Meeting of the Parliament 12 January 2022
I wish you, Presiding Officer, and everyone else who is present a happy new year.
I welcome this debate on mental health and primary care in Scotland. At its core, the debate should be about the challenges that we face in mental health services. Those challenges have undoubtedly been made more acute by the pandemic and by the restrictions that have been put in place to combat it. However, Scotland went into the public health crisis of the pandemic with a pre-existing mental health crisis. People with mental health problems, particularly the young, are forced to wait too long for help. Today, we need to focus on the barriers to progress.
Additional funding for mental health services is welcome. We have long advocated that 10 per cent of the NHS budget should be directed towards mental health services, because those services are in crisis. Waiting times are too long, pathways are often too complex, medication rates remain too high and too many people reach crisis point. GP services, which are often the first point of contact, are severely overstretched. I pay tribute to the work that GPs and all those working in the NHS and our mental health services are doing and will continue to do.
We should never lose sight of the fact that GPs are responsible for diagnosing, treating, monitoring and referring patients to specialist services, and that patients return to GPs when they fail to access satisfactory secondary mental health treatment or if treatment fails. Although I recognise the huge pressures that GPs face, I support the Scottish Association for Mental Health’s call for patients with mental health needs to be given priority for face-to-face appointments, whenever that is possible.
The Government should be well aware that 90 per cent of people who are referred for psychological therapy should start treatment within 18 weeks but that that national standard has never been met. The 18-week waiting time target for child and adolescent mental health services has also never been met. That means that more than 2,000 children are waiting for more than a year to access essential mental health services. Can the minister honestly imagine being 10 or 11 and being asked to wait for more than a year—or, as Alex Cole-Hamilton said, for up to seven years—for treatment for a complex condition that he did not fully understand? That is not just unfair; it is unsustainable and indefensible.
Following Covid, people are up to twice as likely to be experiencing anxiety, depression and high levels of psychological distress. That inevitably places more demand on all care and support services, including community facilities across primary care and secondary mental health facilities. The system is squeezed to crisis point. More than 1,000 vacancies for mental health nurses remain unfilled, and nearly 100 more consultant psychiatrists are needed across the service. The Royal College of Nursing says that we need a long-term fully funded workforce plan for mental health services across primary and acute care. The Royal College of General Practitioners in Scotland warns that 71 per cent of its members saw mental health-related presentations increase a lot during the pandemic.
I want to make an appeal. Mental health problems are widespread. They affect people of all ages and all backgrounds. All too often, when we debate poor mental health, we fall back on jargon and make the services seem inaccessible. The minister talked frequently about lived experience, so what is “lived experience”? It is people who took a drink rather than a walk this morning, because the world outside seemed too bleak. It is children, often young girls, retreating to their rooms to self-harm, starting with pins and pencils before moving to knives. It is people who suffer stress and anxiety at the prospect of doing everyday things. It is adults being treated in secure mental health facilities for their own safety or for the safety of their partners and children.
Let us never forget those who feel that there is no other way out—sometimes they are failed by the system—and who take their own lives. That is the reality of the lived experience for some individuals, their families, their friends and their colleagues.
As a report that was published last July by the British Medical Association and Health and Social Care Scotland stated, more work needs to be done to demystify services. It adds:
“The current terminology used within the system is often a barrier to asking for help”.
Fundamentally, the Government needs to address the barriers and blockages to accessing services, such as the complex terminology, people being forced to tell painful stories time and time again, the locked doors, the long waiting lists and the rejected referrals.