Hansard

A little over 15 months have passed since the Parliament last had the chance to thoroughly debate mental health issues. On that occasion, the Scottish Government conducted a welcome discussion of its “Mental Health Strategy for Scotland: 2012-2015”. Back then, I described the Scottish Government’s task as a stark one and today its challenge remains unenviable.

As my motion states, one in four Scots will experience mental ill health at some point in their lifetime, with the resulting social and economic costs on the health service and sufferers totalling something in the region of £10.7 billion annually.

Mental illness continues to be the dominant health problem of people of working age, and the distress that is caused to sufferers and their families damages careers, relationships and lives. Sufferers of mental illness can feel isolated and experience significant stress. Imagine coping with that and trying to hold down a full-time job or raise a family. Without medical intervention, suffering is prolonged and that only serves to increase the likelihood that treatment will be more difficult or complex than it otherwise need have been.

That is why effective and timely treatment for those who are suffering from mental illness is critical to safeguarding their welfare and returning them to full health. I cannot stress enough how important treatment is and, thankfully, the Scottish Government also acknowledges that, which is why it introduced a national health improvement, efficiency and governance, access and treatment target for at least 90 per cent of patients to receive psychological therapy within 18 weeks of a referral.

As members will recall, the mental health strategy contained 36 commitments that covered a broad range of issues relating to the provision of mental health services, such as early interventions, older people’s mental health and so on. Commitment 13 is:

“We will continue our work to deliver faster access to psychological therapies. By December 2014 the standard for referral to the commencement of treatment will be a maximum of 18 weeks, irrespective of age, illness or therapy.”

By December this year, then, no more than 10 per cent of patients treated should have waited more than 18 weeks for psychological therapy. In July last year, however, the figure stood at 16 per cent, albeit that was well over a year from the target so there was still time for improvement. Unfortunately, by December 2013 the figure had risen to 17 per cent of patients. With just a year to go, the figures are going in the wrong direction.

A similar picture is being painted of the percentage of those who are waiting for treatment. In July 2013, 22 per cent of patients who were waiting for treatment had done so for longer than 18 weeks. Five months later, that figure remained at 22 per cent.

When we break the numbers down health board by health board, that is when we begin to realise that, across Scotland, access to psychological therapies is riddled with inequities and it is getting worse. Good progress is being made in some areas, but we should compare those areas to NHS Highland, where 19 per cent of patients waited more than 18 weeks in July, and Tayside where that figure was 15 per cent. In December in those areas, those figures increased to 27 and 25 per cent respectively.

There were similar significant increases between July and December in those who had waited longer than 18 weeks and had yet to receive treatment in health board areas such as Fife, Grampian, Lothian and the Borders. When we look at the per capita ratio of psychologist distribution across Scotland, we see that there is an applied psychologist for every 7,000 people or fewer in the Lanarkshire, Fife, Tayside and Greater Glasgow and Clyde health board areas. In the Borders and the Highlands, the figure is 11,000 people and in Forth Valley it is approaching 14,000. In the past 12 months, those figures have increased further in the Fife, Lanarkshire, Dumfries and Galloway, Borders and Forth Valley health board areas.

Why is that happening? It is true that, during the past few years, the Scottish Government has increased the number of clinical and other applied psychologists who are working in the NHS; that is undeniable. It was imperative that it did so.

The stigma attached to mental ill health is starting to diminish, albeit slower than any of us would like it to do, I am sure. People are feeling more comfortable about admitting that they are experiencing mental illness and, crucially, are beginning to seek treatment in increasing numbers. That means that demand for psychological therapies across our health boards is greater. I know from recent discussions with the Scottish Association for Mental Health that soon-to-be-published research will reveal that many general practitioners are deciding against referring patients for psychological therapy, because waiting lists are too long.

The key question is therefore whether the new staff members are going to the right places. It appears that they are not. Regardless of the community to which a person in Scotland belongs, if they are suffering from mental ill health and need treatment they must have the same access to psychological therapy as someone in every other part of the country has.

The way to provide an efficient and effective NHS is to ensure that the provision of services constantly evolves and improves. That is why the Sandra Grant report, which was published a decade ago, was such a useful exercise. Dr Grant reviewed mental health services in Scotland and made valuable recommendations on organisational culture and the workforce. She also made observations on inequity and said:

“The quality and quantity of available services for people with mental health problems differs across Scotland.”

As I said, the Scottish Government has yet to address areas with regard to inequity and clearly has not taken full cognisance of Dr Grant’s report. However, I welcome the first commitment in the mental health strategy, which is to commission a 10-year follow-up review on the Grant report. I look forward to the review’s publication later this year. As it says in the motion, I invite the minister to give us an update today on the review’s progress and an indication of what service users and NHS staff might expect from it.

We must accept that the problem of mental illness in sections of our population cannot be solved overnight, particularly given the link with inequality. People in areas of deprivation are more likely to experience mental illness. It is a scandal that those who suffer from mental illness, particularly severe mental illness, die far sooner than the rest of us—in some cases, a couple of decades sooner. Indeed, in its 2012 report, “Health inequalities in Scotland”, Audit Scotland said that although progress on inequalities has been made in some areas, such as coronary heart disease,

“other indicators, such as ... mental health ... remain significantly worse in the most deprived parts of Scotland.”

Organisations such as SAMH should be praised for their work in helping people whose lives have been impacted by inequality. SAMH’s know where to go campaign does excellent work to signpost people who have problems accessing information and support for mental illness to the appropriate service providers. We know that people from deprived areas are less likely to know how and where to access support and even whether they should be accessing support—as opposed to just manning up, as society has for too long wrongly led people to believe that they should do. Any campaign to eradicate that problem gets my support.

We must focus on providing the best outcomes for people who suffer from mental illness by ensuring that they have access to timely and appropriate treatment. We must also ensure that we tackle the causes of inequality, which so often creates the environment in which depression and mental illness can thrive. Let us help those who are experiencing mental trauma and let us help to prevent people from ever reaching that point. Let us put the stigma of mental ill health behind us and put mental health on a par with physical health in Scotland.

I move,

That the Parliament notes that one in four adults will experience mental ill health in their lifetime; recognises the enormous personal, social and economic costs of mental health problems, which are estimated to cost £10.7 billion per year in Scotland; further recognises that mental ill health is now the dominant health problem for people of working age, with it accounting for around 45% of all people not working due to ill health; notes that 13,986 people were waiting to start treatment with psychological therapy services in Scotland on 31 December 2013; understands with concern that 708 young people had been waiting more than 26 weeks for treatment; notes with concern that child and adolescent unit psychiatric hospital admissions in 2012-13 were 21.2 per 100,000, which is up from 19.2 in 2011-12; recognises the increasing demand for psychological therapies across Scotland and is concerned by the disparity in access to such therapies in different NHS board areas; would welcome an update from the Scottish Government on its commitment set out in the Mental Health Strategy for Scotland 2012-2015 to commission a 10-year follow up to the report, National Mental Health Services Assessment: Towards implementation of the Mental Health (Care and Treatment) (Scotland) Act 2003 (the Grant report) to review the state of mental health services in Scotland; believes that more work is needed to continue to reduce the stigma attached to mental health issues, and further believes that Scotland should follow the lead of the UK Government by enshrining in law parity between mental and physical health.