The next item of business is a debate on motion S6M-13291, in the name of Richard Leonard, on behalf of the Public Audit Committee, on adult mental health. I ask members who wish to speak in the debate to press their request-to-speak buttons. I call on Richard Leonard to open the debate on behalf of the Public Audit Committee.
15:47
Thank you, Deputy Presiding Officer. I am very pleased to be opening this afternoon’s debate on the Public Audit Committee’s inquiry into adult mental health. I thank the clerks and other staff for their immense effort on the production of the report.
As we tackle stigma and discrimination, more people now feel able to talk about, and to seek help for, their mental health. That is to be welcomed, but the Covid-19 pandemic and the cost of living crisis have piled even more pressure on already strained services, not least because both have hit people with already existing mental health conditions the hardest. Combined, those are increasing not a demand but, as one witness told us, a need—a social need—which the Government has a duty to meet.
Let me thank the minister at the outset for her considered and comprehensive response to the committee’s report. Let me also congratulate her on introducing something new to the lexicon of ministerial responses to committee reports of this Parliament, because, on a number of our conclusions, she informs us that she is “sympathetic” and, on yet others, that she accepts “the premise” of our recommendation. That sent me scurrying off to my dictionary to look up the definition of a “premise”. There it was, in between “premiere” and “premium”,
“a proposition supporting a conclusion”,
along with the illustrative sentence,
“If the premise is true, then the conclusion must be true.”
So, I hope that the minister and her officials are using the same dictionary as me.
The committee is grateful to the wide range of witnesses who gave very powerful evidence to inform our report findings. They included mental health organisations and charities representing people experiencing, or at risk of, poor mental health; professions and organisations directly responsible for supporting people with their mental health; and representatives of Government and governing bodies that are directly accountable to the Parliament. Each of those voices was invaluable in informing our report conclusions and recommendations.
We are the Public Audit Committee, and our starting point is funding. There have been two significant in-year and emergency budget cuts to mental health spending in each of the past two financial years—fact. Overall, since 2017, there has been a real-terms increase in funding for adult mental health services and a 16 per cent rise in national health service board spending—fact. There has also been a 14 per cent real-terms increase in local authority spending on adult mental health—fact.
However, it is also a fact that we do not know what the impact of those spending decisions has been—including, critically, whether people’s mental health has improved—because we have no data on outcomes. There are also data gaps, which mean that we do not know what the true demand—the true need—for mental health care in Scotland is. We do not know the number of people with a severe and enduring mental health condition, so we cannot accurately assess demand for mental health support in primary care. We have no data on referrals or case loads for community mental health teams. There is also a gap in data on psychiatric services, including on the number of referrals, the number of people on waiting lists, how long people are waiting for treatment and the length of treatment. We do not know.
We welcome the Scottish Government’s response, which recognises those data gaps and alerts us to work that is under way
“to improve the collection of data on mental health in primary care”.
Let me say gently to the minister, however, that not all the data gaps that we highlight are in the realm of primary care, which leaves the committee questioning the extent to which the broader, systematic data gaps will be addressed. That is essential, but it is also desperately urgent, precisely because the Government is committed to spending
“10% of the front-line NHS budget ... on mental health”
by the end of this parliamentary session.
In their report, the Auditor General and the Accounts Commission described accessing mental health support as “slow and complicated”, which is a view that witnesses whom we heard from reinforced.
Our report welcomes
“the Scottish Government’s ambition to achieve a more preventative primary care-based adult mental health service”,
and we welcome
“its commitment to ensure that every GP practice has access to a mental health and wellbeing service by 2026.”
However, we also seek assurances that sufficient funding will be put in place to realise those ambitions.
To be blunt, the Scottish Government’s response to date falls short of providing such assurances. Instead, there is a commitment, in its written response, to
“promoting and adopting this model where possible.”
I ask the cabinet secretary and the minister whether the Scottish Government remains committed to its 2026 target for general practitioner services.
The committee’s report also welcomes the Scottish Government’s promise to ensure that people have a choice in how they access services, including psychological therapy appointments—a choice in whether they are digital or face to face. However, the evidence that we heard suggests that not everyone who wants a face-to-face appointment is getting one. Striking as well is the evidence of marked variations between health boards, which the Government needs to get to the bottom of and report back to Parliament on.
I turn to mental health inequalities. Of course, no one is immune from poor mental health, but the Mental Health Foundation reminded us that poverty, homelessness, living in poor-quality housing and having limited access to green space all increase the chances of having a mental health problem. During its evidence, it stated:
“One of the best ways of reducing mental health inequalities would be to require every Government decision to be assessed on its impact on mental health.”—[Official Report, Public Audit Committee, 9 November 2023; c 23.]
We note that the Government rejects that proposal, pointing instead to the establishment of internal equality champions, even though the Auditor General concluded that the Government has not yet shown that
“mental health inequalities are being considered enough outside of the Mental Health Directorate.”
The committee therefore remains unpersuaded by the Government’s response and, in our report, we ask the cabinet secretary and the minister what more can and will be done to advance a “whole-of-Government approach” to tackling mental health inequalities.
Finally, our report highlights staff recruitment difficulties and high vacancy and turnover rates right across the mental health workforce. Indeed, vacancy rates for mental health officers and mental health nurses have doubled, while there is a chronic national shortage of psychologists. During evidence, we explored with the Royal College of Psychiatrists the extreme pressure that its members are under. We heard its compelling evidence of “a workforce crisis” and an over-reliance on locum psychiatrists, which neither represents value for money nor provides a guarantee of service quality. Therefore, we call on the minister to publish regular statistical bulletins on the state of the mental health workforce and to give much higher priority to workforce planning in adult mental health.
This is a serious and detailed report by a cross-party committee of this Parliament. Its findings are unanimous. Its conclusions and recommendations are direct. It must be a call to action to this Government and to this Parliament. In plain terms, there is no alternative, because the people who we are sent here to represent simply cannot wait.
On behalf of the Public Audit Committee, I move,
That the Parliament notes the conclusions and recommendations contained in the Public Audit Committee’s 1st Report, 2024 (Session 6), Adult mental health (SP Paper 532).
15:57
I begin by acknowledging the work by the Public Audit Committee, led by Richard Leonard, its members and clerks, in preparing a comprehensive and balanced report on adult mental health. The report is “serious and detailed”, as Richard Leonard described it. It describes some of the systemic issues that we know exist and it builds on the Audit Scotland report on the same topic that was published in September.
I believe that our mental health and wellbeing strategy, our delivery plan and our workforce action plan give a clear idea of our policy direction. The strategy vision is of a Scotland that is free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible. It contains our blueprint for a high-functioning mental health system and a set of outcomes that will enable us to measure our progress. It describes the help and support that anyone should be entitled to expect when they ask for it.
The delivery plan and the workforce action plan set out the first set of actions that we are taking to move us closer to our vision, covering an initial period of 18 months. We do not yet have a whole mental health system that is fully reflective of our vision. Although we have made progress in recent years, it is important that we are open and not defensive about the issues that we know still exist. We recognise that our mental health system continues to face increasing demand and financial pressures. As Richard Leonard said, those needs are linked to Covid, Brexit and, of course, the United Kingdom cost of living crisis. We know from listening to our incredible workforce that they encounter a myriad of challenges every day. We also recognise that there has not been parity of esteem between physical and mental health.
Next week, I will come to Parliament to outline our initial thinking on the future of health and social care services. We know that we need to think differently. I want to have a collaborative discussion about our options, putting party politics to one side.
Can I tempt the cabinet secretary to outline now what tangible difference will be made to mental health services?
