Mental Health Needs and Substance Use

– in the Scottish Parliament on 26th October 2021.

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Photo of Annabelle Ewing Annabelle Ewing Scottish National Party

I remind members of the Covid-related measures that are in place and of the fact that face coverings should be worn when moving around the chamber and across the Holyrood campus.

The next item of business is a debate on motion S6M-01761, in the name of Angela Constance, on a person-centred approach to mental health and substance use. I invite those members who wish to speak in the debate to press their request-to-speak buttons now. I call Angela Constance, Minister for Drugs Policy, to speak to and move the motion—in up to 10 minutes, please.

The Deputy Presiding Officer:

I am not sure that your microphone is on, Ms Constance.

Can we see what we can do about Ms Constance’s microphone, please, if her card is in?

The Deputy Presiding Officer:

Please resume, Ms Constance.

Photo of Angela Constance Angela Constance Scottish National Party

Thank you, Presiding Officer.

I very much welcome the opportunity to open the debate on ensuring a person-centred approach to supporting people who have both substance use and mental health needs. The link between poor mental health and drug problems is clear. Research demonstrates that more than 90 per cent of those who are most at risk of a drug-related death will experience anxiety and/or depression.

That is one stark reminder—there are many—as to why mental health and drug and alcohol services need to be joined at the hip and why we must be guided by the principles of a person-centred approach. Taking a person-centred approach means that we must ensure that there is no wrong door for people as they seek help and that services are inclusive, easy to navigate and based on the views of lived experience.

As well as listening to and learning from the voices of people with lived and living experience, we must make good use of their skills and talents to improve the way in which services are delivered. Both Mr Stewart and I are more convinced than ever that change needs to be informed and driven by those who understand the system most.

In March this year, I made a commitment to the Parliament that people, families, networks and communities will be more involved in local and national decision making. That is why we are investing in local experience panels and in a national collaborative of those who have lived and living experience. Mr Stewart has also committed to establishing a similar national panel that will advise and inform across all mental health policy.

I have often heard about the challenges that people experience in accessing the services that they need. They regularly describe a system that is overly complex and difficult to navigate, and in which they are passed from pillar to post. That is why Healthcare Improvement Scotland is already helping to develop, in Dundee, an integrated model of care across mental health and substance use services. That new approach has been firmly based on the views of people who have lived—real-life—experience.

Plans are in place to extend that work across four more health board areas, backed by a cross-Government investment of £2.2?million. I am pleased to announce that that will cover Lanarkshire, Greater Glasgow and Clyde, Grampian and Lothian health board areas.

Photo of Michael Marra Michael Marra Labour

Does the minister recognise that it is more than two years since the publication of the Dundee drugs commission report that called, specifically, for far more integration between mental health and addiction services, and that that kind of delay, when people are continuing to die, is a significant issue for people in the city?

Photo of Angela Constance Angela Constance Scottish National Party

I recognise the value of the work that was led by the Dundee drugs commission, and I am determined, along with Mr Stewart, to ensure that we now motor ahead to a phase of work that is far more about implementation and change on the ground. I therefore hope that Parliament will welcome the extension across the country that I have announced of some of the good work that is going on in Dundee.

Photo of Angela Constance Angela Constance Scottish National Party

No; I will perhaps do so if I have time later.

In January, the First Minister launched the national mission to reduce drug deaths and improve lives. At the heart of that £250 million mission is a clear focus on supporting people to access treatment—the treatment or recovery that is right for each individual and happens at the right time.

We need services to offer same-day treatment; a wider range of treatment and recovery options; more overdose prevention measures and related interventions, such as naloxone kits; increased capacity in residential rehabilitation; and more assertive outreach to get people treatment where they are, bring them the protection of treatment, and make recovery a real option.

People already have a right to healthcare that meets their needs. We need to make sure that we are taking every possible action to deliver on their rights, and we need to implement those rights for everybody, including those who live in our poorest communities.

We know that people who are at risk as a result of their drug use often experience a range of health and social care issues. That was set out for us in the “Hard Edges Scotland” report, which was published in 2019. Everything that we are doing to develop a person-centred approach is designed to meet those issues head on, and our national mission sets out a whole-Government approach.

During the pandemic, we have seen rapid changes to the ways in which people access help and support, particularly for people who experience both homelessness and drug problems. In many instances, that has led to people receiving more person-centred care. We have recognised the importance of those changes and invested over £900,000 in Healthcare Improvement Scotland to support four local authority areas to make those changes permanent, improve the pathways of care for people, and support them out of homelessness and into appropriate treatment and care, including mental health and other supports. Further work is under way to ensure that that learning is shared across Scotland.

The medication assisted treatment—or MAT—standards were published in May this year. Implementation of those standards is one part of our overall approach to turning words into actions. I reiterate the commitment that I made to Parliament that those standards should be implemented across the country by April 2022. Those standards for treatment and care are among the key priorities for changing and improving services so that, no matter where someone lives, the right treatment will be available to them when they need it.

MAT standard 9 sets out our commitment that

“people with co-occurring drug use and mental health difficulties can receive mental health care”.

I have been pleased to see that many alcohol and drug partnership areas in Scotland have already begun to embed that standard within their models for delivery. The work of the MAT standards implementation team will be important over the coming months in embedding the standard across Scotland. I will return to Parliament before Christmas to provide an update on that.

I am very aware of the responsibility that we all have in upholding and enhancing people’s right to health and the important role that services play in that regard. For people with alcohol and drug problems, that right to healthcare needs to go well beyond the right to drug treatment and support, and people will need support from a range of services to support their recovery. That is why I am announcing today, to build on our existing work, a rapid review of the services that are required to support people who experience mental health and substance use problems. That will enable us to set very clear expectations for what services should be available and openly accessible to support people with mental health and substance use problems. Those services need to range from life-saving interventions through to psychosocial and wellbeing support for people as they find their own recovery.

The expectations that we set will reach beyond alcohol and drug treatment and mental health services and will include, for example, services for people who have experienced homelessness, violence and trauma, including women who have experienced domestic violence, as well as more mainstream services, such as primary care. We will not forget the important role of the voluntary sector.

A person-centred approach must also ensure that support is available for the mental health and wellbeing of family members. That is why we will publish a framework later this year to improve holistic support for families. That framework will support local partnerships, the workforce and family members to work together in developing local family support services to make them more approachable and accessible for all those who need help and support. That is backed by direct funding of £3.5 million per annum to alcohol and drug partnerships alongside a further £3 million allocated through the Corra Foundation to support the implementation of the framework.

We know that people who experience mental health and drug problems often experience stigma and discrimination. Stigma can have a devastating impact on people’s lives, and it can be a barrier for people to access services and prevent them from reaching out for help and support. We are committed to removing that barrier and tackling the stigma associated with problematic drug use wherever it is found. A national campaign to tackle stigma is being developed with the input of people with lived and living experience and their family members. The campaign will be launched by the end of this year and it will start a national conversation on how we can all play a part in reducing discrimination against people and supporting people to reduce drug-related harm and improve their lives.

To save and improve lives, we urgently need a person-centred approach that does not make assumptions about people or their journeys; instead, actions need to be based on listening and then delivering on the views and needs of people with lived and living experience and their families.

I move,

That the Parliament recognises the importance of ensuring a person-centred approach to supporting those with substance use and mental health needs; welcomes the investment of £250 million into the national drug mission and the £120 million Mental Health Recovery and Renewal Fund; supports the development of better working links between mental health and substance use services; recognises the need to embed cultural change to address stigma and include a trauma-informed approach; considers that treatment and assistance should be offered from the first point of contact and consistently throughout each person’s journey; notes that, when required, outreach services are available to support people to stay in treatment and that services are designed to ensure that this can happen, and recognises that people may also experience multiple and severe disadvantages, such as homelessness and poverty, which require substance use and mental health services to engage other services.

