Chamber
Plenary, 06 Jan 2010
06 Jan 2010 · S3 · Plenary
Item of business
Child and Adolescent Mental Health and Wellbeing
I declare an interest as a fellow of the Royal College of Psychiatrists and a member of SAMH.
The whole area of children's services has been characterised over a long period—since the initial report in the 1980s—by a lack of any sense of urgency. Christine Grahame is right to draw attention to the committee's concerns about the fact that it is a Cinderella service that is still not being developed despite the provision of significant new funding by the Government, which I acknowledge. Concerns were expressed, particularly in the late 1990s, about the increasing prevalence of mental health problems among children and adolescents. The number of individuals who were suffering from a variety of conditions such as behavioural problems, hyperactivity, attention deficit hyperactivity disorder and autistic spectrum disorder increased significantly between 1974 and 1999. There has been a subsequent stabilisation since then, but the number is still around one in 10.
To see how stressed young people are and what little sense of mental health and wellbeing they have, we need look no further than a paper by Professor O'Connor of the University of Stirling that documents his study of 15 and 16-year-olds in Stirling and Glasgow. He found that 14 per cent of those children had self-harmed and that a further 14 per cent had had serious thoughts of self-harm. That is getting on for a third of all our children of that age, which is an absolutely frightening indictment of how we have dealt with the problem in the past.
There are factors that have changed significantly over that period. For example, we know that more than 100,000 children or thereabouts are growing up in households where there is a drug or alcohol problem. Given that 58,000 children are born in this country each year, that means that two years' worth of our children are being affected by that problem.
In his annual report last year, the chief medical officer, Harry Burns, drew attention to the issue of neglect. We have always identified the problems of domestic abuse, parental mental illness and so on, but neglect is poorly defined, even though we know that it has a serious physical and mental health consequence.
The report that we are debating marks the latest stage in the journey that children's mental health services have been on. The SNAP working group, to which Christine Grahame referred, began in 2000 and reported in 2003. It said that services were patchy; that links between CAMHS and wider services were limited; that there were significant and damaging delays in the diagnosis and treatment of early psychosis; that all four tiers of the services were working beyond reasonable capacity; that there was inadequacy in patient resources, including a severe lack of in-patient intensive care unit, forensic and learning disability services; that there was a lack of training, especially in tier 1; and, as Christine Grahame said, that young people were reluctant to be referred to the services.
The SNAP report led to the framework report, and the committee has quite rightly said that no one is suggesting that that framework is inadequate. Indeed, some progress has been made. For example, successive Governments have endeavoured to eliminate the inappropriate admission of children to adult units. However, 140 children are still being admitted annually to those units—that represents 140 lives that cannot be properly turned round, because those units are totally inappropriate for children. In its 2008 report, the Mental Welfare Commission welcomed the progress that has been made but said that the target of eliminating such admissions by 2011 was challenging. Indeed, that target will almost certainly not be met. The previous agreement between Government and the workforce was that we would have 56 beds for children who were in need of them, but I do not think that that will happen; perhaps the minister can tell me whether it will. The number of beds that is needed if we are to meet European standards is 20 per 1,000 children in the relevant group, which means that we should have 100 beds in Scotland. However, we will have only 48, or perhaps 56. There is a great need for more beds. We should certainly have a number of beds that is in the high 60s, or we will continue to have problems.
There is still no forensic unit and no learning disability service of any note, and the out-patient service is totally rudimentary. There are serious areas of long-term neglect that need to be addressed as an urgent priority.
I will not go into the area of staffing, except to say that the report indicates clearly that, in areas such as Lanarkshire, there are 4.5 CAMHS staff per 100,000 members of the population, whereas in most parts of England there are 20. However, I should say that Lanarkshire has done more than any other council area in terms of tier 1 training for its health visitors. There are eight CAMHS staff per 100,000 members of the population in Lothian and 13 in Dumfries. There are too many areas in Scotland in which even a 20 per cent increase will not make the necessary difference.
In the few seconds that I have left, I turn to prevention, which is the most difficult but probably the most important area. Unless we get the preventive side right, it will not be possible to turn things round. That means that we need health visitors to effect proper screening. We must deal with that in an appropriate manner. We must reduce and eliminate the fragmentation of services in primary care. We must increase the number of public health nurses. I welcomed the commitment in the Government's manifesto to do so, but there has since been a reduction in the number of school nurses.