I said to Ms Baillie in our earlier conversation that I am open to suggestion. I will come forward, as the minister will in concluding, with some of the work that we are already doing and the steps that we need to take to make further improvements. I pledge to engage with Opposition members on how we continue to evolve our mental health and wellbeing policy in the same spirit.
I was pleased to see so much support and involvement from members across the chamber and in Government for last week’s mental health awareness week. Visiting community organisations that support mental health across the country demonstrated that mental health is a cross-Government and cross-party priority.
The Public Audit Committee’s report encapsulates and reflects the context that I have described. I agree with much of it, and I will describe some of the on-going work to address the issues that have been raised. I, too, thank the many organisations and individuals that Richard Leonard thanked for taking the time to give evidence and contribute to the committee’s inquiry. It is unsurprising that the valuable input from so many people led the committee to some of the same conclusions that the Government arrived at following our extensive engagement when we developed our strategy, which included a full public consultation. The themes are clear: the need for prevention and early intervention approaches, the importance of peer support, tackling the workforce challenge, and the need to improve the data and evidence that are available to us.
Underpinning all our work is the budgetary situation. We face the most challenging public finances since devolution, as the First Minister has set out, and Wes Streeting has explained the impact across all of the UK. However, even in that context, we have seen historic increases in mental health spending, which reflects how much of a priority it is for the Government. The core mental health budget has more than doubled since 2020-21. Under the Scottish National Party, mental health spending by NHS Scotland has doubled in cash terms to £1.3 billion in 2022-23, compared with £651 million in 2006-07. The Government and Parliament have worked hard to raise the profile of mental health and wellbeing and ensure that our increased funding is focused on improving outcomes. As Cabinet Secretary for Health and Social Care, I commit to maintaining that level of focus and prioritisation. There is no health without mental health.
I will give two examples of our work to address specific issues that are raised in the committee’s report. The contribution and sustainability of our incredible third sector is a fundamental part of our vision for a high-functioning mental health system that ensures a good balance between specialist services and activities that are focused on upstream support and prevention. I witnessed the value of structured peer support and early intervention when I visited the changing room—extra time programme at Pittodrie stadium last week. That is why we have invested a further £15 million for the communities mental health and wellbeing fund for adults in 2024-25, which will be distributed to grass-roots projects by the Third Sector Interface Scotland network. The announcement means that we will have made £66 million available through our communities mental health and wellbeing fund for adults since 2021. That fund supported an estimated 300,000 people across Scotland in its first year.
However, as the committee recognises, stability of funding is key, and we will continue to explore options regarding multiyear funding whenever possible. To give one example, I note that we announced in March that the next round of the perinatal and infant mental health fund was open for applications through Inspiring Scotland, with funding continuing until the end of March 2026.
As Richard Leonard mentioned, the committee also highlights the importance of data collection and outlines where there are currently gaps. I, too, recognise the need for improvement in data quality. Areas such as primary care and psychiatry referrals are being prioritised, and a range of activity to improve our data is being led by Public Health Scotland. I welcome the committee’s endorsement of Public Health Scotland’s commitment to publish our mental health quality indicators in a dashboard format, and I confirm that that is scheduled to go live in November. Those are just two areas where work is on-going.
The Minister for Social Care, Mental Wellbeing and Sport wrote to the committee and responded to each of its 29 recommendations in detail, as Mr Leonard said. None of what I have outlined today is meant to deflect or distract from a full and frank acknowledgement that we still have work to do. That is fully in keeping with our mental health and wellbeing strategy. We have a blueprint for what good looks like, but we are not there yet. The committee’s report summarises that context accurately, as did Audit Scotland’s report. There are many areas in which we are already working tirelessly to address the conclusions that are reached in the report.
I finish with a sincere offer to colleagues across the chamber. Our delivery plan represents only the first 18 months’ worth of commitments. Those actions need to result in measurable progress towards the outcomes that are outlined in our strategy, which will in turn move us closer to achieving our vision. If there are suggestions on where the Government could go further or where there are gaps in our delivery plan, the minister and I will always be willing to engage in constructive discussion about that.
I thank the Public Audit Committee and everyone who contributed to its inquiry on adult mental health for their work. As Cabinet Secretary for Health and Social Care, I am determined to face the challenges head on and to see an improving picture.
16:05
It was a pleasure and, to be honest, a bit of an eye-opener for me to be involved in the inquiry into adult mental health. I, too, thank all the witnesses that the committee heard from, the committee clerks and indeed the minister for her detailed response to our report. Despite reaching new heights of Government gobbledygook, it was a good response. I also thank my fellow committee members.
The words “crisis” and “emergency” are used a lot, but there is a mental health crisis. We heard that repeatedly from various witnesses. I want to focus on three areas today—the police, a round-the-clock model of care, and the experience of people with mental health issues of getting help from their GPs. I will take those in reverse order.
The difficulty of seeing a GP and the barriers that people with a mental health issue face in doing so were a feature of our evidence sessions. I asked several witnesses about that because my view is that the system that is operated by a lot of GPs, whereby people have to explain themselves to a receptionist, may put people off. Jo Anderson of the Scottish Association for Mental Health told us:
“Graham Simpson is absolutely right.”
I do not hear that too often, but that is what she said. She continued:
“I mentioned the number of times that people have to describe their situation, and the receptionist is the first place that they have to do so.
People quite often told us ... that it is difficult to even get to sit in front of a GP.”—[Official Report, Public Audit Committee, 9 November 2023; c 5.]
Dr Chris Williams of the Royal College of General Practitioners Scotland said:
“it drives frustration and negative experience. At the moment, general practice and our GP workforce face a difficult time.”—[Official Report, Public Audit Committee, 16 November 2023; c 9.]
Of course they do.
We state in our report’s conclusions:
“The Committee recognises the key role that GPs play in supporting people with their mental health. We are concerned however that having to first explain their medical symptoms to a receptionist may deter some people from approaching their GP for help. We suggest that the Scottish Government works with NHS Health Boards to develop guidance for GP practices setting out options that can be used to support people wishing to make a GP appointment for their mental health.”
The Minister for Social Care, Mental Wellbeing and Sport’s response to that was, in my view, disappointing to say the least. She basically disagreed with it. However, we need to make seeing a GP easier and stigma free not just for those with mental health problems, but for everyone. The briefing that RCGP Scotland sent us for today’s debate says that there should be a mix of appointment types and booking methods. I urge the Government to look at that, not just for people with mental health problems but for everybody. There is an idea for the cabinet secretary.
The second area that I want to mention is a model of mental health care that is mentioned in the Auditor General’s report that exists in Trieste, Italy. Sadly—I do not blame the convener for this—we did not get to see that model at first hand. However, in Trieste, they have set up what is essentially a new way of dealing with mental health. The system operates through a network of mental health centres that operate 24 hours a day. People do not need an appointment—they can just walk in. Not only has it improved the way in which mental health is dealt with in that area, but it is also cheaper than what was there before. However, that is not why they do it—they do it because it is better.
The committee heard mixed views about the merits of the Trieste model, but we invited the Scottish Government to consider further the lessons that can be learned from it. From the minister’s response, people would think that we are already following that model, but we are not. She pointed to the Thrive model in Edinburgh and Hope Point mental health hub in Dundee as
“examples of local developments which have adopted many of the principles of the Trieste approach.”
However, if everything was as rosy as she was trying to make out, we would not have the issues that are connected with the third strand of my argument today, which is about the amount of police officer time that is being taken up in dealing with mental health issues.