Photo of Sue Webber Sue Webber Conservative

The motion goes some way towards indicating th e complex factors that need to be addressed if we are sincere in our commitment to tackling the problem. The Labour amendment reinforces how difficult it is to access services, and the subsequent pressures on healthcare that that causes. Although my amendment seeks to acknowledge the long-standing challenges that we face, it also shows our commitment to working with the Scottish Government on the issue.

Let us not forget that, long before Covid, the Scottish National Party was presiding over crises in mental health and drug deaths. The drug death rate has almost tripled since the SNP has been in charge. In 2020, 1,339 drug-related deaths were registered—the largest number since records began in 1996. The SNP’s recruitment drive for mental health workers has fallen short of what was expected. In 2019, the Royal College of Psychiatrists warned that psychiatric services in Scotland were facing “a workforce crisis”.

It is encouraging that person-centred care is being talked about again, but we should remember that the SNP’s mental health strategy mentioned person-centred care in 2017, and that its 2018 alcohol and drug treatment strategy stated:

“Services need to be person-centred, trauma-informed and better integrated”.

That ambition is extremely welcome, but it is not new to Parliament.

Under the SNP Government, people still cannot easily access the vital mental health or addiction treatment that they need, when they need it. That is why we have launched our consultation for a right to recovery bill, which would enshrine in law the right to necessary addiction treatment. As the minister indicated in her speech, some sort of movement towards that appears to be coalescing.

Scotland has the highest figures for drug deaths in Europe, and I thought that every member of the Parliament agreed that tackling that was a priority. Last week, however, Lorna Slater, a Government minister, said that taking drugs “is not inherently dangerous”. I found it extremely disappointing to hear that from a minister in a Government that claims that tackling the drug deaths crisis is a priority. Nicola Sturgeon has vowed to address her shameful record on drugs deaths, so she must condemn her minister’s irresponsible remarks.

A person-centred approach to mental health and substance misuse is essential, and we commend that approach. We cannot treat substance misuse in isolation; we must also treat the mental health issues that are so often its root cause. Despite previous announcements and big promises being made in the chamber, the reality on the ground is very different. We need to consider the things that are working and accept the things that are not. The reality of what people must endure when pleading for access to services should shame us all.

Last week, I visited the Lothians and Edinburgh abstinence programme, which follows a truly person-centred approach to recovery. The service was set up and is working within NHS Lothian and, because of its success, other health boards, including Forth Valley, Fife and the Borders, have been in touch to learn more. One of the different things about the service is that patients live off site and travel to the LEAP facility.

During my visit, I was told that nobody has ever been late to one of the sessions. That demonstrates people’s motivation to get better, and it establishes an environment of mutual trust. Many of the people who have been through the programme come back to support the next intake of patients. That peer support is critical to giving those who are new to the programme the belief that they too can recover from their addiction. Every member of staff, from the clinical lead to the chef, works with the patients and, importantly, with their families, to establish and create a unique person-centred approach to recovery.

Ultimately, our treatment of addiction and substance misuse needs to evolve and move quickly towards a preventative agenda. Although we welcome the inclusion in the motion that “a trauma-informed approach” is needed, I think that we all accept that more still needs to be done. My conversations with the WAVE Trust make it clear that the approach must be embedded across organisations, not taken by just a select few managers or senior leaders.

In January, the SNP announced £250 million of funding to tackle drug deaths. The Scottish Conservatives welcome that, but it distils down to only £50 million a year. After suffering years of successive cuts, it is simply not enough money to tackle the issues that people face. The Scottish Conservatives have launched a consultation for a right to recovery bill. The principle that underlies the proposed bill is ensuring that people who are addicted to drugs or alcohol can access the necessary addiction treatment that they require when they want it. To do that, the proposed bill would enshrine the right to necessary addiction treatment in Scots law. Experts whom I have met welcome that and are contributing to the consultation. The FAVOR Scotland chief executive officer, Annemarie Ward, said:

“Nicola Sturgeon keeps playing political football and kicking this Bill into the long grass ... If the First Minister wanted to bring this Bill in, she could start the process tomorrow ... This is a human rights issue which goes beyond politics.”

Drug deaths are our national shame. We lose far too many people each year. The system is broken and leaving people on the streets to die. It must be overhauled by enshrining in law rights such as our right to recovery as soon as possible.

I move amendment S6M-01761.2, to insert at end:

“; notes that people cannot easily get access to the vital mental health or addiction treatment that they need; recognises that Scotland went into this pandemic with a pre-existing mental health crisis, with people seeking mental health treatment being forced to wait far too long for help; believes that progress in the rehabilitation and treatment of addiction in Scotland has been too slow, and calls for a legal right to recovery to tackle Scotland’s ongoing drug deaths crisis.”

Photo of Claire Baker Claire Baker Labour

I welcome the debate and the understanding and acknowledgment of the strong connection between mental health and substance abuse, and the focus on how that is recognised and embedded in treatment programmes and pathways, as well as on how society’s understanding of people who are in the grip of addiction is improved by understanding the mental health challenges that they face and how addictive behaviour can provide an escape from distress and—too often—the experience of trauma.

In September this year, a memorial service was held outside the Parliament on national overdose awareness day, to remember the 1,339 people—the highest number that this country has recorded—who died this year from a drugs overdose. That is unacceptable, and it is a failure of Government. Our immediate challenge is to reverse that record, stop people dying from a preventable cause and press ahead with the harm reduction measures that can respond to chaotic lives and introduce some stability.

The MAT standards that the minister talked about are vital and ambitious, and I want them to be delivered. I accept the minister’s assurances that Parliament will soon receive the progress report that Labour asked for in the debate in June. MAT standards 9 and 10 are critical for the delivery of mental health support, as they recognise the right of people to ask for support for co-occurring drug use and mental health difficulties and recognise the trauma that continues to impact people’s lives and often fuels their substance misuse. The commitments to addressing stigma are also important, and the context in which treatment is accessed and delivered is critical. I do not have time just now to talk about the “National Trauma Training Programme: workforce survey 2021”, which was published today, but it provides important insights that require a response.

Scottish Labour’s amendment recognises that, although the public debate focuses on drug fatality figures, the broader crisis is driven by the interconnectedness of drug abuse and mental health. In 2019-20, almost 15,000 people had drug-related hospital stays, and 92 per cent of them had drug-related mental and behavioural diagnoses, which means the figure has tripled in just over 10 years. Mental health services have been under significant pressure for years. They have been undervalued and underfunded for too long and, following the pandemic, further demands on those services are predicted.

The correlation between drug and/or alcohol misuse and poor mental health is strong. The residential rehabilitation working group report in December stated:

“Studies have consistently shown a high prevalence of comorbidity of mental disorders in people who have problems with alcohol and drugs … Recent research ... on residential treatment suggested that better outcomes are experienced when mental health treatment is integrated into residential treatment.”

Integration of services is crucial, and our amendment uses the example of accident and emergency staff and ambulance staff co-ordinating with drug support services, which I know is happening in Fife. The amendment also highlights the work of Drugs, Alcohol and Psychotherapies Ltd in Fife as an exemplar of a holistic approach to recovery. It offers counselling services for people who are in treatment and recovery, as well as targeting services at families and young people in schools and centres. When DAPL was established, there was local resistance to the centre, which sits in the heart of the Leven community, but it gained community support, because people recognised that it was our folk who needed help—it was their neighbours, families and colleagues.

That the debate addresses substance misuse more broadly is to be welcomed, and I thank Alcohol Focus Scotland, Scottish Health Action on Alcohol Problems and others for the briefings that they have provided. We are right to focus on addressing drug deaths, but investment is also needed in support and recovery services for wider substance abuse, including alcohol abuse. Last year, alcohol-specific deaths increased by 17 per cent. There was a spike after a number of years of reductions. The proportion of those with alcohol dependency who access specialist treatment is low, and more needs to be done to offer them person-centred and responsive services and treatments.

