Meeting of the Parliament

Meeting date: Tuesday, November 7, 2023

Official Report 1015KB pdf

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Mental Health

The next item of business is a statement by Marie Todd on the vision for Scotland’s mental health. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.

14:21  

I am glad to make this statement this afternoon as we publish our “Mental Health and Wellbeing Delivery Plan 2023-2025” and our “Mental Health and Workforce Action Plan 2023-2025”. Those plans, which were published jointly with the Convention of Scottish Local Authorities, describe the work that we will undertake together with a wide range of stakeholders and partners to deliver the vision that is set out in the “Mental Health and Wellbeing Strategy”, which was published in June.

Mental health is a topic that attracts passionate and robust debate in Parliament and rigorous scrutiny of the Government. That is as it should be, but there is a consensus across all parties on the importance of supporting good mental health and wellbeing across the country.

We are all here today with the ambition of ensuring that anyone who needs help for any aspect of their mental health and wellbeing should be able to get that help. To that end, I will outline the strategy’s vision for improving mental health in Scotland at all levels of need. I will cover the importance of taking an outcomes-focused approach to how we monitor and evaluate progress. I will also highlight some of the key commitments that are contained in the delivery plan and the workforce action plan.

Over the past 18 months, we have undertaken a significant programme of stakeholder engagement. We heard from people and families with lived experience of mental health conditions, as well as from organisations that are led by and support those with lived experience. I thank the hundreds of people and organisations who passionately shared their views—their input has been invaluable.

The mental health and wellbeing strategy’s vision is of a Scotland free from stigma and inequality, where everyone fulfils the right to achieve the best mental health and wellbeing possible. The vision covers a very wide spectrum, from maintaining good mental wellbeing to supporting communities to ensuring that specialist services are available whenever they are needed. Crucially, it means recognising and responding to the many underlying social determinants, circumstances and inequalities that can affect mental health and wellbeing.

The strategy has people at its heart, and our outcomes demonstrate the changes to people’s lives that we want to see. For example, we want everyone to have an increased knowledge and understanding of mental health and wellbeing and to know how to access appropriate support. We acknowledge that people will have different starting points, life experiences and journeys. They may have experienced different kinds of inequalities and discrimination. Although needs may vary and people will require different kinds of support, it is vital that the overall outcomes that we are aiming for are the same for everyone.

Monitoring progress towards our outcomes will allow us to better understand what is working well and where we might need to change our focus in future. The delivery plan that we are publishing today illustrates the work that we feel is key to progress over the coming 18 months.

I will give some examples. Building capacity in local communities is vital. We are driving a shift in the balance of care across mental health and wellbeing to ensure a focus on prevention and early intervention. We will therefore build on the success of our community-based supports, which benefited more than 45,000 children, young people and carers in the second half of 2022 alone.

Recognising the recent Audit Scotland report, we will work collaboratively to improve access to mental health support. That involves developing multidisciplinary teams around general practice and maximising the role of community mental health teams, digital provision and NHS 24 to make access quicker and easier.

It is crucial that we acknowledge that not everyone wants to, or is able to, access support in the same way. Ensuring a range of provision, with a key role for universal services, the third sector and peer support, is essential to achieving our vision, as is building on the successes that we have achieved to date through our expansion of digital therapies. We will continue to improve access to clinical services, including child and adolescent mental health services and psychological therapies.

In addition to boards’ core funding, we will invest more than £50 million this year in our mental health outcomes framework to support the delivery of clinical services in priority areas.

Our actions will continue to evolve over time. We will regularly refresh the delivery plan, based on a full assessment of where we know we can build on existing good work. There will be actions that we will want to expand or refine. Our actions must also continue to reflect the significant challenges that remain. We have record levels of investment and record staff numbers, and we are treating and supporting more people than ever, but we know that demand continues to increase.

I make an offer to all parties: please work with us to identify where we can go further and what our commitments in future years should be. I will always approach such discussions with anyone across the chamber constructively.

