Mental Health Services

Part of the debate – in the Scottish Parliament on 19th December 2018.

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Photo of Clare Haughey Clare Haughey Scottish National Party

Thank you, Presiding Officer.

We all have mental health. That is a simple truth, but it has not shaped the services that support our health and wellbeing. For generations, mental ill health has been misunderstood and stigmatised. It has not been treated as being as important, nor has it been treated as comprehensively, as physical health. I know that there is consensus across the chamber that that needs to change.

The Scottish Government is absolutely committed to bringing change to people’s lives. We made Scotland the first nation in the world to introduce a waiting times target for child and adolescent mental health services and the first in the United Kingdom to have a target for psychological therapies. In 2017, we declared our ambition with a 10-year mental health strategy. We are now raising the bar higher. We have an unprecedented opportunity to build a world-class mental health system that works for everyone: today I will set out how we will do that.

We have already committed £0.25 billion of additional investment through our programme for government. Through a comprehensive package, we will take action to reform children and young people’s mental health services; improve specialist services for everyone who needs them; take a 21st century approach to adult mental health; respect, protect and fulfil rights; and make suicide prevention everybody’s business.

I start with the services that support our children and young people. Although specialist services see more people than ever before, waiting times are unacceptable and there are gaps in the community support that is available for children and young people who have less acute issues. Also, there is poor out-of-hours help available at times of crisis.

We have not shied away from open and honest discussions about those challenges: indeed, we commissioned an audit of rejected referrals. When the audit report was published in June, the Government accepted all its recommendations. That is why we established a joint task force with the Convention of Scottish Local Authorities, chaired by Dr Dame Denise Coia, to look at children and young people’s mental health. Dame Denise published her initial recommendations in September and I am pleased that the task force has published its delivery plan today. It is an ambitious programme of work that will inform what can be done by the whole of the public sector, and beyond, to realise our shared ambitions. In support of that work, I announced today that we will invest £4 million, which will be distributed through NHS Education for Scotland, to recruit additional CAMHS staff across Scotland. The staff will be instrumental in supporting the new services that were announced in the programme for government and reducing pressure on the existing system.

It is right that we take immediate action to support the workforce, because it is the heart of our efforts for achieving better mental health in Scotland. I give my thanks to the people who work with children, young people and adults who have mental health issues for their essential work and inspiring commitment.

The programme for government makes clear our commitment to rapid significant change, and mental health is at its heart. I want to ensure that we progress that work quickly and effectively. For that reason, I am pleased to publish today a delivery plan that sets out how we will use the resources and commitment in the programme for government to reform and improve mental health services in Scotland. The delivery plan sets out comprehensive reform of support for children and young people.

We will substantially expand the range of perinatal support that is available to women. From next year, we will provide the educational tools to meet workforce needs, recruit and train primary care psychological therapists and roll out more effective models of supporting perinatal and infant health.

We will ensure that early intervention to support children and young people is embedded in our schools. We will invest more than £60 million in additional school counselling services across Scotland, and create about 350 counsellors in school education. We will have an additional 250 school nurses in place by 2022, and we will enhance support and professional learning materials for teachers on good mental health. By the end of the 2019-20 academic year, every local authority will be offered training for teachers in mental health first aid.

In further and higher education, we will provide more than 80 additional counsellors over the next four years, through investment of about £20 million.

We will improve services for community mental wellbeing for five to 24-year-olds and their families. We want them to have direct and immediate access to counselling sessions, self-care advice and family and peer-to-peer support. During 2019, we will expand the successful distress brief intervention programme to include people under the age of 18. We will make mental health and suicide prevention training mandatory for all national health service staff who receive mandatory physical health training.

I turn to waiting times. In recent years, performance has varied across Scotland. Some NHS boards have regularly met, or have been close to meeting, the 18-week waiting times standard. Others have struggled to deliver over a sustained period. The Scottish Government is already investing £54 million over four years to improve access to mental health services. However, we are not yet seeing the improvement that we need, so we will intensify our actions.

All NHS boards will have in place plans to drive rapid improvement by spring next year. NHS Healthcare Improvement Scotland will work with all NHS boards to support those plans. That will ensure that people get the right help at the right time, without being subject to unnecessarily long waits. That work will be overseen by a new mental health delivery board, which I will chair, that will ensure that progress is tracked regularly and that any obstacles are addressed quickly. The board will drive the actions that are set out in the programme for government delivery plan. I will report on progress to Parliament in the autumn.

It is equally vital that adult mental health services are considered in a coherent and complementary way. We need to put in place a much broader range of services to ensure that our approach is preventive and provides the right treatment at the right time. Our broader healthcare services, community services and wider society need to help people across Scotland to maximise good mental health. We all need to promote what good mental health means in the same way that we promote what it means to be physically healthy. We will drive that change through investment in changing primary care, our work on distress brief interventions, better access to mental health professionals, and our commitment to seeing the delivery of the access waiting times standards.

Alongside that work, we will help people across Scotland to benefit from digital services, such as the NHS inform service, the breathing space service and online cognitive behaviour therapy. The programme for government delivery plan sets out clear actions and timescales for doing the work.

We are also working to protect and realise our commitments to a rights-based approach. Two major reviews are under way: one on the reform of the Adults with Incapacity (Scotland) Act 2000, and one on how the Mental Health (Care and Treatment) (Scotland) Act 2003 meets the needs of those with learning disability and autism. We will continue to support stakeholders who are working to ensure that people can fully enjoy their rights, free from stigma and discrimination.

In August, we published “Scotland’s Suicide Prevention Action Plan: Every Life Matters”, which sets out our vision of a Scotland where suicide is preventable and where help and support are available to anyone who is contemplating suicide, as well as to those who have lost a loved one. As the plan makes clear, I want to build on our good work by reducing the suicide rate by a further 20 per cent by 2022. Collaborative leadership must be at the heart of our approach, which is why we established a national suicide prevention leadership group, under the chair of former Deputy Chief Constable Rose Fitzpatrick. The group will set out its plans to make that vision happen shortly, and its work will be backed by £3 million in funding over the course of this parliamentary session.

We need bold, dynamic thinking to ensure that our mental health and wellbeing is supported as well as our physical health. I am determined to accelerate the pace of change. I have used the word “reform” several times during my statement, and that is what we will see. Achieving that will depend on delivering change across the whole system. We will work in partnership with local government and others, because we must all recognise the role that we have to play and the importance of getting this right together.

We must do that in a way that ensures that the rights of individuals are always placed at the centre of decision making. It is about not just what we do, but how we do it. That is essential to making lives better, to fostering recovery and hope and to bringing the real and decisive change that Scotland wants to see.