The Dundee drugs commission’s 2019 report is one of many that have highlighted barriers to accessing services for people with co-occurring conditions. Michael Marra talked about his concern about the lack of progress in addressing that. Every contact must count, and we must ensure that providers of drug, alcohol, mental health and other services support individuals in an integrated and accessible way.

The Labour amendment proposes a change to the Government motion. I am not clear whether the Government’s intention is to claim that outreach services are available to support people in recovery at this point in time, but I believe that such support is not yet universally available. Our amendment represents a more accurate description of current service provision.

The Conservative amendment is right to underline the delays in accessing mental health support and the need to improve such access, but its call for a legal right to recovery is a matter for further scrutiny. We need to question whether legislating for a right to treatment is the best way to improve services, to ensure consistency of care provision, and to achieve better delivery of services. We will consider the related member’s bill fully if and when it progresses from consultation to introduction in Parliament.

I move amendment S6M-01761.3, to leave out from “that, when required” to “this can happen, and” and insert:

“with concern that, in 2019-20, there were 14,976 drug-related hospital stays in Scotland, 13,791 (92%) of which included a drug-related mental and behavioural diagnosis, and in the same year the rate of drug-related mental and behavioural stays was more than three times higher than the rate in 1997-98; agrees that those admitted to hospital, treated in A&E or at the scene by the Scottish Ambulance Service need to be linked up with appropriate community-based services to ensure they get the help and support they need to address the underlying drivers of their substance use; regrets that mental health services have been under-resourced for too long with unacceptable waiting times delaying treatment; recognises that outreach services are essential in supporting people to stay in treatment, but considers that more provision is required across Scotland, and that universal counselling services, such as Drugs, Alcohol and Psychotherapies Limited (DAPL) in Fife, must be more widely available to support people in recovery, and further”.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

I welcome the fact that the Government has made time for this important debate, particularly when it has done so in a cross-departmental way. I would like to see more of that, because the issue absolutely walks hand in hand in terms of our response to the drug death emergency and in recognition of its link to mental ill health.

The Dutch psychiatrist Bessel van der Kolk wrote:

“Traumatized people ... feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs”.

It is well documented that people who seek to mask unresolved trauma do so with drug use. The Scottish Liberal Democrats have a long and proud history of putting people at the heart of discussions about the issue. We have long recognised the link between this social problem and unresolved trauma, so I welcome again the inclusion of the £120 million mental health recovery and renewal fund, which my party helped to secure in last year’s budget negotiations.

The drug death crisis that Scotland faces is not just a national scandal of global proportions but a tragedy. Every statistic represents someone who has lost their life and whose life has more often than not been blighted by a set of circumstances that were outwith their control, which has led to a level of suffering that most of us cannot even begin to comprehend.

I have said before and will say again that drug deaths are a symptom of trauma and not simply a cause of it. In 2017, 74 per cent of drug death casualties in Tayside were known to have a co-existing mental health condition. Statistics show that, of those who are sent to prison for drug use, 11 per cent will die within the first month of having been released. Assistant Chief Constable Steve Johnson told the Scottish Affairs Committee at Westminster of the helplessness and hopelessness that his officers feel.

The drug death catastrophe is one of the worst health inequalities in our society. Last year, 96 per cent of drug deaths in Scotland occurred outside the most affluent areas. My office is conducting research into the connection between drug deaths and care experience, because we know anecdotally that the link is disproportionately large.

In some areas of deprivation, drug use has become an almost generational rite of passage, but nobody ever chooses to become addicted to drugs, in the same way as nobody chooses to develop a mental illness. Those who suffer from addiction deserve the same level of care and compassion as those who do not. People are most at risk of death from drug use when they are at their most vulnerable, such as after being released from prison, after a bereavement, after a relationship breakdown, when in poor mental or physical health, or when without a home.

Earlier this year, I was disgusted when I heard reports from Shelter Scotland that several drug-abusing patients were unable to claim housing benefit while in residential rehab. That is a scandal. We cannot brush over people becoming homeless because they need access to rehab. That is a real and present problem in our system. The Conservatives at Westminster may oversee housing benefits, but access to benefits should not be so limited that people must make a choice between obtaining the treatment that they need for a potentially deadly illness—

Photo of Angela Constance Angela Constance Scottish National Party

I will be brief. I appreciate the issue that Alex Cole-Hamilton is highlighting, but is he aware of the investment that I made to address that issue, not at source at Westminster, but to ensure that nobody in Scotland had to make the choice between keeping their tenancy and going into rehab?

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

I was just about to recognise that commitment in my next remarks—the minister has done it for me.

Although I am glad of the focus and resources that the Government is directing towards addressing this crisis, I have serious concerns that they are sometimes directed towards the wrong place. Had my amendment been selected, it would have noted the concern that we have about the Scottish Government’s current attempts to centralise drug and alcohol rehabilitation through the creation of a national care service, my opposition to which is long standing and a matter of public record.

We have seen time and again that the centralisation of public services by the Scottish Government leads to tragedy. I therefore urge the Government to think again and to listen to its own words. Centralising something as fragile and as complex as drug rehabilitation is the very opposite of a person-centred approach and risks making this tragedy even more awful than it is already.

Photo of Gillian Martin Gillian Martin Scottish National Party

I will use the short time that I have today to relay some of the points that I have had put to me by my colleagues in Aberdeenshire Alcohol & Drugs Action, which is based in Inverurie.

Some of the issues that are faced by people in rural areas whom they support can be quite different from those that are faced by people in urban areas, and figures around problematic substance use and its drivers can be difficult to assess.

We are all acutely aware of the figures on national drugs fatalities and their geographical concentration. Certain Scottish cities have acute problems that show up in the devastating concentration of those figures. Often, those concentrations mirror Scottish index of multiple deprivation areas. We know that poverty and multiple deprivation are so often root causes of poor mental health and substance use.

However, those measurements can often miss rural poverty, social isolation that is compounded by geographical isolation and the difficulties that rurality can present in accessing services, which can often be located far away from those who need them.

The chief executive of Alcohol & Drugs Action, Fraser Hoggan, told me that there are opportunities for better joining up of the work of drug and alcohol services with mental health support services, and that many of the most effective support services for people with problematic use are in the third sector.

Photo of Kevin Stewart Kevin Stewart Scottish National Party

Much of what we will discuss in today’s debate—particularly in my closing speech—are suggestions that have come from Aberdeenshire. We have spoken to folks on the front line in Aberdeenshire and we recognise that there is a difference in rural places. Some of the top tips that we are acting on come from folks in Ms Martin’s neck of the woods—I pay tribute to them for that.

The Deputy Presiding Officer:

There is a wee bit of time in hand, so I will give you the time back, Ms Martin.

Photo of Gillian Martin Gillian Martin Scottish National Party

I thank the minister for saying that. The people at Alcohol & Drugs Action are very supportive of the person-centred approach. It is great to see the increased funding for the third sector and to hear that the minister is very aware of some of the things that they have told me. They have said that a better alignment of mental health services with the third sector may ensure better outcomes for people and a more streamlined approach to reaching a dual diagnosis.

We are rightly scrutinising the reasons behind, and the response to, increases in problematic drug use. I have no doubt that many of the contributions will centre on those issues. In my area, the drug action group to which I referred told me that one of the things that it is most worried about during the pandemic and the lockdowns is the big increase in referrals due to the problematic consumption of alcohol, which Claire Baker also mentioned. It said that it has seen such problematic consumption in particular among men and women in their 40s, 50s and early 60s.