The first iteration of the delivery plan represents work across Government. It shows how the mental health portfolio is fully aligned with on-going core work across Government on child poverty, employability, housing and much else. That cross-portfolio approach is essential to addressing the underlying causes of poor mental health as well as to ensuring the provision of the right support for those who need it.

I turn to the workforce. Our amazing workforce is foundational to our vision. We must ensure that our whole workforce is diverse, skilled, supported, sustainable and able to operate at safe levels. The workforce action plan is aligned to the “National Workforce Strategy for Health and Social Care in Scotland”. It places training, wellbeing, job satisfaction and the principles of fair work at its heart.

The plan also looks at the whole workforce journey. That includes how we attract, train, employ and nurture. Some of our key actions will support and improve workforce planning, such as for psychological therapies delivery. That is linked to the new national specification for psychological therapies and interventions.

We will promote existing and alternative pathways to widen access to careers in mental health. That involves going beyond the traditional university and college routes. Improving equality, diversity and inclusion training for staff is central to our plans. We will prioritise upskilling the workforce by providing funding for training to help with treatment, support and recovery.

In recent weeks, I have met representatives of mental health nurses and psychologists, and I have heard from those with lived experience. I have seen many examples of the good practice, high-quality support and innovation that are currently happening across all parts of the system.

Many people play a key role in our workforce. We have recognised the existing and potential contribution of everyone who supports mental health and wellbeing at every level of need, not just in the national health service. It is critical to recognise and value volunteers, experts by experience, unpaid peer support workers and unpaid carers who work with and support people. That includes family, friends and befrienders.

Although we can recognise successes, we should also acknowledge the scale of the challenges that we face. To meet those challenges, we must work collectively to consider what the future workforce needs to look like and to develop more multidisciplinary approaches that meet the diverse needs of those who are seeking help.

The action plan sets out our first steps, and we know that much more will need to be done in future iterations. Achieving and sustaining our ambitious vision will require time and incremental change as funding and resources permit.

The delivery and action plans will require local and national leadership as we work collectively towards national outcomes, while maintaining local flexibility. For that reason, I am delighted that we have published the documents jointly with COSLA, as councils are key partners for much of the work that has been outlined.

Governance arrangements will be crucial to ensuring that we are making the right progress, so we will establish a mental health and wellbeing leadership board to provide national leadership and strategic oversight of priorities. It will ensure that our commitments deliver clear benefits that are aligned with the strategy’s vision and outcomes. It will provide constructive support and challenge to ensure progress against actions, and it will play a key role in evaluating impact.

The publication of the strategy, the delivery plan and the workforce action plan represents a reset and a refocus of our whole mental health policy that allows us the opportunity to set a new level of ambition and to be clear about what a high-functioning mental health system should look like. Most important, it describes what help anyone is entitled to receive when they ask for it, for any aspect of their mental health. I commend the strategy, the delivery plan and the workforce action plan to Parliament and I am happy to answer questions.

The minister will now take questions on the issues that were raised in her statement. I intend to allow about 20 minutes for questions, after which we will move to the next item of business. I would be grateful if members who wish to ask a question pressed their request-to-speak buttons.

I draw members’ attention to my entry in the register of members’ interests, as I am a practising NHS general practitioner.

A robust strategy is needed to tackle mental health, but it is incredibly difficult for our mental health professionals to do their job without sufficient funding. The Royal College of Psychiatrists has contradicted the minister’s statement and said that the workforce will not grow to keep pace with demand. In the latest budget, funding for mental health was frozen and, since then, CAMHS waiting times have continued to suffer—about 30 per cent of patients are still waiting for more than 18 weeks, and health boards are struggling to recruit the staff they need.

New funding is welcome, but it will be too late for the thousands of children who are on CAMHS waiting lists—the waiting lists that Humza Yousaf promised to clear by March 2023. As with the drug deaths strategy and the Covid recovery plan before it, this is another flimsy plan that will fail to deliver results for the Scottish people. When the aim is not achieved, the Government will simply say that it will learn lessons.

Will the minister reiterate that the Scottish National Party Government is still committed to clearing CAMHS and psychological therapies waiting lists, or has that target been abandoned? Given that one in four vacancies in the CAMHS workforce have been advertised for six months or more, how will the plan eliminate the long waits to fill vacancies?