The whole area of children's services has been characterised over a long period—since the initial report in the 1980s—by a lack of any sense of urgency. Christine Grahame is right to draw attention to the committee's concerns about the fact that it is a Cinderella service that is still not being developed despite the provision of significant new funding by the Government, which I acknowledge. Concerns were expressed, particularly in the late 1990s, about the increasing prevalence of mental health problems among children and adolescents. The number of individuals who were suffering from a variety of conditions such as behavioural problems, hyperactivity, attention deficit hyperactivity disorder and autistic spectrum disorder increased significantly between 1974 and 1999. There has been a subsequent stabilisation since then, but the number is still around one in 10.
To see how stressed young people are and what little sense of mental health and wellbeing they have, we need look no further than a paper by Professor O'Connor of the University of Stirling that documents his study of 15 and 16-year-olds in Stirling and Glasgow. He found that 14 per cent of those children had self-harmed and that a further 14 per cent had had serious thoughts of self-harm. That is getting on for a third of all our children of that age, which is an absolutely frightening indictment of how we have dealt with the problem in the past.
There are factors that have changed significantly over that period. For example, we know that more than 100,000 children or thereabouts are growing up in households where there is a drug or alcohol problem. Given that 58,000 children are born in this country each year, that means that two years' worth of our children are being affected by that problem.
In his annual report last year, the chief medical officer, Harry Burns, drew attention to the issue of neglect. We have always identified the problems of domestic abuse, parental mental illness and so on, but neglect is poorly defined, even though we know that it has a serious physical and mental health consequence.
The report that we are debating marks the latest stage in the journey that children's mental health services have been on. The SNAP working group, to which Christine Grahame referred, began in 2000 and reported in 2003. It said that services were patchy; that links between CAMHS and wider services were limited; that there were significant and damaging delays in the diagnosis and treatment of early psychosis; that all four tiers of the services were working beyond reasonable capacity; that there was inadequacy in patient resources, including a severe lack of in-patient intensive care unit, forensic and learning disability services; that there was a lack of training, especially in tier 1; and, as Christine Grahame said, that young people were reluctant to be referred to the services.
The SNAP report led to the framework report, and the committee has quite rightly said that no one is suggesting that that framework is inadequate. Indeed, some progress has been made. For example, successive Governments have endeavoured to eliminate the inappropriate admission of children to adult units. However, 140 children are still being admitted annually to those units—that represents 140 lives that cannot be properly turned round, because those units are totally inappropriate for children. In its 2008 report, the Mental Welfare Commission welcomed the progress that has been made but said that the target of eliminating such admissions by 2011 was challenging. Indeed, that target will almost certainly not be met. The previous agreement between Government and the workforce was that we would have 56 beds for children who were in need of them, but I do not think that that will happen; perhaps the minister can tell me whether it will. The number of beds that is needed if we are to meet European standards is 20 per 1,000 children in the relevant group, which means that we should have 100 beds in Scotland. However, we will have only 48, or perhaps 56. There is a great need for more beds. We should certainly have a number of beds that is in the high 60s, or we will continue to have problems.
There is still no forensic unit and no learning disability service of any note, and the out-patient service is totally rudimentary. There are serious areas of long-term neglect that need to be addressed as an urgent priority.
I will not go into the area of staffing, except to say that the report indicates clearly that, in areas such as Lanarkshire, there are 4.5 CAMHS staff per 100,000 members of the population, whereas in most parts of England there are 20. However, I should say that Lanarkshire has done more than any other council area in terms of tier 1 training for its health visitors. There are eight CAMHS staff per 100,000 members of the population in Lothian and 13 in Dumfries. There are too many areas in Scotland in which even a 20 per cent increase will not make the necessary difference.
In the few seconds that I have left, I turn to prevention, which is the most difficult but probably the most important area. Unless we get the preventive side right, it will not be possible to turn things round. That means that we need health visitors to effect proper screening. We must deal with that in an appropriate manner. We must reduce and eliminate the fragmentation of services in primary care. We must increase the number of public health nurses. I welcomed the commitment in the Government's manifesto to do so, but there has since been a reduction in the number of school nurses.