Every person who works in drugs and alcohol services to whom I have spoken over the years has highlighted the importance of family support. Since details of my meeting last month with Alcohol & Drugs Action were publicised on my various social media platforms, I have been approached by constituents’ family members who are desperate for support. Can there be anything more terrifying that finding yourself alone and without advice and support as you discover that your son, daughter, partner or parent has a problem with alcohol or drugs? We need to empower families to aid the recovery of their loved ones. The pathways exist, but perhaps they need to be better communicated.

Alcohol & Drugs Action commended the person-centred approaches that have been outlined by the minister, but it called for fewer bureaucratic barriers to make it easier for third sector organisations to fund what it calls the trying of new things, such as programmes that are based on such organisations’ knowledge of and relationships with their service users and communities and, crucially, more support for peer-led programmes. People who have suffered from addiction in the past can often be inspiring to those who are going through such trauma in the present.

I will conclude with a direct quote from Fraser Hoggan. He says:

“There’s a lot of great ideas out there, and we need to find a way to put them into action. We need flexible and innovative local-tailored strategies, as they are key to earlier intervention and the success of preventative measures.”

From what Kevin Stewart said, it sounds to me as though that message has been heard loud and clear.

Photo of Miles Briggs Miles Briggs Conservative

I take the opportunity to again put on record my thoughts and sympathy for all those who have lost their lives to drug and alcohol addiction in Scotland. It is equally important that Parliament acknowledges the strength and campaigning of the many families and friends who are left behind.

For years, I have been calling on ministers to support those families, so I welcome today’s announcement regarding family network funding. It is long overdue and will make a difference in allowing people’s families and friends to support them.

As has been outlined already, access to rehab and treatments is absolutely critical, and I welcome some of the positive steps that are being taken as we look towards putting these reforms in place and, I hope, establishing a right to rehab, including through the bill that is to be introduced by my party leader, Douglas Ross.

In the time that I have today, I will touch on a key issue that I believe is missing from today’s debate, but which is critical if we are to develop a policy solution that will genuinely reduce drug deaths and harms. That issue is housing. Housing is at the heart of stability for each and every one of us across Scotland. For many people living with an addiction, or for individuals who are homeless, a lack of housing often results in the escalation of substance misuse, or issues developing or returning, not to mention the negative impact that that will have on an individual’s mental health.

The housing first model is a good one, but it has not delivered the outcomes that we all want to see from councils. There needs to be more funding for housing. Councils report that they simply do not have the resources to deliver the accommodation that is needed, particularly in the capital.

I strongly believe that housing must be at the heart of the drug deaths strategy—it can, and does, provide the stability that is needed by vulnerable individuals, from people who are homeless or rough sleeping, to individuals leaving prison—

Photo of Miles Briggs Miles Briggs Conservative

I will if I can get some time back.

Photo of Kevin Stewart Kevin Stewart Scottish National Party

Everyone knows about my interest in housing over the past few years, and that interest will continue. Housing first has been a real success, with tenancy retention rates of more than 90 per cent and the involvement of some of the most vulnerable people. Councils have been pump-primed to bring those services into play. That is the right thing to do—it will save them money and, beyond that, it lessens the human cost by getting it right for people. It is the right approach, and I encourage every council to continue that investment, which will save them money in the long run.

Photo of Miles Briggs Miles Briggs Conservative

I agree with those points, but they do not address what I said about getting people into different models of housing—I am thinking of homeless people who want to get into a supported model that includes rehab, for example. I know that the drugs minister has been reaching out to a number of rehab and housing providers across Scotland, including the hugely impressive safe as houses project, which is run by Alternatives in West Dunbartonshire community drug services. That is a great model that could be extended across Scotland. We have not heard anything about it in the debate but I want it to be part of any future strategy. It is important.

I would be grateful to hear from the minister in his closing speech how housing will be an integral part of the response. The safe as houses project is one example of an approach that works in a different part of the country from Edinburgh, where we do not have such a model. I would like to see it here.

The amendment that was lodged by Alex Cole-Hamilton but not selected for the debate makes an important point. I have already raised concerns about the potential for drug and alcohol partnerships to be destabilised by the impact of being brought into a national care service at a point when they are fragile. I note that they are not included in the response that I received from the Minister for Mental Wellbeing and Social Care to a question in which I asked the Scottish Government

“which powers and responsibilities it plans to remove from local authorities under its proposed National Care Service.”

I am interested to find out whether ministers have already had a rethink on that. I hope that they will listen to the concerns and not introduce a top-down reform of drug and alcohol services, which would destabilise them.

I hope that we will develop a genuinely person-centred approach to mental health and substance abuse. If we are to do that, housing must be at the heart of delivering stability and a safe space for people who desperately need it in their lives.

For too long, individuals and their families have complained that trying to access support and drug and alcohol services has been complicated. In some cases, support networks have been cut out and individuals’ decision making for themselves or their family member has been disrespected. People often do not feel that they are in control of decisions about their care, recovery programmes or access to services. That needs to be reformed and I hope that that reform will be delivered.

We are only at the start of the journey to deliver the reforms but I hope that what the minister outlined will make a difference.

The Deputy Presiding Officer:

I call James Dornan, who joins us remotely.

Photo of James Dornan James Dornan Scottish National Party

The topic is difficult to talk about, especially given that, in the past 18 months or so, we have all been affected by loneliness, depression and anxiety as a result of the pandemic.

There has been great progress in Scotland towards creating an environment or society where people can talk about mental health openly and honestly. We have come a long way from chastising people who suffer with depression or borderline personality disorder, telling them to keep a stiff upper lip or blaming them for their own misery. However, there is more for us to do.

We hear a lot about Scotland’s drug deaths problem being a result of poverty, crime or a lack of education. Those social inequities can lead to drug use but I am willing to bet that, more often than not, those issues stem from the same thing that they are blamed for causing: that is, a mental health issue pushes people into crime, poverty or failing in education.

Poverty, crime and illiteracy are descriptors for people—Scots—who are deprived of health, safety and knowledge. The language of blaming the surrounding conditions can have a dehumanising effect on the people whom it is meant to help. Addiction is a mental illness in itself. It does not care whether someone is rich or poor, black or white, young or old. Everyone knows someone who has struggled with addiction, if they have not struggled with it themselves.

I read the National Records of Scotland “Drug-related deaths in Scotland in 2020” report, which was published in July. What stood out to me was that the largest increase in drugs-related deaths per age group in the past 20 years was among people aged between 35 and 44, closely followed by people aged between 45 and 54. Should that not tell us that substance abuse is more than just the result of juvenile delinquency and destitution? Perhaps it should tell us that the people who are most vulnerable—Scots with invisible illnesses—are turning to substances such as heroin, alcohol and cocaine as a way to self-medicate.

For that reason, I welcome the Scottish Government’s policy shift in allowing police officers to hand out warnings to people who are in possession of class A drugs, such as opiates and stimulants. Although it is perhaps convenient for the Opposition to claim that the Scottish Government is, in effect, decriminalising illicit drugs, I suggest that we are attempting to decriminalise mental illness.

Addiction often co-occurs with mental illnesses such as schizophrenia, bipolar disorder, depression, anxiety, borderline personality disorder and obsessive-compulsive disorder, to name only a few. However, we can no longer ask the people who are suffering from poor mental health to face prosecution for a disease for which they did not ask and over which they have little control if it is left untreated.

The war on drugs was never really that; it was always a war on the poor and the sick. Whatever people thought it was, that war was lost a long time ago. It is time for a new direction. I sincerely hope and expect that, under the leadership of the relevant ministers—Angela Constance, Kevin Stewart and the First Minister—this is a new beginning for Scottish society. I hope that we start to look at those who are suffering from mental illness, including addiction, with compassion and understanding. I hope that we begin to offer medical treatments for what is without a doubt a medical issue rather than throwing people who are suffering into the criminal justice system, further isolating them and adding to their despair.