The member will be aware that we have made record-breaking investments in CAMHS in the past number of years. Since the Government took power in 2007, we have doubled the money that goes into mental health services compared with the amount that went in before the Government took charge.

CAMHS staffing levels have more than doubled under the Government. I absolutely agree that there are still challenges for us to rise to, but we are on the right trajectory. The past six quarters have had the six highest figures on record for the number of children starting treatment from CAMHS. We have also gone further. The Government has made sure that counselling is available in every high school in Scotland. We have also invested in local authority community-based mental health support, which more than 45,000 children and young people and their family members accessed in the second half of last year.

We have absolutely not lost our commitment to meeting the CAMHS targets. We will achieve the waiting list target for CAMHS and we will achieve the waiting list target for psychological therapies. We are making the right investments and are improving the situation. I would expect to see further improvement continuing on the same trajectory.

I thank the minister for an advance copy of her statement. The scale of Scotland’s mental health crisis cannot be overstated. A recent survey by the Royal College of Psychiatrists found that 53 per cent of respondents were not confident that they or a family member could access mental health support if needed.

The Government’s latest strategy rightly focuses on the need for patients to be able to access good mental health support earlier and in their own communities. However, both the strategy and the accompanying workforce plan fail to acknowledge the increasing pressures that that will place on a declining GP workforce that is constantly firefighting and has no headspace to make service improvements.

Will the minister tell us how patients can have confidence in the strategy, given that the workforce has already told me today that it is not possible to deliver it?

We will work closely with the workforce. I recognise that general practice is under immense strain, and we talk about that day in, day out in this chamber. There were challenges prior to the pandemic, but there is no doubt that the pandemic has placed an even greater strain on our health and social care system than it has ever experienced before. However, we are investing in primary care and in a diversity of workforce in primary care.

So that we do not just rely on general practitioners in primary care to deliver support to mental health, we have invested in specialist mental health workers, community link workers and the full multidisciplinary team, including nurses with specialist skills and qualifications, practitioner nurses, pharmacists and, sometimes, psychologists and counsellors, all of whom are available through the primary care door at GP practices.

I recognise that we are not able to wave a magic wand to fix everything that is needed in mental health care, but we are absolutely on the right track. It is important to recognise the challenges that we face as well as the progress that has been made in recent years. There has been sustained investment. We have record numbers of staff providing more varied support and services to a larger number of people than ever before. Although I recognise that there are still challenges, and that needs are increasing, I think that we would all acknowledge—I would absolutely say—that this strategy, this workforce plan and this action plan are the answer to those challenges.

I refer members to my entry in the register of members’ interests: I am a mental health nurse holding registration with the Nursing and Midwifery Council.

The independent forensic mental health review’s final report, which was published in February 2021, made wide-ranging recommendations for the future of those services including that

“All forensic mental health services, including both inpatient and community services, should be brought under the management of this new Forensic Board.”

Will the minister update me on the progress towards implementing those recommendations?

Continuing to improve support for those in the forensic mental health system is one of the priorities that are set out in Scotland’s mental health and wellbeing strategy. Therefore, the delivery plan that was published today includes an action to progress issues that the independent review identified. That includes continuing to bring together stakeholders to agree a clear plan for addressing the strategic planning and governance of forensic mental health services.

The first phase of that work was the establishment of a planning and collaboration short-life working group, which undertook an options appraisal. A report of the appraisal was published in August. Taking into account that work, which did not result in a clear consensus, my plan is to update Parliament and to publish a document on progress towards delivering the independent review’s recommendation early in the new year.

I recognise the member’s on-going commitment to, and interest in, making progress on the issue, and I am more than willing to keep her updated on progress.

It is good that the strategy recognises the importance of the perinatal period for mothers, but it does little to deliver. Last year, a consultation on extending mother and baby unit provision found that most respondents wanted another unit outside the central belt, as many of them were from the NHS Grampian area. After requesting an update on progress, I was told yesterday that a report will be published once the options have been fully considered and the next steps have been determined. Will the minister finally listen to women and tell them when that will be?