It is quite clear to me from speaking to officers in my patch and hearing from our witnesses that our officers are spending far too much time—sometimes, it is the majority of their time—dealing with people with mental health problems. Indeed, Chief Constable Jo Farrell has spoken about that recently. Every year, the police respond to more than 100,000 mental health incidents, only 13 per cent of which involve a crime. On busy days, a call that is related to mental health comes in every two or three minutes.
In England, some forces are adopting a hard line and responding to mental health incidents only when a crime has been committed or where there is an immediate threat to life. Ms Farrell says that she does not want to go that far, but she argues that Police Scotland must no longer be asked to carry out the routine work of other agencies. I agree. She says that she wants her officers to stop carrying out welfare checks on people with mental health problems. My question to Ms Farrell is, if she does not want to follow the English model, exactly what she does want to do, given that her officers are reaching the point of burn-out because of the situation. Incidentally, the minister’s response to the issue was to mention a multi-agency group, whatever that is.
I say to the minister and everyone in the sector that we need action and not talking shops in order to help those who are suffering and those who are tasked with helping them.
16:11
I put on record my thanks to the members and clerks of the Public Audit Committee for their work on this vital and timely report on adult mental health services. I also commend the many witnesses who gave evidence to the committee on this subject matter and contributed valuable insight on all aspects of the mental health landscape.
The committee’s report, and the Audit Scotland report “Adult mental health” before it, have left no doubt: mental health services are in crisis. A sharp increase in demand for support, in part due to the impact of the pandemic and the cost of living crisis, has added further pressure to an already strained service.
However, worsening mental health in the Scottish population is not the fault of the people and we cannot blame an increase in poor mental health alone for the pressure on services. Individuals often have little control over the circumstances that lead to them requiring support. Indeed, they have no control over national or global events such as recessions or pandemics, and we should welcome the fact that more people feel comfortable enough to speak up and seek help when they need it.
Although we know that demand is rising, concerningly, we know only part of the picture. As the committee report says, we need better-quality data to fully understand the scale of demand. At present, data is published on psychological therapies waiting times, but that is largely the only measure of how adult mental health services are performing. There is no measure of quality of care or of outcomes and, as the Audit Scotland report found, that does not amount to sufficient Government oversight over service performance.
We cannot debate the issues around mental health care without considering the workforce crisis in the NHS. Vacancies for mental health nurses have more than doubled between 2017 and 2023. The number of people choosing to study mental health nursing has failed to fill the number of funded places at Scotland’s universities in recent years. In addition, a quarter of consultant psychiatry posts were vacant at the start of this year, with boards spending almost £30 million on locums in 2022-23. Health services can exist and thrive only if we have the staff to deliver them, and urgent action is required from the Government to deliver a recruitment strategy that does not just attract people into mental health care but retains them.
Another concern that is raised in the committee’s report is the ambiguity on how to access support. Although there are local support options, patients and primary care services are not always aware of all the resources or services that are available in their area. With a cluttered landscape of NHS boards, health and social care partnerships, councils and the third sector all providing myriad services, we need to ensure that the suite of support options that are available is communicated simply and clearly.
We also know that, even with many forms of support being available, access to help varies across Scotland. The situation is particularly difficult for people from ethnic minority backgrounds, people in rural areas and people living in poverty. For example, people in the most deprived areas are three times more likely to end up in hospital for mental health issues. That preventable disparity should shame us all.
Both the committee report and the Audit Scotland report reference the Scottish Government’s commitment to ensure that every GP surgery has access to a mental health and wellbeing service by 2026. I think that, across the chamber, we are agreed that support via primary care is crucial. A Scottish Action for Mental Health survey found that six out of 10 people who had tried to access support through their GP or specialist service since 2021 faced challenges or impediments.
The Government’s progress on delivering on mental health and wellbeing services in primary care has been stagnant. That commitment was made in 2021, but in 2024 the services have yet to be fully established. The promise of a primary care and mental health and wellbeing services fund to support delivery never came to pass, despite the health and social care partnerships planning implementation for almost a year. The pledge to recruit an additional 1,000 mental health workers has not been met, either. I think that ministers will understand why we question how they can expect to be taken seriously on mental health policy when their actions since 2021 amount to a string of broken promises.
In the absence of a clear pathway for where to access help, and without the support via primary care that patients were promised, people who need support are not getting the early interventions that they require, and that is loading more cost into the system in the long run. In turn, people are reaching a crisis point, which is having an adverse impact on their health outcomes and on other services. As the committee noted, Police Scotland is now in effect “filling the gaps” in the mental health care system. The chief constable, Jo Farrell, estimated earlier this month that a mental health call comes in every three to four minutes. That is one of the many examples of why we need to shift from responding to crisis to a model of prevention, which enables people to access the support that they need, locally and when they need it, before the issue spirals into something more complicated.
The community link worker programme is proof of the power of community-based social prescribing as a prevention tool. Link workers play a crucial role in providing practical support to help people with their mental health, and it is regrettable that funding for those valuable roles is subject to the ambiguity of short-term annual funding awards. I welcomed the Scottish Government’s intervention to protect the roles of link workers in Glasgow last year, but a sustainable funding model for those roles and other support that is delivered by the third sector must be considered for the longer term.
I sincerely hope that the committee’s report acts as a catalyst for action from the Scottish Government. Regrettably, the mental health budget has been frozen and cut in-year for the past two consecutive years. The psychological therapies target has never been routinely met. The Government is not on track to meet its target of 10 per cent of NHS spend going to mental health. In fact, an £180 million budget shortfall has been estimated.
Mr Sweeney, you need to conclude.
Action is urgently needed, and I sincerely hope that the comprehensive work of the committee ends the inertia of the Government and compels it to take that action.
16:17
I, too, extend my gratitude to the Public Audit Committee and its clerks for their work in the production of the report. I also thank those who participated in the evidence sessions and in the important efforts that were made to prepare the report by the Auditor General for Scotland and the Accounts Commission, which informed much of the committee’s work. The Public Audit Committee report offers key recommendations and conclusions based on comprehensive evidence, and it serves as a reminder that we must do more to support mental health in Scotland.
The report highlights that the Royal College of Psychiatrists has pointed to a consistent increase in the demand for mental health services over the past three years. There has been a specific increase in certain conditions, such as neurodivergent disorders, autism and attention deficit hyperactivity disorder. Its evidence points to the fact that, in some cases, referrals have increased by between 700 and 1,000 per cent. It is undeniable that some of that increase results from a better awareness of symptoms and, to a certain extent, from people who seek diagnosis being less stigmatised than before. We know, however, that there is a long way to go around stigma. For those who are waiting, we need to see what else can be done so that there is no further rise in the trend of people seeking a private diagnosis for many of those conditions.
The Poverty Alliance also conducted a snapshot survey that identified that the increasing cost of living is negatively affecting the population’s mental health. Both testimonies serve as a poignant reminder that the findings and recommendations of the committee’s report must be taken seriously, and they point to the scale of the emergency.
However, undeniable progress is being made in places, and several initiatives are worth highlighting. One of those initiatives, which is laid out in the report, is a project in my region called Chris’s House. Chris’s House has established a relationship with the police in Lanarkshire to highlight the services that the initiative offers to support anyone who the police have been called to who is in crisis or approaching crisis. The services and wraparound care that it offers are incredible, and the link between statutory and voluntary services is vital, especially around suicide and those in crisis who need support. As we know, the pathways are difficult to navigate but, for a person in a moment of crisis, that is almost impossible. We therefore need to ensure that the follow-up care beyond such moments is there quickly to support people and that the person in crisis is not required to go looking for that support.
