Public Petitions Committee

Meeting date: Thursday, April 25, 2019

Official Report 542KB pdf

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Continued Petition

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Mental Health Support for Young People (Inquiry)

The next agenda item relates to the committee’s inquiry into mental health support for young people in Scotland. As members will be aware, the inquiry was launched in connection with petition PE1627, on consent for mental health treatment for people under 18 years of age, which was lodged by Annette McKenzie.

At our meeting on 21 March, the committee heard evidence from the Minister for Mental Health on the progress of the Scottish Government’s mental health policies, to assist the committee in determining where it could focus its work in the inquiry. That will aid in avoiding duplication of effort by various agencies and in identifying the themes that we would like to examine more closely.

More in-depth analysis of the inquiry submissions has been conducted, and prominent themes from all the call-for-evidence activities that have been received have been set out in the committee’s papers. The intention today is to consider the themes and then decide on three or four themes that will be the on-going focus of the inquiry. As we are all aware, a lot of work is already going on outwith the inquiry, and we do not want to duplicate those efforts. We also want to ensure that the inquiry has sufficient focus, so that we can understand, as much as possible, how young people can get the mental health advice and support that they need.

Do members have any comments on, or suggestions for, the themes on which they would like the inquiry to focus?

I am interested in looking at the roles of general practitioners and teachers, in relation to the argument about professional constraints. Annette McKenzie’s case, which was very hard to hear, exercised the committee. The profession acknowledges that decisions were made by the GP but there was the constraint of a lack of time to properly deal with mental health conditions. I am interested in looking at the triage system, which could direct people who are suffering with their mental health to the appropriate place. The majority of teachers would welcome some sort of mental health training, because the majority of them do not receive such training. We could make some headway on the issue of professional constraints.

You are absolutely right in saying that we should look at that area. We should try to get a sense of whether the GPs’ argument is that it is impossible for them, in the time that they have, to make such decisions and that it would be more appropriate for somebody else to do that front-line work. If so, what would that system look like? Having that conversation with GPs would be really interesting.

I was struck by the argument that a young person should not be given antidepressants after the first consultation. However, it turns out that that relates to antidepressants rather than to other medication. In the case that prompted the petition, medication other than antidepressants was given, but, ultimately, that seems not to have been a material consideration. We want to look at the issue and have that conversation with doctors. What is the rationale for saying that someone should not be given antidepressants following their first appointment? Is it that doctors will not know a patient’s circumstances well enough? If that is the case, should the restriction not be extended to a broader range of medications? It would be very useful to have that conversation.

On Brian Whittle’s second point, about teachers, we should also think about other school staff. Quite often, young people will go not to their own guidance teacher but to someone in whom they feel they can confide. Are those people—whether it is support staff members or whoever—geared up to deal with such conversations? It would be useful for the committee to do a bit of work on that issue.

In everybody’s areas, there are high schools in which there is good practice in dealing with pupils’ mental health issues, so it might be worth having a look at that good practice.

Yes, that is one area that we could look at.

Peer support is an important area to look at. All these issues are important, but peer support came up in an evidence session on another petition—I cannot recall which one. The Scottish Association of Mental Health was very keen to promote peer support, and I am keen to look at where there is good practice. Where that is not happening, we should look at ways in which peer support can be introduced and supported.

It is interesting to note, from our briefing, that the child and adolescent mental health services that are provided by NHS Greater Glasgow and Clyde have an early intervention pilot project under way, which involves working alongside school staff. I am keen to get more information on that work, so a trip to Glasgow might be an option.

A visit to Glasgow is always to be welcomed.

You would say that, convener.

I would be keen to learn some more about any early intervention projects that are under way.

If we are going to speak to GPs, I would like us to ask them what access they have to alternative treatments, as opposed to just medication.

My sense is that they would argue that they are constrained by time and in their options but that the one thing they can do is medicate, although I sense that that is not what GPs would want to do if there were alternatives. We need to get a proper sense of that, too.