I thank Tess White for her on-going interest, which we share, in that area. The options appraisal that she referred to has been completed, I have read it and the Scottish Government is considering its response to it. I am more than happy to update the Parliament and stakeholders on what the options appraisal recommends once we have made plans for how to respond to it. I do not want to present the public with the options appraisal until I can set out what our next steps are.

I am sure that members across the chamber will agree on the importance of removing stigma in relation to mental health and wellbeing. Will the minister provide an update on how the plans in her statement can help to continue to tackle such stigma?

That is an excellent question. Stigma is the bane of my life and of many colleagues’ lives, because it prevents people from getting the help that they need and to which they are entitled. That is why one of the strategy’s first priorities is to aim for

“a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible.”

Stuart McMillan will be aware, and will agree, that we have made great progress in that regard over recent years. We are now in the lucky situation in which many people feel comfortable talking about mental health and mental ill health and about what they do to keep themselves well, but we have more to do. Given my history of working with them, I have a personal interest in supporting people with severe and enduring mental illness, who still face relatively large amounts of stigma.

Why is there little detail in the minister’s statement on how we can retain existing staff? Staff turnover is as great a problem as lack of recruitment. Last week, the Royal College of Psychiatrists produced a report that states that 42 per cent of existing consultants are over 50 and that half of them are considering early retirement. Can the minister give details on what strategy is in place to retain those hard-working staff?

A number of pieces of work, including a review of mental health nursing, are being done across the workforce. Right across the spectrum of the workforce, we are trying to support people and enhance the conditions under which they work.

I thank the Royal College of Psychiatrists for its comprehensive and wide-ranging “State of the nation report: The psychiatry workforce in Scotland”. I absolutely acknowledge the issues that are raised in the report. The workforce action plan ensures that the commitments in our mental health and wellbeing strategy are underpinned by plans for a resilient and sustainable workforce. I agree that it is important that the workforce feels valued and supported in order to promote better health and wellbeing outcomes.

We will use the report to support the work of the newly created psychiatry working group, and I look forward to engaging with the college and with many other stakeholders. Recently, I met mental health nurses and psychologists to ensure that the issues that are identified in the report are considered as part of our on-going work to implement the new workforce action plan.

In June, the minister responded to me regarding my concerns about the lack of assessments for attention deficit hyperactivity order for adults in my constituency. The response said that there is no routine reporting of community adult mental health service activity, nor any national routine reporting. In the documents that accompany the statement, is there a commitment to improving and collating data on ADHD in adults to inform workforce requirements?

In terms of data, we know that there are gaps in current reporting, and our mental health and wellbeing strategy acknowledges that. The need for better data and evidence is specifically reflected in the strategy’s outcomes and in the priorities. As I said in response to Christine Grahame’s previous question, I am happy to consider that issue but, from regular discussions with health and social care partnership leads, we are aware that the number of adults coming forward has increased significantly, so capturing what we have now might not capture what we need in the future.

We have published quality standards to support general adult secondary mental health services. That is part of a wider ambition to develop a suite of standards for mental health services that will improve the quality and safety of mental health care and support. Those standards will be measurable and will provide a basis for continual improvement through enabling greater scrutiny and assurance of services against the standards. The standards will be part of the solution. They will undoubtedly focus on access to services and will set expectations around services and prioritising referrals on the basis of need. The standards will provide clarity on the prioritisation process and the need to support people who are waiting to access services.

Many members are still interested in asking a question, so I would be grateful for concise questions and responses.

I thank the minister for her offer of cross-party collaboration and welcome the new delivery plan, although the crisis in mental health remains, despite the best efforts of staff.

The documents that have been published today promise more working groups, more reviews and more plans for future plans but, last winter, the Government cut £50 million from the mental health budget. Where are the extra staff that the Government promised to support police and to provide support in accident and emergency units?