Local work with liaison groups, hospitals and the police has yielded encouraging results.
Through the interaction that I have had in my constituency capacity, I am aware of the fantastic work that Chris’s House does. I wish to reflect again on the question that Jackie Baillie posed to me about the difference that we can make on mental health by having proper collaboration between the community and voluntary sector and statutory services and with private sector innovation. That can answer the question that Gillian Mackay has posed about how we can continue to sustain improvement through the community and voluntary sector.
Absolutely. I will come on to say more about the third sector and the support that it needs, although, looking at the time, that will probably be in my closing speech.
We know that several inequalities remain across Scotland. I want to touch on the issue of data in particular. There are specific and on-going issues with the quality and depth of the data that we record and, therefore, with the data that we can rely on to plan and target services. That situation is not unique to mental health services but, given the acute pressure on those, it is essential that we collect and process the data that we need. The committee’s report refers to
“the lack of data that is held by the Scottish Government, IJBs and others ‘to fully understand demand for mental healthcare’”
and makes the point that
“comprehensive, good-quality data is essential for assessing demand and planning services”.
The report further states:
“information about demand for mental healthcare in Scotland only covers those already accessing or attempting to access some mental health services.”
Therefore, improvement in the collection of quality data is needed. I echo the report’s concern that the lack of such data means that there is no effective means of measuring outcomes or the impact that substantial investment in services is having on the ground.
Once again, I thank the committee, its clerks and those who gave evidence.
We move to the open debate.
16:22
As a member of the Public Audit Committee, I am pleased to have the opportunity to participate in this debate on adult mental health. I thank all the people who participated in the process and contributed to the production of the report.
As we all know, mental health across the board is a major issue that this country faces. Most particularly since the Covid pandemic, we have seen a substantial change to the mental wellbeing of the people of Scotland and, indeed, people across Europe. That behavioural change seems to be in part driven by poor resilience in the face of the adverse conditions in which Brexit and the cost of living crisis in particular have placed us. Fragile mental health makes an individual vulnerable, and it can mean that they struggle to cope with day-to-day activities.
Of course, there is a positive element in all this. In today’s Scotland, there is a greater willingness to speak about mental health, and more people are prepared to talk about their own mental health. That is a good thing, and it needs to be encouraged. Perhaps that new openness has contributed to people recognising mental health issues and being open to seeking support in greater numbers than in the past.
At times, the Public Audit Committee had difficulty making sense of how well funds that are targeted at adult mental health are spent and how effectively they are used. As is so often the case in the public sector, the data that is key to decisions on where to focus efforts and resources in order to make the biggest impact simply is not there or is inconsistent in collection and format across the country. Significant gaps in data will impact on the ability to make well-informed decisions about the delivery of mental health services.
Over the years, the Scottish Government has rightly had a strong focus on adult mental health. That is evidenced by the increased spend by NHS boards since 2017-18 of £1.2 billion, which is a real-terms increase of 16 per cent, and an increased spend by councils in the same period of £224.7 million, which is a real-terms increase of 14 per cent. The mental health directorate budget has increased by £290.2 million since 2017-18, representing a real-terms increase of 356 per cent. However, is that enough? Is it being spent on the most effective areas? Without data, it is very difficult to be sure.
There has also been a heavy reliance on the police service to provide coverage with some mental health issues. I have heard that as high as 85 per cent of police call-outs involve assistance with a mental health issue. That is not an ideal use of police resources, nor are the police trained to manage mental health. An alternative model needs to be developed and implemented in answer to that dissipation of police time and effort. I am pleased that Police Scotland and its partners are looking at possible solutions to better manage the issue, and I look forward to the outcome.
I welcome the Scottish Government’s commitment to ensuring that every general practice has access to a mental health and wellbeing service by 2026. That will be a game changer in supporting adult mental health. My only fear is that the cost might well be substantial and that, with Scotland’s budget cuts putting pressure on public finances, ambition might exceed the available cash.
The situation overall is exacerbated by a shortage of trained staff to provide the support that is needed. The vacancy level for general psychiatry consultants is the highest of all medical and dental consultant roles in Scotland. Indeed, there has been a reduction in the number of psychiatrists in the past five to 10 years, whereas an increase might have been expected to meet demand. Vacancy rates are running at 30 per cent, and 20 per cent of the consultant workforce is made up of locums. That makes meeting the needs of adults who suffer from poor mental health difficult and expensive. I hope that the Scottish Government’s workforce planning will help to address that issue.
There is no doubt that poor mental health among adults is a growing problem, but I am heartened by the Scottish Government recognising it as such and seeking ways to address the issue. There is no easy solution in the short term but, with long-term workforce planning, resources can be deployed to improve service availability.
I commend the report.
16:26
I offer my thanks to Audit Scotland for the work that it has put into the report and to members of the Public Audit Committee for their scrutiny work.
I also pay tribute to healthcare professionals who work in this field of medicine, who often have tough and very stressful jobs. They do so much work with scant resources, and that should be applauded.
I echo Colin Beattie’s comments about the openness for discussion in our society. That can only be a good thing. We are not yet there in how open we need to be about mental health, but it is positive that we, along with the third sector, Governments and charities, are going in the right direction.
In the short time that I have, I will focus my remarks on some of the issues with access to mental health support services that affect people who live in rural communities.
It is clear from the report and from comments from charities such as Scottish Action for Mental Health that we need whole-system reform to how mental health support is designed, delivered, resourced and accessed. That last part is particularly critical, especially in light of the fact that the number of people who were seen by a mental health professional within 18 weeks fell between 2022 and 2023 in most health board areas, including many of the health boards in the Highlands and Islands region, which I serve. During that period, the number of people who were seen within 18 weeks fell by 15.1 per cent in NHS Grampian and by 6.4 per cent in NHS Western Isles. That is not good enough, and I can only imagine that the reality behind those statistics is huge and overwhelming pressures on staff.
There are also issues in the way in which people access mental health support services. The data highlighted in Audit Scotland’s report shows that there is a postcode lottery as to whether someone can be seen face to face or remotely. For example, in 2022, 74 per cent of mental health appointments in the Western Isles were by telephone or video call, and just 9 per cent were in person. In Orkney, the percentage of appointments that were by telephone or video was even higher, at 94 per cent. However, in Shetland, 64 per cent of appointments were made in person, and the figure for NHS Highland was 48 per cent.
Although it is welcome that some people are receiving treatment by a healthcare professional, the report highlights comments that three quarters of people—75 per cent—felt that face-to-face support was by far the better option. Indeed, according to the report, in 2022, most psychological therapies appointments across Scotland took place digitally or by telephone. That is not to say that different models of treatment delivery are right or wrong, but it is clear from the evidence that people feel a greater benefit from in-person treatment.
The report highlights that not all NHS boards routinely offer patients the choice of a face-to-face appointment and that some health boards are developing new services that will operate entirely remotely. Although new initiatives are clearly welcome—especially if more patients can be seen—we must do more to ensure that health boards can still offer face-to-face appointments where appropriate. That is particularly the case given that, in 2021, the Scottish Government and the Convention of Scottish Local Authorities published “Enabling, Connecting and Empowering: Care in the Digital Age—Scotland’s Digital Health and Care Strategy”, which stated:
“People will not be forced to use a digital service if it is not right for them”.
The report highlights a number of factors that affected the type of appointment that was offered to patients. Those included the availability of clinical space, clinical need and whether people were affected by digital exclusion. It is clear that more needs to be done to support service providers, particularly those in more rural and remote parts of Scotland, to enable them to offer patients a range of treatment options.
