Chamber
Plenary, 06 Jan 2010
06 Jan 2010 · S3 · Plenary
Item of business
Child and Adolescent Mental Health and Wellbeing
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 was one point that I wanted her to address, it was the one that Richard Simpson raised in his final minute and which is dealt with in paragraph 123 of the committee's report, which says:
"it is vitally important that there are standard health checks and developmental checks on every child at crucial stages of the early years."
Access and more money are all very good, but unless we identify those who need that service, I am afraid that they are pretty worthless.
We all knew that addressing mental health and development issues in childhood was a problem, but I for one was shocked at what the Health and Sport Committee uncovered. The report paints a harrowing picture of how poorly we understand and nurture young people in Scotland today. The concluding remarks in paragraph 149 state:
"Despite the commitment of … Government"
since 1999, and
"the existence of an agreed framework and the devotion, good work and admirable efforts of many individuals … mental health and well-being"
of young people
"seems not to have been a priority amongst those responsible for delivering the policy."
The starting point for the report is the four-tier model that is used for CAMHS. Unless those who are not mental health specialists—including general practitioners, health visitors, school nurses, teachers, social workers, nursery staff and parents—identify problems early in a child's development, there will be no referral to tiers 2, 3 or 4.
The committee was told that if the window of opportunity when a child is aged two or three is missed,
"the consequence can be life-long poor mental health."
The British Psychological Society Scottish division of educational psychologists confirmed that
"CAMHS are not geared up to deliver early intervention",
and Dr Philip Wilson stated:
"We either pay for a service for young children or pay 10 times over later in life".
The British Psychological Society stated:
"There is considerable confusion at times about how to respond to self harm, aggressive or acting-out behaviours. It is also evident that young people who are withdrawn, depressed or struggling socially can often be missed."
The society went on to say that
"primary care health and education staff can be unclear and disconnected from the integrated children's services processes".
Just as worrying, the Scottish division of the Royal College of Psychiatrists stated that some professionals
"still deny the existence of disabling mental health disorders in children".
The SNAP report has been mentioned several times. In 2003, it stated that CAMHS were "patchy", the teams were under "heavy pressure", links were "limited" and there were
"delays in referrals and access."
It also stated that specialist services were "difficult to access", and that there were "long waiting times" and a "lack of training" in the wider non-specialist tier 1 network.
Seven years on, what has changed? The Scottish Executive report in 2005 credited the SNAP report with providing a
"strategic vision for the mental health of children"
and yet Dr Graham Bryce confirmed that
"we have not found a mechanism to drive the implementation of the policy".
We have the policy, but we seem not to have moved any further towards implementing it. We are more than three years into the 10-year implementation plan, yet not one witness was able to give any indication of progress or interim goals achieved.
Just as worrying, as Christine Grahame mentioned, was the lack of clarity on priority and responsibility between local authorities and the NHS. The low priority that is given to child psychiatry in Scotland is reflected in the years-long—nearly 10 years, I believe—vacancy for the post of professor in Edinburgh. More teacher training is desperately needed, but, equally, far greater emphasis is needed on development issues for under-fives, on the health visitor role and on training for nursery staff. There has also been confusion with regard to in loco parentis, and the fact that what a teacher understood to be an accurate definition in fact meant the exact opposite.
As Christine Grahame said, the most compelling evidence was on the critical need for health visitors: not to give parents access and a number on a nursery wall, but to address before the age of two the early neglect and the lack of early relationships and secure attachments of a child, which we heard are
"powerful predictors of mental ill health."
We heard that it is possible to predict at the age of three as many as 70 per cent of those who will end up as in-patients in psychiatric hospitals or in prison. Professor Law stated that the majority of those with attachment disorders can be identified in the first five years of life.
I realise that I am running a bit short of time, Presiding Officer. I know from my family—
"it is vitally important that there are standard health checks and developmental checks on every child at crucial stages of the early years."
Access and more money are all very good, but unless we identify those who need that service, I am afraid that they are pretty worthless.
We all knew that addressing mental health and development issues in childhood was a problem, but I for one was shocked at what the Health and Sport Committee uncovered. The report paints a harrowing picture of how poorly we understand and nurture young people in Scotland today. The concluding remarks in paragraph 149 state:
"Despite the commitment of … Government"
since 1999, and
"the existence of an agreed framework and the devotion, good work and admirable efforts of many individuals … mental health and well-being"
of young people
"seems not to have been a priority amongst those responsible for delivering the policy."
The starting point for the report is the four-tier model that is used for CAMHS. Unless those who are not mental health specialists—including general practitioners, health visitors, school nurses, teachers, social workers, nursery staff and parents—identify problems early in a child's development, there will be no referral to tiers 2, 3 or 4.
The committee was told that if the window of opportunity when a child is aged two or three is missed,
"the consequence can be life-long poor mental health."
The British Psychological Society Scottish division of educational psychologists confirmed that
"CAMHS are not geared up to deliver early intervention",
and Dr Philip Wilson stated:
"We either pay for a service for young children or pay 10 times over later in life".
The British Psychological Society stated:
"There is considerable confusion at times about how to respond to self harm, aggressive or acting-out behaviours. It is also evident that young people who are withdrawn, depressed or struggling socially can often be missed."
The society went on to say that
"primary care health and education staff can be unclear and disconnected from the integrated children's services processes".
Just as worrying, the Scottish division of the Royal College of Psychiatrists stated that some professionals
"still deny the existence of disabling mental health disorders in children".
The SNAP report has been mentioned several times. In 2003, it stated that CAMHS were "patchy", the teams were under "heavy pressure", links were "limited" and there were
"delays in referrals and access."
It also stated that specialist services were "difficult to access", and that there were "long waiting times" and a "lack of training" in the wider non-specialist tier 1 network.
Seven years on, what has changed? The Scottish Executive report in 2005 credited the SNAP report with providing a
"strategic vision for the mental health of children"
and yet Dr Graham Bryce confirmed that
"we have not found a mechanism to drive the implementation of the policy".
We have the policy, but we seem not to have moved any further towards implementing it. We are more than three years into the 10-year implementation plan, yet not one witness was able to give any indication of progress or interim goals achieved.
Just as worrying, as Christine Grahame mentioned, was the lack of clarity on priority and responsibility between local authorities and the NHS. The low priority that is given to child psychiatry in Scotland is reflected in the years-long—nearly 10 years, I believe—vacancy for the post of professor in Edinburgh. More teacher training is desperately needed, but, equally, far greater emphasis is needed on development issues for under-fives, on the health visitor role and on training for nursery staff. There has also been confusion with regard to in loco parentis, and the fact that what a teacher understood to be an accurate definition in fact meant the exact opposite.
As Christine Grahame said, the most compelling evidence was on the critical need for health visitors: not to give parents access and a number on a nursery wall, but to address before the age of two the early neglect and the lack of early relationships and secure attachments of a child, which we heard are
"powerful predictors of mental ill health."
We heard that it is possible to predict at the age of three as many as 70 per cent of those who will end up as in-patients in psychiatric hospitals or in prison. Professor Law stated that the majority of those with attachment disorders can be identified in the first five years of life.
I realise that I am running a bit short of time, Presiding Officer. I know from my family—
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...