Hansard

As the Scottish Government’s first dedicated Minister for Mental Health, I have been driven by a simple principle: we must prevent and treat mental health problems with the same commitment, passion and drive as we do physical health problems. That principle is shared across this chamber and beyond, which is why it is at the heart of our new strategy.

Everyone has mental health: for all of us, our health has both mental and physical aspects, but they are not always thought of in the same way. We want to create a Scotland where stigma related to poor mental health is eradicated and where prevention and early intervention are central. We want to be a nation where mental health care is person-centred, recognising the life-changing benefits of fast, evidence-based treatment.

In the past decade, mental health services have changed dramatically. There has been excellent work from the national health service, local authorities and third sector organisations. Staff in all those organisations, at all levels, make life-changing and life-saving interventions every day. However, we all have a mutual ambition to go further. Today’s strategy and its 40 actions set out our starting point.

The strategy has been fundamentally shaped by views and feedback from organisations and service users across Scotland. We received almost 600 responses to our engagement paper and we held public events and meetings. The volume and the content of the responses and discussion demonstrated passion and commitment for change.

In late 2016, the Health and Sport Committee carried out an inquiry into mental health. The committee’s findings were thoughtful and constructive and gave added impetus to the issues that we were developing. The committee raised the importance of child and adolescent mental health, including rejected referrals, early intervention, treatment, and the need for multiple services, such as health, education and local authorities, to work together. The overarching message to us from the engagement was simple: be more ambitious and recognise mental health as an essential part of all health and social wellbeing.

As this is the first national strategy since the integration of health and social care, we have worked closely with the Convention of Scottish Local Authorities in developing it. We will continue to work closely with COSLA as we implement the strategy nationally and locally.

Intrinsic to the strategy—and to implementing the actions and the vision—is a human rights-based approach. A concrete way to do this is to use the principles of participation, accountability, non-discrimination and equality, empowerment and legality—PANEL. The reality of implementing the actions and the development of future actions must continue to keep human rights at the core.

I suspect that we all share the Scottish mental health partnership’s vision of

“a Scotland where people can get the right help at the right time, expect recovery, and fully enjoy their rights, free from discrimination and stigma.”

I want mental and physical health to have parity of esteem in practice. It is there in law already, but people’s lived experience and our data suggest that there is a way to go. Achieving parity will not be easy, but it is vital. We estimate that only one in three people who would benefit from treatment for a mental illness currently receive that treatment. We also know that people with lifelong mental illness can die 15 to 20 years prematurely. That is a major health inequality and I cannot accept it.

To achieve parity of esteem over the 10 years of the strategy we must see and be able to measure: equal access to the most effective and safest care and treatment; equal efforts to improve the quality of care; allocation of time, effort and resources on a basis commensurate with need; equal status within healthcare education and practice; equally high aspirations for service users; and equal status in the measurement of health outcomes.

Improving mental health services and care is not solely the preserve of the health portfolio or the NHS. To tackle the causes of poor mental health, action is required across Government, including in the education, housing, justice, environment and economy portfolios. That is also true of agencies and organisations outwith the Scottish Government. There must be work across all public services to harness the widest range of opportunities to improve the population’s mental health. Without doubt, poverty is the single biggest driver of poor mental health. The fairer Scotland action plan sets out how we will help to tackle poverty, reduce inequality and build a fairer and more inclusive Scotland.

The broader implementation of mental health law must promote a human rights-based approach. We will ensure that that is made clear in statutory guidance. We will also commission a review of current legislation to see whether—and what—further reforms are necessary so that the needs of people with learning disabilities and autism are properly taken into account.

That is not the only legislation that we propose to consider. We will reform the adults with incapacity legislation so that it fully reflects the requirements of the United Nations Convention on the Rights of Persons with Disabilities. In that reform, we propose a particular emphasis on the provision of supported decision making.