That is just a snapshot of some of the issues that are faced by my constituents in rural areas and people in other parts of Scotland. I have not even touched on the funding of mental health link workers in primary care practices or the wider conversation about system reform. A more extensive debate is needed on the issue.
We need a more modern, efficient and local approach to delivering mental health services in communities. That will be delivered only by listening to healthcare professionals on the ground and to our constituents who desperately need those services.
16:30
The Audit Scotland report, which was issued last September and which was the focus of our committee’s work, had four key messages for the Government. Those messages focused on the difficulties in assessing the impact that significant funding increases were achieving due to the absence of good-quality data, access issues across Scotland for communities that are most in need of mental health services, the need for clear oversight of service provision as a whole to allow for better planning for better outcomes, and a review of the progress that has been made to date against previous commitments.
As members might expect, the Public Audit Committee explored those issues in further detail, and we produced our own report, which contained no fewer than 29 comments and recommendations, the great majority of which, I am pleased to say, the Government accepts and is taking action on to make improvements.
I should note that demand for mental health support services has increased significantly in recent years. SAMH reported a 50 per cent increase during the pandemic, and the number of calls to the NHS 24 mental health hub on 111 shot up by more than 400 per cent, from around 2,000 calls per month to more than 11,000 calls per month. The mental health service option became a 24-hour service, which partly explains that rise. However, that also demonstrates the level of demand. Let us not overlook either the impact that the prolonged cost of living crisis is having on the mental health of a sizeable proportion of our community.
On resources and hard cash, the Scottish Government is investing a total of around £1.3 billion to support mental health services. As the Auditor General for Scotland noted, the allocation to the mental health directorate itself has gone up from £63 million to £290 million—my colleague Colin Beattie mentioned that. The difficulty for all of us is to be able to assess the impact of that increased spend and to be sure that the public are getting the services that they need. That was clearly reflected in the committee’s work and recognised by the minister in her substantial response to the report.
Variation in access to services featured prominently during the committee’s work, and there was some discussion of how various communities, and minorities in particular, are served by the support systems that we have in place. The committee heard that our ethnic minority communities often face greater challenges in finding and accessing services where they live, and that was a cause for concern.
It was also noted that people who live in our more deprived communities are three times more likely to end up in hospital as a result of mental health issues—I believe that another member mentioned that earlier. Therefore, the need to target service support to those communities that are most in need is a clear issue, and I know that the Government has taken that matter up directly.
It is also interesting that digital access to services featured in the report. Wide variations were seen across Scotland. Some of our mainland health boards had extremely low face-to-face service provision. However, I am delighted to note that Ayrshire and Arran had the highest level of face-to-face provision in Scotland, with more than 86 per cent of people receiving face-to-face consultations, compared with the average in Scotland of about 40 per cent. People must be given a choice about the type of consultation that they receive, and our health boards must deliver that.
The need to have clear and general oversight of the entire service provision is essential if we are to understand and deliver on our commitments. The Auditor General and the committee recognised that the complexity of fragmentation in the system, with multiple bodies providing support and funding, not only impacts on accountability but makes it more difficult to be sure that services are being developed to fully meet people’s needs.
Finally, on reviewing progress of the 10-year strategy to 2027, there was a bit of a mixed picture. That is not to say that good work is not being done—it most certainly is, and we have all seen and witnessed some fantastic work going on in our constituencies across Scotland. Better data and access arrangements, co-ordinated oversight and engagement with the public, who rely on us for that support, are the keys to delivering the improvements in mental health that I am sure we all seek for the coming years.
16:35
I thank the Public Audit Committee and the clerks for the detailed report, which I hope will make a positive contribution to improving adult mental health services across Scotland. There is much in the report, but with only four minutes, I will focus on only a few of the areas that are covered.
The committee heard compelling evidence that demand for mental health care continues to rise, which is adding to the pressure that an adult mental health system that is already under significant strain faces. Given that strain, I pay tribute to all those who work in the sector, whether in acute or community-based services, or in community-based third sector organisations, all of whom do a great job, often under immense pressure.
For many people, when they feel ill their first port of call will be their general practitioner. The committee recognised the key role that GPs play in supporting people’s mental health. However, as we—and, I suggest, most people in Scotland—know, GP services are under constant pressure, with increasing numbers of people finding it more difficult to access their GP.
The Government made a commitment to ensure that every general practice has access to a multidisciplinary mental health and wellbeing service by 2026, and it backed that up with a commitment to provide £40 million a year. The questions that have been asked by Scottish Action for Mental Health are important, so perhaps the minister will give clarify the position when she responds to the debate. Is the Scottish Government still committed to the full roll-out of a primary care multidisciplinary mental health and wellbeing service by 2026? Is the Scottish Government still committed to providing £40 million of annual funding to support primary care multidisciplinary mental health and wellbeing services by 2026? When will a fully costed delivery plan be published, as has been recommended by the committee?
In order to get a full range of services based at community level, we must have good local infrastructure in place. When it comes to their health centres, sadly, the people of Lochgelly and Kincardine know all too well about SNP broken promises. I understand about the very challenging financial times in which we operate, but the committee makes a clear and important point when it states that
“It is crucial that the Scottish Government publishes a costed delivery plan setting out the wider funding and workforce that will be needed to achieve its aim of establishing sustainable and effective MHWPCS across Scotland by 2026.”
The report also states that
“The Committee is clear that it is not the role of police officers to ‘fill the gap’ in the mental healthcare system.”
I listened carefully to the interview that the chief constable gave last week. She was clear that we need more specialist mental health services that police officers can call on to provide the care and support that are needed, which will allow officers to focus on core policing.
As Change Mental Health states:
“The Scottish Government need to clarify what role the police will play in supporting those in a mental health crisis, and work with statutory services and the third sector to fill these gaps.”
My message today is that we can and we must do more.
I call Emma Roddick, who will give the last speech before we move to closing speeches.
16:39
I welcome the committee debate on such an important report. I know that many constituents care deeply about the issue. I have met, across the Highlands and Islands, many local organisations that I know are making a difference. From Mind Your Head in Shetland to Centred (Scotland) in Inverness, I know that much work is going on that meaningfully impacts on the lives of people in my region who are suffering from mental illness.
A visit that I will never forget was a visit to the distress brief intervention programme offices in Inverness, where I heard about the flexible support that is being offered to people who are in immediate need. I heard from staff how important it was for them to help, how they went above and beyond, and how, in the words of one, they do not understand what happened to people before the service went live. I genuinely believe in the distress brief intervention model: it is exactly the kind of flexible support in a crisis that I argued for when I was a mental health campaigner, as a teenager.
I have noticed that politicians are excellent at talking about awareness and prevention. We love a public awareness campaign, having leaflets and wearing badges during mental health awareness week, but we cannot prevent every mental health crisis. People will continue to suffer from trauma and people who have lifelong mental health conditions will continue to need support for—I hope—a very long life ahead of them. Traumatic events will continue to happen no matter how many safeguards we put in place to guard against them. There are natural disasters, accidents, bereaved children, traumatic births and bad actors. Events have happened elsewhere in the world to people who move to Scotland and need our help. We cannot stop all the wrong things in the world, so mental health services are necessary.
Audit Scotland highlighted that the target of 10 per cent of front-line NHS spend being on mental health has not been achieved. That needs urgent work. Its report also talks about the need for 24-hour access when immediate care is necessary. We know that all services—including the third sector, policing and council services—are stretched by mental health crisis presentations. Front-line support by people who are qualified to deal with mental health crises is needed. The Audit Scotland report suggests that it is not the role of police officers to fill the gap in mental health care. That is true, but we must also recognise, as Change Mental Health has pointed out, that people who are in emergency situations need support. Someone who is an immediate danger to themselves or others cannot be put on a waiting list. That takes me back to the distress brief intervention programme, which I firmly believe should be invested in more because we know that it is helping with co-ordination of services.
