Chamber
Plenary, 06 Jan 2010
06 Jan 2010 · S3 · Plenary
Item of business
Child and Adolescent Mental Health and Wellbeing
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 publicity when it was first published.
A general point is to emphasise the need for NHS and local authority chief executives to take ownership of and responsibility for the framework developed by the then Scottish Executive in 2005 that was aimed at improving the mental health of children and adolescents—health that has been so sadly neglected over decades, even by those who now argue loudly for immediate action.
Although all seem to agree that the framework is evidence based and should be put into practice, it appeared in the evidence that was presented to the committee that the sense of priority accepted by successive Governments has not been transferred into the delivery of services. As but one example, Helen Eadie and I travelled to Lochgilphead to take evidence from a heroic and dedicated group of workers in the field to find that there were only four psychiatric CAMHS nurses covering a catchment area that includes 20 inhabited islands and a total population of around 90,000. Theoretically, the area should be served by 18 psychiatric nurses if an adequate service is to be provided. How much longer can we tolerate such neglect of our most vulnerable children?
It has been made clear that responsibility for implementing the framework lies on the shoulders of chief executives in the NHS and local authorities. I welcome the minister's statement that we will look further into that situation and see that they keep up to the mark.
I turn my attention to the role of schools in combating mental illness in adolescence, because a confused picture emerged in the evidence that was given to our committee. The background is that many mental health problems in young people present as inappropriate social or sexual behaviour. Such mental health problems can arise in early life and are often related to problems in the home, but they can be exacerbated by a subsequent inappropriate response. It is indeed a very confusing picture.
Some effects of those mental health problems can lead to physical problems such as an unwanted pregnancy, a sexually transmitted disease or self-harm. Often the teacher is the first person to pick up that something is amiss, so his or her role is vital in helping such youngsters. As Richard Simpson pointed out, the extent of the problem has been revealed in a recent paper by Professor Rory O'Connor at the University of Stirling, which showed that 14 per cent of adolescent respondents to a survey had self-harmed and about the same number had had thoughts of self-harm. A retrospective study in the area in which I worked as a GP showed even worse figures, so Professor O'Connor is definitely not overestimating the problem. The figures for unwanted teenage pregnancies and sexually transmitted diseases are as bad—they are a disgrace to Scotland.
However, we heard evidence that teacher training in these matters is patchy or even non-existent. There is considerable disagreement over the confidential nature of any communication between pupil and teacher, especially when it involves children under the age of 16. One experienced teacher—Heather Muir—explained that if she heard that a child was having under age sex, she was under an obligation to report it to the social work department and possibly the parents.
A respected headteacher—Brian Cooklin—defined the phrase "in loco parentis" as meaning:
"we can do nothing without parental consent."—[Official Report, Health and Sport Committee, 25 March 2009; c 1721.]
That is important. I am not saying for a moment that a teacher should never disclose information given by a child—the interests of the child or even the greater community sometimes mean that that is the appropriate action—but a policy that makes disclosure mandatory can do harm, either directly or more subtly, by preventing children from coming forward for help. Doctors do not always have to disclose and nor should teachers always be required to do so.
In her evidence, the Minister for Public Health and Sport reassured the committee that it is not a criminal offence to fail to report a criminal offence. Now, of course, two under age children who have sexual intercourse are both engaged in criminal activity. That is welcome—I do not mean the new law, but the fact that the teacher does not have to report the offence.
What we are concerned with here is not the letter of the law but what happens in schools. If we have headteachers interpreting the responsibility of a teacher to mean that parental consent is always required, some of our most vulnerable children will be very poorly served, because, sadly, the parents—or a parent—are often part of the problem, rather than the solution.
Clear guidance is required to help the ordinary classroom teacher deal with what is an incredibly complex and dangerous minefield of accepted practice. Backing is needed for classroom teachers who decide in good faith not to disclose. Perhaps a mentoring system for less-experienced teachers could help in that respect. We must realise that those who use judgment, rather than slavishly follow set-down rules, will sometimes get things wrong, which means that support from higher up is even more important.
The minister acknowledged to the Health and Sport Committee the problems in this field by saying:
"We can also reflect on whether more needs to be done to ensure that things are as clear and supportive as they can be for those on the front line who need to make such decisions. We should perhaps have a think about what more could be done."—[Official Report, Health and Sport Committee, 6 May 2009; c 1897.]