We will ensure that improving mental health and wellbeing is central in all new public health priorities. We will challenge the NHS to prioritise the physical health of people with mental health problems and remove barriers to people accessing services. I visited Maryhill health and care centre in Glasgow this Tuesday, and the mental health information station in Edinburgh this morning, and heard first-hand about those challenges. We will focus on prevention and early intervention for children, young people and adults, to help to prevent the development of mental health problems and to step in promptly where they develop. We have already agreed to fund a managed clinical network for perinatal mental health. It is the first MCN in Scotland for mental health and is a significant step forward in achieving parity.

We have made considerable progress in improving access to specialist child and adolescent mental health services, but demand continues to increase. We have listened to concerns about rejected referrals to CAMHS and will commission an audit of those services. Sometimes CAMHS is the right route for young people and, at other times, an alternative would be better. We will look at the whole system—we recognise the importance of not only specialist services but early interventions at tiers 1 and 2. That could be of particular importance to looked-after children.

We will complete the roll-out of targeted parenting programmes to ensure availability across Scotland. We will commission the development of a matrix of evidence-based interventions that can improve the mental health and wellbeing of children and young people. We will also develop a new, separate, 10-year child and adolescent health and wellbeing strategy, which will cover physical and mental wellbeing.

Schools are one of the key places to ensure that the children of Scotland have the care and support they need. That is why we will soon commission a review of personal and social education, the role of pastoral guidance, and counselling services in Scotland. Our aim in that review is simple: to ensure that every child has appropriate access to emotional and mental wellbeing support in school.

We will facilitate work with Police Scotland to ensure that people who have mental health problems who are in contact with the police, or who are in distress, get the help and support that they need. That will include work through our refreshed justice strategy and our distress brief intervention programme. We will also work with the Scottish Prison Service and partners to improve the mental health of prisoners, including young offenders.

We aim to create a social security system in Scotland that is based on dignity, fairness, and respect, and which supports people with mental health problems. Not securing employment is the biggest inequality that people with mental health problems can face. Utilising our new employability powers, we will work across services to support people to stay in, or return to, work. That includes being committed to working with employers to support the mental wellbeing of their employees.

As I mentioned earlier, the physical wellbeing of people with mental illness is of major concern to me. I am committed to ensuring that services such as screening and smoking cessation are supported to help to improve participation rates for those with mental health problems. That will be the start of tackling the 15 to 20-year premature mortality. Other work will be needed and I believe that I can count on the support of many in taking the right steps to address this significant health inequality.

Through our twin programme of investment and reform, we are working to shift the balance of care across health and social care. In the coming year, we project that NHS spending on mental health will exceed £1 billion for the first time. In each year of this parliamentary session, we are committed to increasing that investment, with mental health receiving an increasing share of front-line NHS investment.

None of the improvements to mental health services will be realised without having the right staff in the right place. We will work to give access to dedicated mental health professionals in all accident and emergency departments, all general practices, every police station custody suite, and all our prisons. Over the next five years, that will mean making an additional investment of £35 million for 800 additional mental health workers in those key settings. That increased investment through the NHS for that workforce will be in addition to the £150 million already set out for improvement and innovation. I can therefore confirm today that over the next five years, the total Scottish Government direct investment in mental health will be more than £300 million, which will support implementation of the strategy.

In primary care, we are developing new multidisciplinary models of supporting mental health. That will help to achieve the “ask once, get help fast” principle and better equip people to manage their own health and encourage recovery.

Presiding Officer, as I hope I have made clear, the strategy is not the end of the process—it is just the beginning. The voices of stakeholders and service users have been key to the development of the strategy, and I am determined that they will also be key to its implementation. That is why, to help me to steer the strategy, I will be convening a biannual forum of stakeholders. In that forum, I want to hear stakeholders’ views and get their help—now, and in the future.

To ensure that we learn from what the actions laid out so far have achieved, we will carry out a full review at the halfway point of the strategy. I hope that members across the chamber will be able to see reflected in the strategy the ambitions that they and others have promoted. I believe that the strategy can be built on and developed in the years to come. I believe that, together, we can deliver the mental health support, care and services that the people of Scotland deserve.