Police cannot deliver psychological support or help a person to work through their trauma, but there is absolutely a role for them in identifying, protecting and correctly referring people who are having mental health crises. We should not shy away from that. As we discuss the great pressure that the police force is under, we can recognise that its role can be defined and agreed to, because the police will interact with those crises.
Trauma-informed support across the board still needs attention and training resources, because people are still regularly reporting that they are having to share their traumatic experiences over and over with different authorities. That will compound their trauma and encourage dissociation and distrust of the services that they will need moving forward, rather than support them to process what has happened to them. I have been through a mental health crisis, so I know how critical the initial support is, how life changing a poor reaction or a thoughtless comment can be, and how transformative the right non-judgmental support can be. It is important that we keep improving crisis services and that we make sure that, no matter who the person runs into first when they are in crisis—the police, accident and emergency services, social workers or the Scottish Ambulance Service—they are supported to access the right service and help to recover, whatever that looks like for them.
We move to closing speeches. I note with some disappointment that a member who has participated in the debate is not here for the start of closing speeches, which is a discourtesy to other members who have spoken in the debate and to the chair.
16:39
In closing, I will emphasise the critical points that have been raised by the committee’s report, and by the various stakeholders that informed it.
Richard Leonard mentioned taking a preventative approach to mental health, with which I whole-heartedly agree. We need to keep people well in order to ensure that we prevent them from ending up in secondary services, and that we give them a better quality of life. The preventative approach has some new branches, but many of the levers—including access to good quality housing, fair work, fair pay, and all the things that we know make lives better—fall outside the portfolios that we are talking about in the debate.
I hope that the cabinet secretary, ministers and others in the Government will ensure that decisions that are made by the Government will seek to enhance and improve mental health care. I recognise Emma Roddick’s comments that not every mental health condition or crisis can be prevented, but we should be doing everything that we can do to ensure that support is there when people need it.
Although several incentives have been brought forward to enhance access to mental health services across Scotland, the report highlights the importance of addressing broader inequalities and the fact that many current incentives lack detail. “HMICS Thematic review of policing mental health in Scotland” shows that police are shouldering the responsibilities that should be shared by a more integrated system.
A whole-system response is necessary for effective mental health services, and the committee’s report also makes it clear that tackling mental health inequalities extends beyond the healthcare system. The chief executive of NHS Scotland shared how health boards can support local communities through employment, procurement and leveraging of the broader policies that are focused on tackling inequalities and poverty.
I also want to touch briefly on the recommendations about GPs and people contacting their GPs. I agree that, for many people, repeating the story about or the symptoms of their mental ill health might deter them from seeking help. I also agree that guidance should be produced, but it should go further than just general practices, so that we are not retraumatising people purely so that they can get an appointment or help. The Royal College of General Practitioners has asked that guidance and any other innovations be allowed time to be implemented. I echo its call for protected learning time for GPs and their teams.
The third sector is delivering a huge number of services and support, but as the committee highlights, funding and certainty about that funding are a barrier to how those services and support are delivered. I was pleased to visit a project on nature prescriptions in Calderwood country park last week with Voluntary Action South Lanarkshire, RSPB Scotland and other partners. The project is fantastic and I hope that other Central Scotland members—and perhaps even the minister and the cabinet secretary—will consider going to see it. It highlighted to me how difficult the current funding regime for third sector organisations is because of the need for them to reinvent the wheel to access funds without knowing when funding decisions will be made.
Some of those whom we spoke to on Skye as part of the Health, Social Care and Sport Committee’s inquiry into remote and rural healthcare could not even get people to reply to emails about when funding could be expected. The mix of support that the third sector provides is phenomenal, so we need to recognise that in the way in which such organisations are treated and supported.
I also believe that, for there to be meaningful reform, the Scottish Government must prioritise mental health funding by meeting its target to increase spending and ensure that at least 10 per cent of front-line NHS spending is dedicated to mental health care.
I remain encouraged by several commitments that have been made by the Scottish Government in its response to several of the shortcomings that are addressed in the report. However, I hope that that translates into concrete action to reinvigorate the mental health care system, which we encourage our constituents to rely on.
16:47
I echo colleagues in expressing my thanks to the convener, Richard Leonard, and to all members of the Public Audit Committee, together with the clerks, for producing the report. I also offer my thanks to those who gave evidence to the committee and offered their important insights into the realities on the ground.
Like so many of Scotland’s public services, adult mental health services are in a state of acute crisis after 17 years of the SNP Government. Paul Sweeney was right to talk about prevention because, across our communities, people are struggling to access the mental health support that they so desperately need. What makes me angry is the fact that, although the SNP Government has made promise after promise to take action on mental health, it feels like empty words. In the past two financial years, mental health funding has been clawed back to the tune of almost £70 million. With those sorts of decisions, is it any wonder that we are having today’s debate?
The Public Audit Committee report on adult mental health details a litany of failures that have been argued about across the chamber. It is clear that urgent and meaningful reform must be implemented if mental health services in Scotland are to survive.
We have doubled our investment in mental health services. Now that we know that there will be an election on 4 July, are we going to see an incoming Labour Government making greater investment in our public services, so that we can continue to make improvements? Can we get that exclusive from Jackie Baillie today?
I am surprised that the cabinet secretary even has to ask that question. Labour created the NHS, Labour will defend it and Labour will invest in it.
When the SNP Government had record levels of funding from a previous Labour UK Government, it squandered that money and spent it on other things. Scotland used to spend 22 per cent more money per head on health than England did. Today, that gap has fallen to 3 per cent. That has happened on the SNP’s watch. It has not invested in the NHS, and the public will find it out for that.
Will the member take an intervention?
No, thank you.
I welcome Gillian Mackay’s suggestion about further collaboration with the voluntary sector, but that should have happened before now.
Alex Rowley and Graham Simpson raised the lack of service provision and its impact on policing. That is not new. The report’s findings echo an Audit Scotland report on adult mental health from September 2023, which highlighted the same themes and the same issues. That report came out eight months ago, but Scotland’s mental health services remain in a state of crisis, and little action appears to have been taken to address the situation. I sincerely hope that the Scottish Government heeds the recommendations of the Public Audit Committee’s report with more urgency than it has shown to date.
To begin with, better data collection is vital. Audit Scotland and the Public Audit Committee covered the need for that. Failure to collate proper data is a theme that runs throughout Scotland’s struggling health and social care system, and it is all too characteristic of a Government that seeks to obscure the truth and hide the facts. Without proper data collection, the Government cannot hope to address the issues that Audit Scotland and the Public Audit Committee have highlighted in relation to investment in services.
The Government pledged to increase mental health spending by 25 per cent over the parliamentary session and said that at least 10 per cent of front-line NHS spend would go to mental health. How are we doing on that? The latest data from Public Health Scotland shows that, in 2022-23, only 8.53 per cent of NHS expenditure went to mental health—again, that is a decrease on the previous year, and it is lower than the equivalent spend of 14 per cent in England and 11 per cent in Wales.
We have had enough of the spin and the warm words. The Government must tell Parliament when it will meet its own target that at least 10 per cent of front-line NHS spend will go to mental health. That is important because properly funding primary care and GP services is essential if we are to address the mental health crisis. Related to that is the retention and expansion of clinical link workers. The Government should give a cast-iron commitment to long-term funding for clinical link workers if it is serious about tackling the concerns in the report.