As I tried to set out when I spoke about the workforce plan and the action plan, the strategy is very much about shifting the balance of care from acute services to community services. It is about building and strengthening resilience and capacity in our communities and making sure that early intervention and prevention are possible. As I said in response to previous questions, specific work is going on across the mental health workforce, but it must be acknowledged that there is also a need to increase resilience right across our communities. Mental health should be everyone’s business, and the strategy’s ambition is to ensure that it is everyone’s business.

We know that more rural areas of Scotland often struggle to recruit clinicians with specialist knowledge in areas such as mental health. How will the Government ensure that people in primary care teams have time to expand their knowledge and to do the early intervention work that is so vital? What work is under way to attract mental health workers to our rural communities?

The member will be aware that we have done a lot of work in primary care to try to ensure that a healthy multidisciplinary team is available as people access care through their general practice. That means that, in many general practices, specialist mental health workers are already available to support the general practice staff. We are keen to continue that work and to continue to invest. We are looking particularly to ensure that our investment aligns with the areas of greatest need, recognising that there is a link to socioeconomic factors and social determinants of health, which apply to mental health as well as to physical health. A lot of work is going on to ensure that the right people are available in the right place and at the right time for individuals.

Scotland’s incredible mental health workforce carries out vital work every day. Can the minister say any more about the work that is under way to grow the mental health workforce in Scotland and how the current plans will build on that work?

I have said something on that already, but I am more than willing to elaborate further. Since 2007, we have been proactive in increasing the number of mental health staff. In that time, the number of psychology and child and adolescent mental health services posts has more than doubled, and the number of psychiatric consultants across all specialties in NHS Scotland has increased by 16.3 per cent, which is a total of 525 whole-time equivalents.

For mental health nursing staff, the workforce has increased by 36.5 per cent, which equates to almost 10,000 extra whole-time equivalents. We have also exceeded our commitment to recruit 800 additional mental health workers to A and E departments, GP practices, police stations, custody suites and prisons.

We know that, to achieve our vision for mental health and wellbeing in Scotland, we rely on having the right workforce that is supported to have the right skills in the right place at the right time. Our aim is to have a workforce that is diverse, skilled, supported and sustainable and that can operate at safe levels. That is why our workforce plan outlines a number of actions that we will take to support our vision, such as a review of mental health nursing in Scotland. Some of our other key actions will address the delivery of psychological therapies. We are always looking to promote and establish alternative pathways to widen access.

The minister said that every senior school in Scotland has counselling services. How many full-time equivalent counsellors are there in Scotland’s schools?

I do not have that data to hand, but I can follow up in writing to Annie Wells. I am absolutely certain that we have delivered on our commitment to make counselling available in every secondary school in Scotland. It has been well used and a great success. We are keen to build on it.

I refer members to my entry in the register of members’ interests, as I am a registered general nurse with the Nursing and Midwifery Council.

The vision for mental health rightly has a focus on promoting positive wellbeing. Across remote and rural Scotland, many people—particularly older people—experience social isolation and loneliness. Will the minister provide an update on how the plan will seek to tackle loneliness and isolation, particularly in remote and rural areas such as Dumfries and Galloway and the Scottish Borders?

The delivery plan recognises the need for us to continue to build capacity in local services and third sector community groups to ensure that everyone in Scotland, particularly those who are most at risk, is able to access mental health and wellbeing support in their local communities.

Since 2021, we have invested £51 million in our community mental health and wellbeing fund for adults, with approximately 3,300 grants being given to local projects across Scotland in the first two years alone. The fund supports grass-roots community groups in building resilience and tackling social isolation, loneliness and mental health inequalities. As such, it prioritises a range of at-risk groups, including older people and those who live in remote or rural areas.

During its second year, more than 1,200 of the projects supported by the fund included a focus on addressing social isolation and loneliness. Those included the Balmaclellan Community Trust, which I think is in the member’s region. The trust provides a fun, informal and safe environment and a place for people to reconnect with each other and revitalise communities and neighbourhoods in the local area.

That concludes the ministerial statement on the vision for Scotland’s mental health. I cannot take further questions, as we are very tight for time this afternoon and I need to protect the coming items. I will allow a moment for front benches to organise themselves.