It would be useful for us to map out, against the areas that are identified in the clerk’s paper, what is already happening. We should certainly try to go out. We may want to talk to those who have direct experience of the consequences of the system. Annette McKenzie has been a powerful witness for us, but it would be useful to get some more understanding from the front line of what it has meant for families.

It is important that a young person knows whom to ask and that the person they ask knows what to say. That is really powerful. Maybe it comes under the heading of advice and awareness raising. People talk about it as being mental health first aid. It is the idea that all of us, as human beings, should have the capacity to respond in a way that will help the person at that point. It is also important to understand that the person might want to get support not from family but from friends or somebody else.

The other thing that I am interested in talking to GPs and other professionals about is the constraint of confidentiality. That is at the heart of what happened in Annette McKenzie’s case, and it is at the heart of the petition. It is about the family of somebody who is in such circumstances not aware being aware of it. We have had the debate about confidentiality and protection, but it would be interesting to talk to professionals and find out whether they treat mental health issues differently. With a physical illness, they would give the person advice, direct them to a support group and other things, and tell them that they must talk to their family. Do they feel constrained around mental health in a way that they do not feel constrained around physical health? I would hope that, when somebody was very anxious, a reasonable starting point would be to say to them, “Of course, your family or your friends might be able to help you. Is there somebody that you want to talk to?”

Something that has been on my mind since Annette McKenzie brought her case to us is the capacity of a person who presents with mental health issues to self-medicate. I understand all the arguments, but that has stuck with me. I would be really interested in hearing the professionals’ views on that.

Yes. I think we agree that we want to go out and make inquiries on the matter in Glasgow, as Angus MacDonald said, and perhaps in other parts of the country. That will allow us to look at some of the support organisations to which people can go and to get a sense of the landscape.

Do members want to flag up any other points in the clerk’s paper? Under the heading of advice and awareness raising, we might also want to get a sense of how modern people’s approaches are. I recall hearing from the Samaritans that they have now acknowledged that some young people prefer to have the conversation by text rather than by phone, so they are developing such a service. I think that a lot of the mental health services are doing that. It would be worth learning more about the technological ways in which people can tap into services and how the system lets young people, in particular, know about those.

All the options that are identified in the paper are really important, but I think that we will want to have a bit of focus. We know that a lot is going on. The danger for us is that so much is going on that we will simply observe it rather than try to intervene and have a wee bit of focus. However, I think that the suggestions that have been made so far will allow us to do that.

11:15  

Taking that approach does not preclude our doing other things at a later stage, and we might want to think about other stages of the inquiry. We might want to timetable a bit of work on professional constraints, advice and awareness raising, and peer support. We can reassure the petitioners and others that the inquiry is very much connected to the petition—it comes from it and from the desire in the petition to understand how the system needs to change.

Some of the other issues in the paper will be covered automatically. Because we are focusing the investigation on the areas that we have discussed, the issue of having a specialist mental health service for young people will inevitably be part of that without requiring a specific focus.

We thank the clerks for the amount of work that they have done so far. I also thank those who have responded to us, because those responses have very much informed what has been done. People clearly have strong views and direct experience that they want to share, and we appreciate that.

We are looking for a staged approach with timelines, to give us a clear idea of how we are going to progress the issue. It was obvious from our meeting with the Minister for Mental Health that a lot of things are going on. However, the question is whether those things have a direct impact at the local level. As we heard earlier, people who are involved in the GPs at the deep end programme have strong views on the issue, and there is an issue of whether what is said in policy terms is being lived out in practice. It would be useful for us to cover that aspect in our approach.

We appreciate that there is a significant amount of work for us to do on the matter, and I, for one, am looking forward to hearing about the direct experience of people who have a lot of expertise and strong views that can help to shape our recommendations.

I thank everyone for their attendance.

Meeting closed at 11:17.