I agree with the minister and look forward to progress in this field.
A general point is to emphasise the need for NHS and local authority chief executives to take ownership of and responsibility for the framework developed by the then Scottish Executive in 2005 that was aimed at improving the mental health of children and adolescents—health that has been so sadly neglected over decades, even by those who now argue loudly for immediate action.
Although all seem to agree that the framework is evidence based and should be put into practice, it appeared in the evidence that was presented to the committee that the sense of priority accepted by successive Governments has not been transferred into the delivery of services. As but one example, Helen Eadie and I travelled to Lochgilphead to take evidence from a heroic and dedicated group of workers in the field to find that there were only four psychiatric CAMHS nurses covering a catchment area that includes 20 inhabited islands and a total population of around 90,000. Theoretically, the area should be served by 18 psychiatric nurses if an adequate service is to be provided. How much longer can we tolerate such neglect of our most vulnerable children?
It has been made clear that responsibility for implementing the framework lies on the shoulders of chief executives in the NHS and local authorities. I welcome the minister's statement that we will look further into that situation and see that they keep up to the mark.
I turn my attention to the role of schools in combating mental illness in adolescence, because a confused picture emerged in the evidence that was given to our committee. The background is that many mental health problems in young people present as inappropriate social or sexual behaviour. Such mental health problems can arise in early life and are often related to problems in the home, but they can be exacerbated by a subsequent inappropriate response. It is indeed a very confusing picture.
Some effects of those mental health problems can lead to physical problems such as an unwanted pregnancy, a sexually transmitted disease or self-harm. Often the teacher is the first person to pick up that something is amiss, so his or her role is vital in helping such youngsters. As Richard Simpson pointed out, the extent of the problem has been revealed in a recent paper by Professor Rory O'Connor at the University of Stirling, which showed that 14 per cent of adolescent respondents to a survey had self-harmed and about the same number had had thoughts of self-harm. A retrospective study in the area in which I worked as a GP showed even worse figures, so Professor O'Connor is definitely not overestimating the problem. The figures for unwanted teenage pregnancies and sexually transmitted diseases are as bad—they are a disgrace to Scotland.
However, we heard evidence that teacher training in these matters is patchy or even non-existent. There is considerable disagreement over the confidential nature of any communication between pupil and teacher, especially when it involves children under the age of 16. One experienced teacher—Heather Muir—explained that if she heard that a child was having under age sex, she was under an obligation to report it to the social work department and possibly the parents.
A respected headteacher—Brian Cooklin—defined the phrase "in loco parentis" as meaning:
"we can do nothing without parental consent."—[Official Report, Health and Sport Committee, 25 March 2009; c 1721.]
That is important. I am not saying for a moment that a teacher should never disclose information given by a child—the interests of the child or even the greater community sometimes mean that that is the appropriate action—but a policy that makes disclosure mandatory can do harm, either directly or more subtly, by preventing children from coming forward for help. Doctors do not always have to disclose and nor should teachers always be required to do so.
In her evidence, the Minister for Public Health and Sport reassured the committee that it is not a criminal offence to fail to report a criminal offence. Now, of course, two under age children who have sexual intercourse are both engaged in criminal activity. That is welcome—I do not mean the new law, but the fact that the teacher does not have to report the offence.
What we are concerned with here is not the letter of the law but what happens in schools. If we have headteachers interpreting the responsibility of a teacher to mean that parental consent is always required, some of our most vulnerable children will be very poorly served, because, sadly, the parents—or a parent—are often part of the problem, rather than the solution.
Clear guidance is required to help the ordinary classroom teacher deal with what is an incredibly complex and dangerous minefield of accepted practice. Backing is needed for classroom teachers who decide in good faith not to disclose. Perhaps a mentoring system for less-experienced teachers could help in that respect. We must realise that those who use judgment, rather than slavishly follow set-down rules, will sometimes get things wrong, which means that support from higher up is even more important.
The minister acknowledged to the Health and Sport Committee the problems in this field by saying:
"We can also reflect on whether more needs to be done to ensure that things are as clear and supportive as they can be for those on the front line who need to make such decisions. We should perhaps have a think about what more could be done."—[Official Report, Health and Sport Committee, 6 May 2009; c 1897.]
I agree with the minister and look forward to progress in this field.
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...