I am very encouraged by what I have heard from the Government over the past few months and I look forward to it taking the issue forward in the person-centred manner that it is talking about. It is not a crime to be unwell and it is not a crime to ask for help. It is time that we offered that help rather than passing judgment and rushing to penalise people who need our support most.

Photo of Michael Marra Michael Marra Labour

I place on record my sympathies for the families of fellow Dundonians and people across the north-east and the whole of Scotland who have lost loved ones to drug death and suicide. Much of my speech will focus on the hard and sometimes technical side of service redesign and how that works, but, at the heart of it all, the victims of those processes are human souls who have our sympathies.

The debate is about the intersection of two of the most acute issues impacting our communities. By every reasonable metric that is collected, the state of our mental health services in Scotland is perilous. That was the case before the pandemic, and the scale of the challenge is all the greater now, as many members have pointed out. I would say that it is down to 14 years of failure in service design, workforce planning, strategic oversight, resourcing and acute service delivery.

Any success in tackling Scotland’s drug deaths epidemic will depend critically on tackling the wider seminal issue of drug addiction, because progress relies on the successful interaction of two services: mental health and addiction services. However, as with far too much in our social and health policy, that is dangerously far from the reality. As colleagues have pointed out, the rhetoric of person-centred care is well worn, but it will remain rhetoric alone while the waiting lists for services and workers’ case loads render current services, in effect, non-existent.

The great work of the Dundee drugs commission, which has been referenced by various members, was a thorough examination of the state of drug and associated health services in Dundee. Published in 2019, it states:

“The most common and consistent message we heard across all our evidence gathering was of ‘a lack of mental health support for those who experience problems with drugs.’”

The commission concluded that the message was expressed as either statutory drug services being reluctant to work with mental health issues or mental health services refusing to work with individuals who had not yet dealt with their drug use. The report notes that there were

“no wholly integrated statutory services” in Scotland

“that respond to the needs of people with mental health and substance” misuse issues.

Those conclusions were of no real surprise. Mental health services in NHS Tayside have been subject to multiple internal and independent reviews due to on-going failures. Back in November 2018, the Dundee poverty commission concluded that the firewall erected between mental health and addiction services was costing lives. The Dundee drugs commission recommended a framework from which to move forward: integrated services, a dual route into treatment and evidence-based commissioning. In 2019, Audit Scotland also discussed the benefits of increasing preventative spending in the area.

However, it is now more than two years since the publication of the Dundee drugs commission’s report. It was a landmark report for my city and, I think, for much of Scotland. It set out the challenges to which the Government had to rise, but I can tell you from the people of Dundee that it is very hard to see what has changed. We have Balkanised services, exclusion from primary care, a punitive culture that still persists in services and leadership by people who have told me that they do not recognise the characterisation of the problem as stated in the Dundee drugs commission’s report.

The scale of the challenge that remains for my city of Dundee is absolutely huge. A progress report is being produced, but it is difficult at the moment to see where the progress has been made. There has to be a change of culture in management, but that must happen now. I hear the minister’s comments on tests of change and small projects that are looking at some of the issues. However, real change will be a culture change in management, and that has to be led by the minister. I know that she is committed to tackling the issues, but delay, denial and endless discussion are still costing lives in Dundee.

Photo of Audrey Nicoll Audrey Nicoll Scottish National Party

I am pleased to support the motion. I am a member of the Aberdeen city alcohol and drugs partnership, and I wish to acknowledge the work that is being done to reduce alcohol harm in Scotland.

Too often in my former professional role, I removed children from a mother who had a history of depression and who had overdosed on release from prison. She was not a bad mother; she was a failed mother. Too often, I searched a suicidal young woman who was suspected of concealing drugs in custody. She was not a criminal; she was criminalised. That must change.

The correlation between problem drug use and poor mental health is well documented. The Scottish Drugs Forum highlights that it is complex but not the result of poor decision making or lifestyle choices. The European Monitoring Centre for Drugs and Drug Addiction highlights the complexities in treating drug use and mental ill health, noting barriers relating to access to and co-ordination within services as well as treatment networks being separated, which risks service users falling through the gaps.

In the First Minister’s announcement on the national drugs mission funds, she acknowledged that more should have been done earlier. The motion reflects the commitment to implementing approaches that reduce harm and save lives.

Alcohol & Drugs Action, in Aberdeen, is developing outreach services for people in custody, and it is engaged in non-fatal overdose follow-up work. Improvement funding has been sought to scale up its sharp response service to mainstream provision, and funding for pre-rehabilitation provision and post-care pathways will assist people who engage in residential provision.

Despite the challenges that the Scottish Ambulance Service faces, its harm reduction team is doing fantastic work to develop non-fatal overdose pathways, and its take-home naloxone programme has seen nearly 600 take-home kits given to individuals who are at risk of overdose.

There is much going on and much to do. In that regard, I have two brief but important points to make. First, workforce development is key to delivering a truly integrated person-centred approach. The mental health nursing programme at the Robert Gordon University, in my constituency, puts compassionate and person-centred care at the heart of students’ learning. The masters-level module on addictions and substance use is open to practitioners working in the field, and it is co-ordinated by mental health nurse lecturers and delivered by alcohol and drug services practitioners. It is a truly collaborative offering.

Secondly, later this week, the Criminal Justice Committee will hold a round-table session on drugs and the criminal justice system. A range of evidence has already been submitted. In the context of the debate, I note the submission from Dr Liz Aston of the Scottish Institute for Policing Research, who highlights that the Misuse of Drugs Act 1971

“shapes the environment within which people use drugs, the way environments are policed, and may impede the introduction or delivery of public health interventions” such as

“the establishment of Safer Consumption Rooms, despite a wealth of evidence on their effectiveness as a drug death prevention intervention”.

I urge the Scottish Government to do all that it can to mitigate the impact of that damaging and antiquated UK legislation.

The public health emergency that we face in Scotland demands an ambitious and wide-ranging response in which the Government, stakeholders, educators and people with living and lived experience work to ensure that people get the right support at the right time, which, ultimately, will save lives.

Photo of Gillian Mackay Gillian Mackay Green

Mental ill health is intertwined with drug use. Trauma and adverse childhood experiences can lead people to use drugs, and the stigma and shame of drug use can prevent them from seeking treatment and help, so we have to tackle the situation from both ends.

I am pleased that the debate crosses portfolios and that the motion recognises that we must do more to support people who use drugs. That includes housing and income and how they join up with the support that comes from the NHS. Ensuring that people who require residential treatment can keep their tenancies and homes will help to reduce anxiety about what will happen after their treatment.

It is essential that we ensure that we provide person-centred wraparound care. I am sure that we all agree that services cannot work in silos if we are to tackle the drugs death crisis. We need joined-up whole-system thinking that addresses the many ways in which people who use drugs are marginalised. We must promote good mental health by providing support to families to reduce adverse childhood experiences.

We also need better mental health support for care-experienced children and young people. I thank all those at the Who Cares? Scotland event yesterday who spoke to the Minister for Children and Young People, and to Anas Sarwar and me, about their experiences. I extend my particular thanks to Nicole, who spoke to me about her experience of drugs and mental health. When I asked her what she would like to say to the Parliament, she told me that she wanted politicians to listen to what people need and to act on that. All participants were also very keen to see trauma-informed care, and for clinicians to be aware of care experience.

Stigma kills. For people who currently use drugs, stigma is one of the biggest factors preventing them from seeking not only help for their drug misuse but any health support, including support for mental health. If people feel that they will be judged for accessing healthcare for their drug use, or that their health conditions will be blamed on their substance use, they are less likely to seek help.

According to the Mental Health Foundation, some people with a dual diagnosis of a mental health problem and drug use find it hard to get the help that they need. Some are turned away from mental health services because they use drugs. That clearly shows the cultural and institutional change that must happen before people who use drugs can access mental health services without fear of stigma.

