools to improve their physical health. Many of the organisations that work in that space—particularly in relation to tiers 1 and 2—signpost people in that direction to ensure that they have a clear pathway to manage their mental health by improving their physical health.

I visited the Combat Stress stall today, and I note that the Government gives £200,000 a year to the Combat Stress Scotland community outreach service, which aims to provide a better response to the mental health needs of veterans, their families and their carers. I think that most people in Scotland will recognise this Government’s commitment to veterans.

Given that the United Kingdom has been heavily criticised for “grave and systematic” breaches of the United Nations Convention on the Rights of Persons with Disabilities, can the minister tell us whether steps will be taken to ensure that the review of the adults with incapacity legislation complies fully with that convention?

As I said in my statement, we intend to review the legislation in that field to ensure that it complies and is compatible with the UN convention, and that work will follow on from the conclusion of the consultation on the Scottish Law Commission’s report on adults with incapacity. We will look at, for example, new models of graded guardianship, with a strong focus on supported decision making. If necessary, we will amend the power of attorney to help individuals make decisions for themselves and provide clarity in advance on deprivation of liberty and what exactly they would prefer to happen if they were detained.