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Background Info

In the quarter ending September 2015, only four health boards met the Scottish Government’s LDP Standard performance target for psychological therapy treatment. Ten fell short of the mark. The health boards were asked to ensure that at least 90% of patients who needed psychological therapies started their treatment within an 18-week period. In the same quarter, 13,030 people started their treatment, which meant only 81.1% were seen across the whole of Scotland. This means many were left waiting for access to the support they so badly needed.

It is my understanding that in November 2015, the Government announced that it will make available a further £100 million of funding, which will help to improve mental health services over a five-year period. The suggested improvement programme will see the Government work with health boards to help support them to reach the 90% within 18 weeks target it initially set. With a significant rise in demand for both adult and child and adolescent therapies, 27% for CAMHS and 26.5% for psychological therapies, is it right to expect those in such a vulnerable state to wait so long? The 18 week maximum is still too long to wait for much needed help. I believe this should be reduced from 18 weeks to 14 weeks for adult therapies, and to 12 weeks for CAMHS. This may seem a drastic reduction but the people who approach their doctor for referral are, for the most part, in desperate need of help and expecting them to wait 18 weeks is unreasonable.

I also understand that there has been an increase in workforce levels but is the workforce capable of dealing with the rise in patients? I believe there are other programmes that can be introduced which will help take some of the burden off the NHS while still giving help to those who need it.

On 12 January 2016, First Minister Nicola Sturgeon said “Delivering the very best mental health services is a priority for this government", with money being spent over a four year period, provided to NHS boards, to:

• Improve capacity to see more people more quickly.
• Work with Healthcare Improvement Scotland to redesign local services to be more efficient, effective and sustainable.
• Improve workforce supply and train existing staff to deliver services for children and young people, as well as psychological therapies for all ages.

I fully agree with the first point: improve capacity to see more people more quickly. As I previously mentioned, I firmly believe the times should be reduced to 14 weeks for adult services and to 12 weeks for CAMHS. Expecting vulnerable people to wait longer is unacceptable.

Moving on to the second point, the introduction of more support groups in communities will go a long way to take some of the strain off the NHS but I do not believe that peer groups are the way forward. Giving more funding to existing centres and services, rather than slashing funding, is a way forward.

On 7 April 2016, I spent the day at FDAMH in Falkirk. I met with service users and the staff who provide the services to the community. During my visit, I met with the women’s group and took part in arm knitting. I understand this may not sound relevant to you but it gives these women somewhere to go, they can learn new skills and, most importantly, they have a support network that helps aid recovery. I also met with the staff who deliver the services and it was evident that the work they do is so vital to so many who cannot wait for counselling on the NHS. They also offer services for young people who don’t fall under CAMHS criteria or are between the age groups for CAMHS and the NHS adult services. They offer a variety of services such as befriending, third age befriending, counselling, social prescribing, family and carer counselling, health and wellbeing groups, and the one that should be rolled out across Scotland: the immediate help service. Every single one of these services provide a lifeline for the community.

GAMH had their funding slashed by 40% last year, which changed the service to a short term service of up to 6 months support. Many people need more than 6 months. What happens once they are discharged from the service? They offer 1-on-1 sessions, group activities, young carer's project, carer's project, later life project, and cover the whole of Glasgow. Six months access is not enough.

Penumbra offer services across Scotland and they offer mental health support to almost 1000 people every week. This is a large number. They receive funding from councils but with budgets being slashed across the country, that funding will be reduced too. They offer services such as Projects for young people, projects which work with people who self-harm, and Supported accommodation and supported living services to name a few.

Taking on more staff and training existing staff to deal with people off all ages is a very important move. Does this include primary care staff? GPs are the main point of contact for referral and help in the first instance. However, they, at times, are failing to provide appropriate care.

Not only did I visit FDAMH and contact other services across the country during February 2016, I conducted an online survey, open to those across Scotland, asking them to share their experiences with their doctors, the information given to them about support available, how they feel things could be improved, and, most importantly, the time they waited to receive therapy.

Overall, I found:

• 80% of those who asked for referral received one.
• Out of the 20% who were refused referral, some were not given a reason.
• Half of those who were referred had to wait 6 months or longer.
• Half of the respondents say they were not given the appropriate number of sessions.
• 60% were not told of any support groups nearby, this is despite the fact that the majority believe that being informed of local support groups while waiting for therapy would help.

These findings have highlighted some issues within the health service. Why are only 80% receiving the referral they have asked for? Why not more? This is not acceptable: those who have been referred are obviously deemed serious enough cases for referral, and 6 months is a long time for mental health issues to impact on somebody’s life with no treatment. The people who have been refused a referral and given no reason are fully entitled to be told why.

With regards to the number of sessions a patient receives, what is this based on? I understand that not everyone will need extensive treatment but if the patient feels they are not ready to be discharged from therapy, shouldn’t they be offered further appointments?

A large number of patients have not been advised of available support groups even though they feel they could help whilst waiting for their appointment to come through. There should be more service centres, either attached to the NHS or through a third party organisation (mental health charity). As someone who has looked into starting a support group myself, I found very little information on how to start a group or how to apply for funding for a new group. Having people who have the same conditions to talk to can really help the patient to realise they are not alone and they have somewhere to go where they feel safe and will not be judged.

One of the biggest issues found was the lack of support given by primary care staff and this is something I have experienced first-hand.

GPs need to be given additional training on how to handle and deal with patients with mental health conditions, be it anxiety or paranoid schizophrenia. Doctors see people living with these conditions every day and they should be treated with the same respect and urgency as those with conditions such as diabetes or asthma.

You may not be able to see mental health conditions and all the symptoms and emotional heartache they cause, but they are very real. Yes, there is a stigma surrounding mental health conditions that needs to be addressed but doctors do not seem to help this matter when they do not listen or refuse to refer patients. This needs to change before more people take their lives. Structural stigma needs to be stopped, and fast.

In conclusion, many changes need to be made to the system and how the people of Scotland can access the services they so badly need. Lowering the maximum waiting times, creating and funding more community based services for patients to attend whilst waiting for referral appointments, training primary care staff to a better standard, and reducing the stigma surrounding these conditions will help make Scotland’s mental health better.