We need a system of harm reduction, including safe consumption rooms and testing of drugs. It is awful that we cannot test drugs to ensure that they are not cut with poisons, cement dust or many other substances, or to ensure that people are informed about the strength of the drugs that they are taking. That would undoubtedly save lives, but we cannot do it under our current powers. We need those powers in order to prevent deaths. That is a public health measure; the powers should be devolved as soon as possible. That first contact would also allow us to build trust and to help people into mental health support or drug treatment.

One of the most powerful things that we can do, whether we agree with each other or not, is change how substance abuse is spoken about, both in the chamber and more widely, when we make comments to the media. Taking drugs is very risky because of the lack of safe consumption facilities. It is risky because we cannot test drugs, because of the entrenched stigma in our media, because of the dangers of illicit supply and because people feel that they cannot come forward for treatment because they will be judged.

Drug use is not a moral failing, but much of the language that we use expresses judgement. By examining the language that we use to talk about drug use in the chamber and in the media, we can help to set the tone. I hope that we all feel the weight of that responsibility.

Photo of Stephanie Callaghan Stephanie Callaghan Scottish National Party

I fully support the motion and welcome the minister’s announcement of a rapid review of services. Although some areas of disagreement remain, the debate demonstrates a collective determination to save lives by addressing the tragic and unacceptable level of preventable and avoidable drugs deaths in Scotland.

Rightly, given the urgency of the situation, much of the response to Scotland’s drug deaths crisis must focus on medically assisted treatments, but that is only part of a wider story; we must also focus on the importance of taking a person-centred approach. One size does not fit all—a personal approach makes successful recovery far more likely.

One-to-one support is imperative from the outset. Current work that focuses on building better links between mental health and substance use services is vital. As others have said, the Scottish Government’s £120 million investment in the mental health recovery fund to strengthen those links is very welcome, as is the £250 million investment in the national drugs mission.

I am aware of the impact that substance misuse has on our communities and the awful stigma that is still embedded in our society around addiction and mental health. Along with the media and others, we in the Parliament have a responsibility to help to reduce the stigma and to be a positive influence on public opinion. In reality, providing the right help at the right time in a way that is free from discrimination and stigma will improve and save lives and make our communities safer places to live, work and play.

Listening is key, so the motion rightly commits to listening to people who have lived experience, those who are living with addiction, and family members. Listening to and respecting each individual paves the way for delivering the faster and more flexible treatment that people need and deserve.

The motion also mentions the need for treatment and assistance to be

“offered from the first point of contact and consistently throughout each person’s journey”.

By delivering services from a clinical setting and on into the community, we can provide vital wraparound care for those who need it most. Public compassion and understanding will give people the confidence to speak openly and discuss the root causes of their addiction.

We must begin by tackling the underlying issues and inequalities that lead to substance misuse. Having worked in some of the most deprived areas across Lanarkshire and Glasgow, I have seen at first hand the impact of drugs on communities and how the cycle continues again and again. It is time to stop that cycle; a human rights-based approach to tackling inequality and poverty will be key. Transforming how people access care, delivering immediate support and following up with sticky support for as long as each individual needs it already works in other countries; it will work in Scotland, too.

As James Dornan said, it really is time to put the war on drugs behind us, because wars put people on the opposite side to their neighbours. Wars create anger, fear and hatred and wars have no winners—only losers. Let us move on, start to build new expectations and heal the trauma of substance abuse person by person. I ask members to support the motion.

Photo of Jeremy Balfour Jeremy Balfour Conservative

There were

1,339 drug-related deaths in Scotland in 2020, which represented a 5 per cent rise from the previous year and was the highest number since records began in 1996. There is no doubt that we are in a crisis in this country, and if nothing constructive and effective is done, there is no telling how much worse things could get.

During a crisis, it is necessary for those of us in positions of leadership to be very careful in what we say and do, so as to not make the situation worse or the problem more extreme. Lorna Slater’s comments last week were astonishingly irresponsible and completely counterproductive to our current efforts to mitigate the horrendous effects of this public crisis. At a time when we should be trying to dissuade the public from abusing dangerous substances, it is frankly unbelievable that she would think that her comments were in any way appropriate. I invite her to get out of her ministerial car and visit some of the areas in my Lothian region to see the devastating effects that drugs have had on both individuals and communities.

A robust debate is continuing about the level of criminalisation of some drugs and the effect on the number of deaths that occur, but that does not give a Government minister licence to make flippant statements of this nature. They are the same as saying that there is nothing “inherently dangerous” about fireworks in the run-up to Guy Fawkes night. They are counterproductive, and I ask the minister, when he sums up, to distance himself from those remarks.

The motion goes only part of the way towards addressing the deep-seated problems relating to drugs in Scotland. As my colleague Sue Webber’s amendment outlines, the SNP cannot hide behind Covid on this issue, as it does on so many other things. We must confront the fact that the problem has been building for years and nothing constructive has been done about it. The 2019 drug deaths task force failed, with the CEO of Faces & Voices of Recovery UK saying that it pursued

“the same failed options that got us into this mess”.

That is just it. After 14 years in power, the SNP has run out of ideas. It has resorted to rehearsing old ideas that have not worked in the past and rebranding them to look fresh and new.

The Scottish Conservatives are taking the issues that surround drug deaths seriously, and that is why we have launched our consultation on a right to recovery bill. Such a bill would enshrine in Scots law a legal right to the necessary treatment for drug or alcohol addiction. It would place an obligation on NHS boards, the Scottish ministers and others, as appropriate, to provide treatment and to set up reporting arrangements, so that access to treatment could be monitored and the situation reported to this Parliament.

The crisis requires bold new initiatives that tackle drug deaths and an acknowledgment that initiatives have failed in the past. The amendment in my Conservative colleague’s name proposes such an approach and I fully support it.

Photo of Paul McLennan Paul McLennan Scottish National Party

Just over two weeks ago, I was honoured to lead a members’ business debate on world mental health day 2021 and its theme: mental health in an unequal world. World mental health day provides elected representatives with the opportunity to highlight the importance of and need for mental health education and to raise awareness of the inequalities in our society and their implications for our mental health and wellbeing.

The significant inequalities that are the lot of people with mental ill health are mirrored in the mental health outcomes of disadvantaged groups. It is no surprise that adults who live in the most deprived areas in Scotland are approximately twice as likely as people in the least deprived areas to have common mental health problems.

We also know that people in the most deprived areas are 18 times more likely to suffer from substance misuse. That is why a person-centred approach to supporting people who have substance use and mental health needs is key to how we tackle the issue. It is key that we support the development of better working links between mental health and substance use services.

Getting more people into treatment at an early stage is key in our national mission to tackle drug deaths. The additional £250 million that has been allocated over the next five years to improve and increase access to services for people who are affected will be of benefit. The investment will support community-based interventions, including prevention work, and an expansion of residential rehabilitation.

Improving mental health is a priority for the Scottish Government. Additional investment of £120 million investment will ensure the delivery of the mental health transition and recovery plan, and the additional 800 additional mental health workers who will be recruited this year will be welcome.

Everyone’s journey to substance misuse is different. Everyone’s support mechanism is different and people’s circumstances are often complex. We all need to listen to people who have real-life experience of living with drug addiction and to their loved ones.

Additional funding will support outreach services in every local authority and, crucially, support implementation of the new medication assisted treatment—MAT—standards in the first year of this parliamentary session, ensuring same-day treatment or same-day prescribing for those who need it. The approach will enable us to deal with issues immediately and place them with community or clinical services. We must ensure that people can start receiving support on the day when they ask for it, and we must allow people to make informed choices about their treatment.

The uplift in funding for alcohol and drug partnerships is another key component in tackling the issue at as local a point as possible, as is the additional funding for third sector organisations—that is an important point.