I am conscious of time, Presiding Officer. Richard Leonard was right to emphasise the inequality of provision. For people who are living in poverty, for people who are living in rural areas and for ethnic minorities, access to mental health support remains slow and overcomplicated. The scale of the crisis cannot be overstated. After years of poor workforce planning, the workforce is at breaking point as it struggles to meet demand.
Accepting the Public Audit Committee’s report and implementing the recommendations as a matter of urgency is the right place to start, but the report demonstrates that people in Scotland have been failed by both the UK and Scottish Governments. It is time for change, and that opportunity is with us now. Thank goodness for that.
16:53
The statistics are sobering, and the Public Audit Committee’s report is damning. In any given year, one in four people experience mental health problems. Life expectancy for people with prolonged mental illness is significantly shorter. The suicide rate is consistently higher in Scotland than it is in Northern Ireland, Wales and England. The number of female deaths by suicide is rising. The cost of poor mental health to the Scottish economy is close to £9 billion.
Scotland is experiencing a mental health crisis, and the healthcare system under the SNP Government is simply not equipped to cope. Demand is rising, but capacity is not. Too many people are languishing on waiting lists for treatment. Millions of pounds are being spent on locum psychiatrists because health boards cannot recruit to permanent positions.
It is therefore welcome and necessary that mental health services across Scotland are being scrutinised by Audit Scotland and the Public Audit Committee. That work shines a much-needed light on the pressures in the mental health care system and the lack of progress by successive SNP Governments. It is clear that the SNP does not have a grip, from the lack of data to support the delivery of services to the barriers that people continue to experience as they try to access care. Patchy provision, too few face-to-face appointments and unachievable policy commitments have defined the SNP’s record on mental health to date.
Meanwhile, real-terms spending on mental health by the Scottish Government has reduced. Third sector organisations such as the Scottish Men’s Sheds Association have been forced to wait anxiously for news of funding from the SNP Government. The first men’s shed started in 2013 in Westhill, in my region of Aberdeenshire, and it has done vital work to improve men’s mental health and wellbeing, but there is no plan in place for long-term, sustainable funding from the Scottish Government.
When I hosted a round-table event on perinatal mental health in October last year, the message was the same—the third sector is stepping into the breach, but there is no certainty over funding. Organisations are worried about recruiting staff to meet demand when they might not be able to pay those staff in the next financial year. Last week, I spoke to one GP surgery in my region that told me that it had nowhere to signpost anyone to in the community for mental health support, because the service had closed. That is dire. There must be a better way for the SNP Government to support such organisations.
Audit Scotland’s report highlighted specific concerns about access to mental health care in rural areas, which I strongly echo. The report quoted a rural resident who said:
“If you live in a rural community or outside of a catchment area you have no services available. You try to access the services where they are available but you’re up against a brick wall.”
The reality on the ground is that there is a postcode lottery in mental health care.
There is no mother and baby unit outside the central belt, which means that new mums in serious mental health distress in my region must leave their families and travel miles for specialist treatment. According to the Maternal Mental Health Alliance, only two out of the 14 NHS boards currently meet UK-wide quality standards for specialist perinatal mental health care.
The centralisation of services is having a massive impact. The Mulberry unit for mental health at Stracathro hospital in Brechin closed in 2017 because of staffing pressures. Services relocated to the Carseview centre in Dundee, which is some 35 miles away and involves up to a two-hour journey on public transport one way. The decision to close the Mulberry unit was not about providing a superior service at Carseview; we know from David Strang’s damning report into mental health services in NHS Tayside that there were serious and enduring issues in the delivery of those services when the Mulberry unit was closed. The people of Angus have been unfairly impacted as a result.
The cabinet secretary has said that he is open to ideas: I would like to ask him and the minister to meet Nicky Connor, who is the new chief executive of NHS Tayside, to review David Strang’s report and its recommendations, whose implementation is still outstanding. As I have said, there has not been nearly enough progress in implementing the Strang report’s recommendations and not enough oversight of that process, either. That is just not good enough. We have a new cabinet secretary, so this is a new opportunity; I ask that he please listen.
Politicians and policy makers have long called for parity between mental health and physical health. That ambition formed the foundation of the SNP Government’s mental health strategy back in 2017. However, that ambition cannot be achieved when mental health services are at saturation point.
It is time for the SNP Government to stop paying lip service to mental health. It must act urgently to implement the recommendations from Audit Scotland and the Public Audit Committee and support Scotland’s mental health services.
16:59
I thank members for their invaluable contributions to the debate. As the cabinet secretary outlined in his opening remarks, the work undertaken by the Public Audit Committee and Audit Scotland on adult mental health services across Scotland has been extensive. I thank the committee, the convener and all who gave evidence to its inquiry.
Whenever mental health is the topic for discussion, I truly believe that we can all come to Parliament in a collaborative spirit. The debate is often robust and passionate, which is exactly how it should be, but we all make our contributions on the basis of a sincere shared belief that the system should and can be improved.
There should be varied support for people who need help with their mental health, at all levels of need. Reducing stigma should continue to be foundational so that people can ask for help without fear of judgment. The performance of clinical services such as child and adolescent mental health services and psychological therapies should be carefully scrutinised so that we can continue to improve it.
We should also focus on continuing to expand community-based provision, peer support and mental health resources in primary care. Overall, we should continue to tilt the balance to early intervention and prevention while valuing our specialist services. Those points come through very clearly in the committee’s report, and they are also key themes in our mental health and wellbeing strategy.
We are wholly focused on making progress towards the strategy’s outcomes and, in turn, its vision. Delivery of that vision is dependent on cross-Government and cross-society collaboration, and we are working to deliver that. The strategy outlines a blueprint of what “good” looks like. That covers improving access to and the quality of mental health services, expanding the range of support that is available to meet emerging need, effectively aligning our workforce and improving the amount and quality of data available. That echoes the themes that came through in both the committee’s and Audit Scotland’s reports.
The theme of accountability ran through the committee’s evidence sessions, and I recognise the importance of the Government being transparent about progress. We have committed to establishing a mental health and wellbeing leadership board, which will be jointly chaired by the Convention of Scottish Local Authorities, to oversee our joint strategy and delivery plan. The board, which will contain representation from across the whole system, including across Government, will meet for the first time in early summer.
The committee in its report has asked us to be up front about progress, and we will be. The leadership board will play a crucial role in delivering that. A number of people have raised the issue of workforce. With substantial investment, we have record numbers of staff providing more varied support and services to a larger number of people than ever before.
On the issue of transparency, NHS Education for Scotland publishes detailed quarterly statistics on the make-up of the mental health workforce for psychology and CAMHS. There is currently a review of mental health nursing, which will be completed by the end of the year, and I am happy to update Parliament on that.
We recognise that there are global shortages in the medical specialty of psychiatry. Work is on-going to ensure that we attract the brightest and best to the profession. Although I am pleased that there was a 100 per cent fill rate for trainees last year, I am absolutely clear that all is not equal in every specialty within psychiatry. Work is on-going to ensure that we have the right workforce for the future.
A number of people raised the issue of the police. I recognise the impact of mental health-related incidents on policing, and I am grateful to officers for their work every day to support those who are in distress or experiencing mental ill health. In a rural area such as the one that I represent, police will always be part of the front-line response to people who are in distress.
The partnership group that we have set up is multidisciplinary. It has representatives from the Scottish Government, the Scottish Police Authority and Police Scotland, who will drive activity to ensure that resources are deployed appropriately and reduce unnecessary demand on officers.