In the same item of business
The Deputy Presiding Officer (Alasdair Morgan):
SNP
The next item of business is a debate on motion S3M-5453, in the name of Christine Grahame, on the Health and Sport Committee's report, "Inquiry into child a...
Christine Grahame (South of Scotland) (SNP):
SNP
Thank you, Deputy Presiding Officer. Your rebuke is noted by me. I was en route and I apologise.First, I take this opportunity to thank all who gave oral and...
That the Parliament notes the conclusions and recommendations contained in the Health and Sport Committee's 7th Report, 2009 (Session 3):
Report on the Inquiry into child and adolescent mental health and well-being (SP Paper 309).
The Minister for Public Health and Sport (Shona Robison):
SNP
Happy new year to all health colleagues.I thank the committee very much for bringing the important issue of child and adolescent mental health services to th...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
I want to ask specifically about an issue that Christine Grahame rightly raised: that universal screening appears to end at eight weeks. That is not even the...
Shona Robison:
SNP
A new chief executive letter is about to be issued that will make it clear that there must be flexibility around the guidance. The guidance is simply guidanc...
The Deputy Presiding Officer:
SNP
You have about a minute.
Shona Robison:
SNP
The promotion of mental health among infants, children and young people is one of our six strategic priorities that are set out in "Towards a Mentally Flouri...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
I declare an interest as a fellow of the Royal College of Psychiatrists and a member of SAMH.The whole area of children's services has been characterised ove...
Shona Robison:
SNP
Will the member give way?
The Deputy Presiding Officer:
SNP
I am afraid that the member is about to sit down—even though he may not know it.
Dr Simpson:
Lab
Perhaps the minister can address the point that she was going to make when she sums up at the end of the debate.To conclude—
The Deputy Presiding Officer:
SNP
Quickly, please.
Dr Simpson:
Lab
The framework is excellent; the timing is wrong. We need greater urgency on this matter, which must become a higher priority.
Mary Scanlon (Highlands and Islands) (Con):
Con
I am sorry to start the year on a negative note but, having listened carefully to the minister, I must say that I was disappointed in what she said. If there...
Shona Robison:
SNP
Will the member take an intervention?
Mary Scanlon:
Con
I have only 10 seconds left.My granddaughter received the measles, mumps and rubella jab at 15 months and her parents were told to bring her back at the age ...
The Deputy Presiding Officer:
SNP
I am afraid that the member is stretching my patience a little bit.
Mary Scanlon:
Con
The Governments of Wales and Northern Ireland have in place national strategies for school counselling and its implementation, backed by ring-fenced funding ...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
LD
Clearly, not being a member of the committee presents me with a slight difficulty. As members know, I am more used to making a winding-up speech than an open...
Shona Robison:
SNP
Does the member acknowledge that the vast majority of children are referred much more quickly than that? The HEAT target is designed to ensure that there is ...
Jamie Stone:
LD
I note what the minister says.As I said just before the minister intervened, we need to ensure that children have timely access to mental health services no ...
Ian McKee (Lothians) (SNP):
SNP
In the short time available to me I will concentrate on two matters that are covered in the committee's important report, which, sadly, received little publi...
Malcolm Chisholm (Edinburgh North and Leith) (Lab):
Lab
As the committee's excellent report and the accompanying evidence make clear, there is a great deal of continuity in mental health policy from the previous A...
Michael Matheson (Falkirk West) (SNP):
SNP
As a couple of members have said, mental health services are often called the Cinderella of our national health service. During the inquiry, I was struck by ...
Dr Simpson:
Lab
Professor James Law of the Royal College of Speech and Language Therapists said that it was bad not only that the number of referrals from health visitors wa...
Michael Matheson:
SNP
I recall the strong evidence that we received from Professor Law.The visit emphasised for me the real need to ensure not only that adequate services are made...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
The American declaration of independence declares that people have "certain unalienable Rights"and"that among these are Life, Liberty and the pursuit of Happ...
The Deputy Presiding Officer (Trish Godman):
Lab
I can give Cathy Jamieson about four minutes.
Cathy Jamieson (Carrick, Cumnock and Doon Valley) (Lab):
Lab
Thank you, Presiding Officer, for giving me the opportunity to make a brief contribution to the debate. I will focus on adolescents, but first I thank the co...