The drug deaths task force has developed a stigma strategy, which identifies actions that will help to reduce stigma. A few members talked about that. Stigma can act as a significant barrier to people engaging with treatment. The considerable stigma that continues to be associated with people who use drugs must be challenged in services, in the media and among the public. We play a key part in that mission

How we tackle substance misuse and mental health provision go hand in hand. I welcomed the opportunity to speak in this debate. Let us work together to support families who are impacted by substance misuse. I urge members to support the motion.

The Deputy Presiding Officer:

We move to the closing speeches. I call Carol Mochan to wind up for Labour.

Photo of Carol Mochan Carol Mochan Labour

In closing the debate for Scottish Labour, I thank my colleagues in the Parliament, all of whom made significant and interesting contributions to the debate. It is always useful to hear about successful projects across Scotland, so I thank members for sharing those stories.

We must also face up to the reality of what is happening. I think that members would agree that Michael Marra described very well the reality for people in Dundee.

When we talk about problems with substance misuse and related mental health problems, we are really talking about people who have, for one reason or another, slipped through the net. Where there should be adequate support to get them back on their feet, there has been little more than a promised appointment that never comes. Only recently, we heard that 31 per cent of calls to the NHS 24 mental health hub go unanswered. We can only imagine how many of those people will immediately give up and seek other ways of coping. This is the story that I hear time and again all over my region, and I know that many other colleagues have heard the same: “I want help but I can’t get it. I’ve been waiting for months just to see someone or even speak to someone.” We can do better than that, and I think that there is broad agreement here in the Parliament, among ministers and others, that we must now do whatever is necessary to pull Scotland out of this nosedive.

However, let us not talk about this in the abstract. We need to be honest with the public and say that addressing the issue will require greater investment and a much longer term approach—two things that the world of politics is often poorly prepared to deal with. Although I welcome the investment mentioned by the cabinet secretary, let us be honest and accept that it is not enough.

We know that the problem of people simply not being able to get the help that they require is widespread in Scotland. As I and others have noted in the chamber today and in previous debates, the number of children and young people waiting a year or more for mental health appointments is at a record high. We should not then be surprised that, for those living with substance misuse, that problem is just as prevalent. We need to find more sustainable ways to get people the care that they require in the community and directly connect the problems of poverty and substance misuse through meaningful policy.

Poverty and homelessness are included in the motion as a consideration but, for me, they should be the core of the debate. If we do not seriously tackle the low-pay, high-debt, exorbitant-housing-costs society that we have built, reliance on substances to deal with that pressure will only get worse. The minute that someone is made homeless or put on the cusp of homelessness through unaffordable rents, their health—mental and physical—will rapidly deteriorate. If that person has already been exposed to a damaging relationship with dangerous substances, it is obvious that they will be at risk of going further down that road, yet little is done to give immediate support to such people and offer them the counselling and respite that they require to follow a different path. Any expense that we incur by increasing counselling and outreach services will be saved many times over by ensuring that people’s health is protected and their homes are secure long before the problems arise.

Scottish Labour believes that we must begin to look at this now. As described by Michael Marra, drug misuse and associated mental health difficulties have spiralled out of control. The conclusion has to be that the issue should be a top priority for every Government, not just here in Edinburgh but in London, too. It needs to remain a priority for a long time to come. There will be no overnight fix, and if we can shift the narrative towards treating this as a health crisis and focus on solutions that are centred around support and prevention, it will change the lives of thousands in Scotland for many decades to come.

I refer to the Scottish Labour amendment in Claire Baker’s name, which I hope will be supported at decision time this evening. The amendment rightly highlights that the number of people staying in hospital due to drug-related mental health problems is on the rise, and further points out that we are not doing enough to make sure that those who need support are being referred to community-based services so that we can address the root causes of their problems. In order to do that, we must more cohesively link together each service and considerably expand the number of outlets that there are for people to seek support from.

The root of all of this is the continued poor funding of mental health services in Scotland. They remain underresourced and blighted by unacceptable waiting times. If we are to change approaches towards community support, and change the disparity in funding for those services, we can shift the trajectory of the debate. Without doing both of those things, headlines may change but lives will not.

Photo of Craig Hoy Craig Hoy Conservative

This has been a very short but a very good, full debate. As Michael Marra rightly pointed out, the debate has shone a light on two of the most complex and interconnected public policy problems confronting modern Scotland.

It comes as no surprise that this debate has touched on three key points: that Scotland has a problem with drugs misuse; that Scotland has a problem with alcohol misuse; and that Scotland has an escalating mental health problem—one which, as Claire Baker said, is made worse by the combined forces of drink and drugs, stigma, poverty and, as Miles Briggs said, poor housing.

Three key themes have also emerged during this debate. First, Scotland needs to embrace person-centred care. I agree with Angela Constance on that, and we will vote with the Government tonight. That means that we need to build a system in which integrated health and social care professionals across the public and third sectors work collaboratively with people who use and need those services. However, the second key theme in this debate is that, despite their need, under the SNP people across Scotland cannot get access to vital mental health treatment, or easily access treatment for dependency on drugs or alcohol. The third key theme is that people must be able to access the support that they require in a timely and accessible way. That is why my party is pressing for a right to recovery bill, which will enshrine in Scots law the right to the necessary addiction treatment. Putting MAT standards into law will ensure that national guidance is clear and enforceable.

Others have spoken of the urgent need for a wide range of measures. My colleague Sue Webber shared insight from the front line and highlighted the stark and shocking levels of drug deaths. Looking beyond the numbers—depressing as they are—she pointed out, quite correctly, that the concept of person-centred care is nothing new. Indeed, in 2017 and again in 2018, the Scottish Government talked of using a person-centred approach. Although the Government is repeating the same language, I sincerely hope that it does not repeat the same mistakes.

Sue Webber also talked of her real sense of disappointment at Lorna Slater’s recent remarks in relation to the dangers that are posed by drug misuse. For Lorna Slater to say that drugs are not inherently dangerous is, in my view, an inherently dangerous position to adopt. I implore her go and speak to those who knew and loved the 1,339 Scots who died of a drugs-related death last year. Lorna Slater needs to learn that being a minister carries a duty of care and a sense of responsibility and she should choose her words with more consideration and care in future.

Photo of Alison Johnstone Alison Johnstone Green

I note that we have time in hand, and I will give Mr Hoy the time back.

Photo of Gillian Mackay Gillian Mackay Green

Does the member recognise that it was his party’s position that was criticised by the prominent drug campaigner Peter Krykant, for the language that was used over the weekend, not Lorna Slater’s position?

Photo of Craig Hoy Craig Hoy Conservative

To be completely frank, that is his view, but my view is based on the words of a minister of the Crown that are on the record. They are irresponsible and she should apologise for them.

We also heard today of the need for services to be not just person-centred, but community focused, which means that they should be delivered as close as possible to those who need them, often by skilled professionals in the third sector. That is why I share the concern of Miles Briggs and Alex Cole-Hamilton about the potential impact of the creation of a national care service.

Although we have, quite rightly, focused on drugs in this debate, we cannot overlook the mounting harm that is caused across Scottish society by alcohol. As Scottish Health Action on Alcohol Problems has identified, the real figure for drink-related deaths is deeply concerning, as it is possibly as much as three or four times higher than the reported figure. SHAAP agrees that alcohol services need to be person-centred and holistic, but it says that those services should

“ensure equity of access by taking into account the specific needs and experiences of the range of groups and communities throughout the country”.

Surely, ministers must realise that rolling drug and alcohol services into a cumbersome, centralised national care service is likely to work against that grain. It will combine centralisation and ministerial control and, as such, is likely to be anything but person-centred.

Finally, the debate has also highlighted the breadth of opinion that exists on the emotive issue of drugs. We have heard today about the decriminalisation of class A drugs and about safe consumption rooms. However, whatever our views on such interventions—I am sceptical on both—there is surely a more pressing need: the need to make people safe and to free them and their families from the misery and the danger of drugs.