On tangible progress that has already been made and is being built on, the group will implement the enhanced mental health pathway, which allows Police Scotland to pass on calls from people who need mental health or distress support to the NHS 24 mental health hub. That is available 24 hours a day, seven days a week. It will enable call-handling staff—
Will the member take an intervention?
Yes, certainly.
I thank the minister for taking the intervention. I am interested to hear more about that, because we need tangible action so that police officers are not spending so much time tied up with dealing with people with mental health issues. When can we expect to see that action?
As I said, some action is already under way, so that police officers can ensure that the people who are asking them for support and help can be referred to NHS 24. There is an ability for call-handling staff at Police Scotland to make referrals to the distress brief intervention programme, which we have heard about. That is an incredible resource that has not been available before, and it is an alternative to sending police officers out in response to a call. More than 62,000 people in Scotland have been able to access distress brief intervention since it was started, and referrals from Police Scotland are steadily rising. Local mental health clinicians are available 24 hours a day—we need to increase awareness of that. Police Scotland has access to that support 24 hours a day, seven days a week, so that the people who are contacting them can be enabled to access local clinical support.
On access to GP appointments, members are aware that there have been substantial changes in the primary care workforce. Although GPs are still the cornerstone of primary care, many other disciplines are now available through GP practices, some of which specialise in mental health. Receptionists are asking questions about the nature of calls so that they can ensure that people are able to access the right professional on the team.
I would love to say more about digital access, which has made such a difference in my constituency, but I am running short of time. Digital access must be by choice. In areas such as mine, it enhances access to services, but I agree that it is not for everyone.
I repeat the offer that was made by the cabinet secretary by saying that I am always willing to engage constructively across the Parliament to put party politics to one side on areas in which we think we might be able to go further to address the issues that we all know exist. That is the case for issues that were identified in the committee’s report and in the Audit Scotland report. In the spirit of collaboration, we will move forward together.
I call Jamie Greene to wind up the debate on behalf of the Public Audit Committee.
17:08
I apologise for my croaky voice; I will see whether I can make it through the speech. Contrary to convention, I am also happy to take interventions while I speak on behalf of the committee. I am the deputy convener of the Public Audit Committee, and I regret that the debate was cut short today due to additional business, because it is so important.
Off the back of mental health awareness week, this is a timely debate. The Public Audit Committee is often undervalued in the Parliament. The report was frank, stark, well constructed, cross-party and unanimous. That is important. It is so important that we all talk about mental health and that we lead by example to break down stigma and taboos around mental health. I hope that I play my part in that—members may have heard me on BBC Scotland last week.
The debate has rather starkly highlighted the many challenges that adult mental health services in Scotland face. I summarise the current situation as, indeed, did the report, simply as a growing crisis. However, the way in which the Government chooses to respond to the crisis will impact the lives of many for decades to come. There is absolute consensus in the chamber about which actions the Scottish Government needs to prioritise, about the rise in demand and about the many gaps in delivery, because the causes of poor mental health are varied, complex and interconnected. It is also clear that many people are falling through gaps in the system, and that is not good enough.
I will turn to some of the specific issues that were raised in the debate. The convener of the committee, in his opening comments, talked about the rise in demand, citing the pandemic as a recent cause of strain and, of course, the current cost of living crisis, which has put more pressure on people and services.
A rise in demand, on the one hand, provides proof and evidence that fewer people are suffering in silence and alone, because society is breaking down taboos and stigma over mental health. It should have parity with physical health. However, the increase in demand is reflected in an increased strain on services, which are not always resourced or funded to match that demand. Waiting times are simply unacceptable across too many metrics. Although any progress on those is welcome, the sector faces a workforce crisis, and we all know it. If the people are not there, nor is the support. The committee’s report raises serious concerns that demand has not been met for far too many of our fellow Scots.
When it comes to out-of-hours support, as Graham Simpson said, it is too often left to Police Scotland to deal with incidents where someone is facing a mental health crisis or is in distress. My experience on the Criminal Justice Committee vindicates that view. It is now widely accepted that, when other services are simply not there, particularly out of hours, people ring the police, and the police are obliged to respond to those calls. The number of police incidents relating to mental health increased by 62 per cent over four years alone, and the cost of that is more than £14 billion per year.
The new chief constable, Jo Farrell, has been clear that the status quo cannot continue in that regard, but we see no firm pathway towards reducing that burden, as Alex Rowley said. We are encouraged by evidence that some local policing partnerships are reducing the impact on police at a local level. That approach could be rolled out on a national basis.
Of course, we looked at other triage approach pilots that police forces elsewhere in the UK are trying and which have proven to be successful. I urge the Government, on a cross-portfolio basis, to learn from any successes in that regard. I am pleased that a multi-agency group has been established but, as we heard from members on our front bench, it cannot simply be a talking shop, because tangible results are what matter—as in that waiting lists must come down and suicide rates must start falling.
Others have mentioned the issue of data. Data sounds relatively dull in a debate such as this, but it is the concerning lack of data in relation to adult mental health services that worried the committee. We discovered that we do not really know the full extent of demand for mental health services.
More concerning is our conclusion that we do not know whether investment is delivering the intended outcomes. Sadly, that is a common critique from Audit Scotland across a wide range of portfolios. When VOX gave evidence to the committee, it said:
“It seems ridiculous that we do not collect that information and data or have that evidence about how things are working”.—[Official Report, Public Audit Committee, 9 November 2023; c 29.]
That is important, because gaps in data will have serious consequences when it comes to designing future services. We need the ability to make informed decisions about the delivery of mental health services.
We welcome the commitment to develop a mental health dashboard in 2024, similar to the approach taken by NHS England. It is encouraging that Public Health Scotland is also devoting resource to that. However, what is key is the macro picture and the Scottish Government’s wider commitment to 10 per cent of the front-line NHS budget to be spent on mental health by 2026. In our report, the committee said that progress on that has simply been far too slow and is too difficult to track. Mental health services in Scotland are not where they should be, and we must accept that. Every GP practice should be offering mental health and wellbeing services by 2026.
Our report was frank. We believe that there is
“limited oversight, transparency and accountability in relation to the performance of adult mental health services”.
Therefore, we asked the Scottish Government to explain how it plans to make progress towards its 10 per cent financial commitment and how it will improve access to preventative and primary care services.
Others mentioned the postcode lottery of services. Tim Eagle referenced access in rural parts of Scotland. Willie Coffey talked about the specific needs of ethnic minorities. I also refer to the LGBT community, who face their own mental health issues. The issues that people in Scotland face are quite varied, depending on where they live and their needs. It is the Government’s job to respond to that.
The committee rightly wanted to pay tribute to the vital role that the third sector plays in supporting people with their mental health—organisations such as SAMH, Change Mental Health, VOX, the Mental Health Foundation and many others—including one called Your Voice in Greenock, in my area. However, those services should be complementary to—not replacements for—statutory health services.
The nature of third sector funding is fragile and often unpredictable. We recognise that the Scottish Government does not work in multiyear funding settlements, but the committee highlights the need for certainty for such third sector services, as Tess White highlighted when she raised the plight of the men’s shed network. The Government needs that funding reassurance to ensure that the vital work of the third sector can go on.
I would like to end—my voice has made it, thankfully—by thanking the Auditor General for his work, the Public Audit Committee and all the members who participated in the debate for their stark comments and contributions. It is absolutely clear that so much more work is to be done. Any progress will be welcome, but far too many people remain in need of help and support, and none of us should be comfortable with that. The report should be a wake-up call. I hope that it is.
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