Seòmar agus comataidhean

Thank you, convener. I thank the committee for asking me to attend today to give evidence on the draft Mental Health (National Secure Adolescent Inpatient Service: Miscellaneous Amendments) (Scotland) Regulations 2023.

Before we begin the questions, I thought that it would be helpful for me to provide some short opening comments. I am pleased that, after many years of planning and development, the national secure adolescent in-patient service—known as Foxgrove—is almost ready to admit patients. Foxgrove will be a vital and important addition to children and young people’s mental health services in Scotland.

Foxgrove will provide services for children and young people aged between 12 and 18 who are subject to measures for compulsory care and treatment, have a mental disorder, present a significant risk to themselves or other people and require a medium-secure level of security in order to meet their needs. Having the facility in Scotland will mean that young people with extremely complex needs can have their needs met in a purpose-built and designed facility, with expert care delivering high-quality mental health care and treatment.

Members will hear me speak more about the mental health strategy in the chamber this afternoon, but the opening of the facility supports the vision that is set out in Scotland’s “Mental Health and Wellbeing Strategy” for a Scotland that is

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

One of the outcomes within the strategy is:

“increased availability of timely, effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs.”

Foxgrove will play a key part in that by providing a dedicated and appropriately skilled multidisciplinary healthcare team to deliver the level of care that young people deserve, closer to home.

Adding Foxgrove to the regulations will ensure that the service can implement a range of safety and security measures to support the therapeutic environment and ensure the safety and security of children and young people as well as staff and visitors. The measures will be applied only when necessary, and they will be applied in a proportional way that is sensitive to the developmental stage of the child or young person.

Of course, it goes without saying that, when the measures are applied, they will also uphold and protect the human rights of children and young people.

Moving on to the specific the statutory instrument that is before the committee today, the regulations make amendments to the Mental Health (Safety and Security) (Scotland) Regulations 2005 and the Mental Health (Detention in Conditions of Excessive Security) (Scotland) Regulations 2015, so that the same safety and security measures that are available in other medium-secure in-patient settings can be applied, where necessary, in Foxgrove.

Children and young people who are detained in Foxgrove will also have the same right of appeal against detention in conditions of excessive security as those detained in other medium-secure in-patient settings. I consider that a right of appeal is an essential safeguard in the process, and that children and young people should have that right when they are detained in Foxgrove.

The regulations do not create any new enforcement or monitoring mechanisms; they simply apply the existing mechanisms to Foxgrove.

Laying the regulations is an important step in preparing Foxgrove to admit patients, which it hopes to do early in 2024. They lay the framework for a safe, secure and—importantly—therapeutic environment, where children and young people’s human rights are upheld and protected, and they allow them to appeal the level of security at which they are detained.

I am happy to answer any questions that the committee has.

I will ask Dr Blower to tell you a little bit more about how CAMHS operates.

In general, and as you would expect, medical services that are available to children operate with UNCRC at their heart. In Scotland, we use getting it right for every child—GIRFEC—as a framework for all public service interaction with children and young people, so you would expect that to be human rights compliant and age appropriate.

With regard to the consultation, we have not done a formal children’s rights and wellbeing screening sheet and impact assessment to assess how compliant these regulations are, but we have asked a lot of the questions relating to the CRWIA as we have gone along. The reason for not doing a formal CRWIA is that these regulations are an amendment to existing regulations and they do not contain any new protective measures; they are about applying measures that are already available to a new site. We would certainly consider doing a full and formal CRWIA if that was what Parliament wanted.

We think that the timescales are right, because the patients are not likely to be short-stay patients; they are likely to be longer-term patients. We think that the appeal processes are appropriate.

I do not know whether it would be reasonable to ask Dr Blower about that. Would you like to give a little bit more information about that, Aileen? Ruth Christie could perhaps then pick up on the question about consultation on the timescales.

Yes.

It is a step forward for the care of children with complex problems. These regulations will help us to uphold and protect children’s human rights in those situations. It is generally regarded as a positive step. Children who find themselves requiring secure care are currently usually transferred to England for medium-secure care. Being able to care for them in Scotland and therefore provide continuity of education—different education systems operate in the two countries—will help us to uphold the Promise rather than cause any challenge to those principles.

The Scottish Government is absolutely committed to delivering on the Promise. We made the Promise and we intend to uphold it.

As we stated earlier, officials have met each of the stakeholders who contributed to the consultation. They have had detailed discussions and have reassured the stakeholders that the processes are appropriate. We are comfortable that we have the support of stakeholders, that we have been able to adequately explain how the service will operate with regard to children’s rights, and that the service is an important step forward in upholding children’s rights.

I do not know whether Ruth Christie wants to say a little more about those meetings with stakeholders, which took place subsequent to the consultation.

A full CRWIA was not required because the regulations do not create any new enforcement or monitoring mechanism. As I said earlier, they simply take mechanisms that already exist and apply them to a new hospital. I do not think that that will change because of UNCRC incorporation. In everything that we do, and with all the public services that we deliver to children, the Government tries to work—as it has done for many years—according to and in compliance with UNCRC principles.

The difference was that, when UNCRC incorporation did not happen, that was justiciable. There were consequences to it not happening. However, incorporation would not make any difference in practice to how we approach the issues, because we try very carefully to be UNCRC compliant at all times anyway.

Do you want to hear from Dr Blower about how CAMHS operates from a human rights perspective?

I will ask Dr Blower to say a little more about how the legislation is likely to operate in practice, but all the legislation that comes through the Scottish Parliament is ECHR compliant and we always try to develop legislation that is UNCRC compliant, even though we have not yet incorporated that fully.

The right to family life is really important. Dr Blower was trying to explain just how much care is taken regarding the child’s developmental stage and their welfare. Family life is really important to all that. Restrictions on the use of mobile communications, for example, might be applied on some occasions, but that will be done thoughtfully and the general principle will be that it is important for children who are being held in the unit to be able to maintain their links with family and friends outside that unit.

I will let Dr Blower say a little more.

Convener, could I talk a little bit more about the safety and safeguards that are in place?