Surely, the safest way in which to approach the issues that confront vulnerable Scots is not for them to be given places—safe or otherwise—in which to consume heroin, but for them to be given a right to treatment so that they no longer take heroin at all.

Presiding Officer, as Stephanie Callaghan said, and as Paul McLennan echoed, we should strive for cross-party support to ensure that the Parliament delivers policies that deliver the care and treatment that people so clearly need. Whether they are struggling with alcohol or drug addiction or are suffering a mental health crisis, they have a right to faster, better and more targeted care than many presently receive: better, faster mental health services; child and adolescent mental health services that work for our children; a tougher and more effective suicide prevention strategy; person-focused and locally run alcohol services; and a simple, basic, immediate, countrywide and legally enforceable right to recovery. That is what my party is pressing for.

The Presiding Officer:

I call Kevin Stewart to wind up.

Photo of Kevin Stewart Kevin Stewart Scottish National Party

I welcome the opportunity to close the debate and commend all that is being done to support those who are most vulnerable, as well as their families and carers. I also recognise the hard work and commitment of those who work in services, particularly during these difficult times.

Much has been said about person-centred approaches. The person-centred approach is happening in many places and is working for people. We need to ensure that it happens everywhere and to export best practice to every part of our country.

I thank all members for their input and reflections during the debate on what can often be a challenging and emotive issue. In the main, there is a lot that we can all agree on. We should build on that agreement.

Mental health and substance use often go hand in hand, so it is crucial that we ensure that our services reflect that. I assure all members that we are striving towards achieving a cross-Government approach—an approach that Alex Cole-Hamilton commended us on, with reference to Angela Constance and I having the debate jointly. However, more than just Angela Constance and I are involved. We will continue to ensure better links between services and a culture of inclusivity, and we will put the needs of individuals at the heart of everything that we do.

Photo of Michael Marra Michael Marra Labour

I commend to the minister the work of the Brechin Healthcare Group in the North East region. It hosts just the kind of services that he has been talking about—mental health services alongside addiction services—and is volunteer run. Is it possible for the minister to accept my invitation to visit that group or to have discussions with it about its plans for the months ahead?

Photo of Kevin Stewart Kevin Stewart Scottish National Party

I am sure that either Ms Constance or I, or both of us, can meet the group—although it might be virtually, at the moment. I am more than happy to do so. There is nothing that Ms Constance and I like more than listening to the voices of lived experience.

I thought that Michael Marra was going to ask the question that he has lodged for Thursday; I am glad that I did not have to spoil the answer that he will get.

As members know, I was previously the Minister for Local Government, Housing and Planning. Miles Briggs mentioned housing. In my former role, I regularly encountered many of the issues that we have spoken about. In particular, I am very conscious that unmet mental health needs can perpetuate homelessness and that some of the folk involved may use substances to cope with their distress and trauma.

For that reason, I am delighted to announce that we are investing almost £0.5 million over the next three years in a new intensive assertive outreach service for people who are experiencing homelessness and complex mental health needs in Edinburgh. Some of those people are entrenched rough sleepers; others are locked in a cycle of repeated episodes of rough sleeping, institutional provision and temporary accommodation. For those folks, many of whom have a long history of trauma and a lack of trust in statutory services, a much more intensive and assertive approach to meeting their mental health needs is required.

Photo of Kevin Stewart Kevin Stewart Scottish National Party

I will take an intervention if Miles Briggs just lets me finish this part of my speech.

The new programme will be delivered by the Simon Community alongside the City of Edinburgh Council and Castle Rock Edinvar Housing Association.

Photo of Miles Briggs Miles Briggs Conservative

I very much welcome that announcement. Over the past five years, Alex Cole-Hamilton and I have visited services for adults in the capital that are, quite frankly, in crisis. Sometimes there is a two-year wait to see a mental health specialist. In relation to mental health services, people in crisis who are homeless or sleeping rough have been at the bottom of that list, so I welcome the announcement. However, a two-year wait for other residents across the capital is still completely unacceptable. What professionals will be recruited to deliver that service? Currently, we do not have those professionals working, and they need to be put in place if we are to meet any service expectations.

Photo of Kevin Stewart Kevin Stewart Scottish National Party

That was a very long intervention.

Workforce planning is absolutely essential. Ms Webber spoke about the lack of mental health professionals. Since 2006, the psychology workforce in Scotland has increased by 110 per cent. In Scotland, we have more folks working in mental health services than anywhere else in the United Kingdom. Fifty-six whole-time equivalents per 100,000 are working in Scotland; by comparison, the UK average is 40 whole-time equivalents per 100,000. That does not mean that we do not need to do more, and we will do more on that front.

I regularly hear stories from individuals and their families who have struggled to navigate their way through what is for them a complex and complicated system. That can lead to further disenchantment and can, in some cases, exacerbate pre-existing trauma.

Healthcare Improvement Scotland is currently taking forward work to develop a more integrated approach between mental health and drug services. We have committed an additional £2.2 million to support the expansion of that work over the next three years. That work, which is now under way, seeks to develop a new model and pathway of care, with a view to creating a national network to spread good practice, innovation and learning about best practice Scotland-wide. Our ambition is that the network will drive improvement and change, ensure that people receive the best care, and develop and deliver integrated and inclusive mental health and alcohol and drug services based on what service users have told us that they need and expect. The approach will improve opportunities for people with lived and living experience as well as others involved in the system to have an active role in the planning, design and delivery of their services.

We have committed to a set of national standards for secondary mental health services with a key aim of supporting transitions between services while reducing inequalities in the system, which will complement the work on the new network. The support that is available should be consistent, regardless of where a person lives in Scotland, and should take account of both urban and rural areas. Gillian Martin pointed that out earlier.

Early intervention is key to dealing with many instances of substance use and mental health, whether that is through our primary care services or school mental health counselling services. Mental health assessment services and the distress brief interventions that have been put in place can often be a lifeline for those who are seeking help. I want to ensure that those services are working effectively to deliver support from day 1.

We committed to undertake a review of primary care services. The new approach focuses on multidisciplinary team working. That will reduce pressures on services and ensure improved outcomes for patients, with access to the right professional at the right time as near to home as possible.

Later this year, and on the basis of local plans submitted by integration authorities, we will start to provide funding to begin the national implementation of a new model for mental health in primary care.

I turn now to culture change, as there is still much to be done on that front. I have already mentioned empathy, which must be at the heart of the services that we deliver, whether for patients, their families or those working in services.

Recently, I was shocked and disturbed when somebody working in substance use services in a mental health ward told me that they themselves feel stigmatised by colleagues. Both staff and patients should feel empowered and not afraid to seek help—and not concerned that their voices will not be heard. Gillian Mackay said “Stigma kills”, and she is absolutely right. We must rid ourselves of that stigma, not only for service users but for front-line staff, who also feel stigmatised because of the job that they do.

In order to raise awareness of the potential impact of psychological trauma on a wide range of outcomes, including in relation to substance use and mental health—

The Presiding Officer:

Minister, I would be glad if you could now bring your remarks to a conclusion.

Photo of Kevin Stewart Kevin Stewart Scottish National Party

Since 2018, we have invested more than £4 million in our national trauma training programme, which is led by NHS Scotland. We must continue to invest on that front.

My officials are supporting a short-life working group on substance use on in-patient wards. The group was created following David Strang’s recommendation in his report on Tayside and aims to create an approach to substance use on in-patient wards that ensures both staff and patient safety on wards.

The Government will be working with all partners to deliver a service that treats individuals as individuals, not as a diagnosis. By ensuring early intervention, supporting those using services better and caring for those who drop out of services, we can make a significant difference to the outcomes for some of Scotland’s most disadvantaged and vulnerable people.

I urge Parliament to support the motion this evening.