Chamber
Plenary, 06 Jan 2010
06 Jan 2010 · S3 · Plenary
Item of business
Child and Adolescent Mental Health and Wellbeing
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 Administration and from the Scottish Needs Assessment Programme report of 2003 in particular. Now, however, there is even stronger evidence about the supreme importance of the very early years for mental health, which is backed up by exciting new research about the effect of early family relationships on brain development.
As we head towards more difficult times for public expenditure, it is more important than ever that we identify the areas that are most important for the future of society and ensure that they are prioritised. I believe that the early years, and the first three years of life in particular, are such an area.
Evidence to the Health and Sport Committee certainly supported that point of view, especially the evidence given by Dr Philip Wilson on 25 March. He referred most strikingly to some work in the United States, which Mary Scanlon also mentioned, that suggested that it is possible to predict at the age of three as many as 70 per cent of children who will end up as in-patients in psychiatric hospitals or in prison. He also described the intensive home-visiting programme that was developed by David Olds in the United States, which I am pleased to say is now being taken up on a pilot basis by NHS Lothian, as the minister said.
Follow-up studies in the US indicated that children in vulnerable families who had received intensive home visiting from health visitors up to the age of two were, by the age of 15, half as likely to have psychological problems and half as likely to have been involved in the criminal justice system as similar children who were not in the programme. There is no more graphic illustration of the potential importance of health visiting, which was a major feature of the committee's report.
We should remember, however, that the example that I gave was targeted on vulnerable families, and I remind members that that was the thinking behind Hall 4, which was issued while I was a minister, as was the SNAP report. A good impulse was behind that, because we must have intensive rather than occasional home visiting if we are to support vulnerable families. That said, a clear danger is that children will be missed if not enough health visiting is undertaken, and it is generally agreed that the approach has swung too far the other way. It is important to find the middle ground—the minister recognised that in her speech, although people might feel that the balance needs to be redressed even further.
The committee's report and all members today have certainly acknowledged that health visitors are crucial in early identification. Equally, the report recognises that the task is not just for health visitors; we need a multi-agency strategy to address obstacles to early intervention. The committee made important recommendations about nursery schools and about training for the early years workforce across the board.
However, none of that can be at the expense of specialist CAMHS staff, not least because those staff train the wider early years workforce. I will focus on the staffing recommendation because it is clear that for many other issues, such as waiting times, staffing is the most crucial—but not the only—relevant element. The spotlight in the report is on the NHS and the figure of 20 specialist staff per 100,000 population, but we should remember the role of local authorities. In Edinburgh, several jointly funded posts were the result of changing children's services fund money. There are great concerns about the continuance of the local authority's contribution to those posts, and the fact that many of those staff in Lothian have temporary contracts is a particular concern.
A wider issue is council funding for mental health services in the voluntary sector. If we do not support the voluntary sector and other support services for mental health, the burden on CAMHS staff becomes all the greater. A superb project in my constituency that was funded by the fairer Scotland fund, called women supporting women, lost half its funding last year and is existing on a lesser service this year. That project has helped hundreds of women with young children in my constituency. Without that support, they and their children might well have had to access psychiatric services. We need to remember the wider funding situation, as well as the specific NHS money.
Of course, I welcome what the minister said about increased NHS funding for specialist CAMHS staff and the announcement a few weeks ago about clinical psychologists, but psychiatrists have told me that expanding the psychiatric workforce is an issue. The Government says that lots more psychiatrists are in training, but what guarantee do we have that they will obtain permanent posts? NHS boards must create the posts, which is a concern for some psychiatrists. The committee also raised the issue of research.
I should not really be mentioning the next subject just in my last 20 seconds, but it is clear that a key issue is the mental health improvement agenda. I note that SNAP's former chair, Graham Bryce, highlighted the failure to step up that programme, which must be central in the work against stigma, to which I know that the Government is strongly committed.
As we head towards more difficult times for public expenditure, it is more important than ever that we identify the areas that are most important for the future of society and ensure that they are prioritised. I believe that the early years, and the first three years of life in particular, are such an area.
Evidence to the Health and Sport Committee certainly supported that point of view, especially the evidence given by Dr Philip Wilson on 25 March. He referred most strikingly to some work in the United States, which Mary Scanlon also mentioned, that suggested that it is possible to predict at the age of three as many as 70 per cent of children who will end up as in-patients in psychiatric hospitals or in prison. He also described the intensive home-visiting programme that was developed by David Olds in the United States, which I am pleased to say is now being taken up on a pilot basis by NHS Lothian, as the minister said.
Follow-up studies in the US indicated that children in vulnerable families who had received intensive home visiting from health visitors up to the age of two were, by the age of 15, half as likely to have psychological problems and half as likely to have been involved in the criminal justice system as similar children who were not in the programme. There is no more graphic illustration of the potential importance of health visiting, which was a major feature of the committee's report.
We should remember, however, that the example that I gave was targeted on vulnerable families, and I remind members that that was the thinking behind Hall 4, which was issued while I was a minister, as was the SNAP report. A good impulse was behind that, because we must have intensive rather than occasional home visiting if we are to support vulnerable families. That said, a clear danger is that children will be missed if not enough health visiting is undertaken, and it is generally agreed that the approach has swung too far the other way. It is important to find the middle ground—the minister recognised that in her speech, although people might feel that the balance needs to be redressed even further.
The committee's report and all members today have certainly acknowledged that health visitors are crucial in early identification. Equally, the report recognises that the task is not just for health visitors; we need a multi-agency strategy to address obstacles to early intervention. The committee made important recommendations about nursery schools and about training for the early years workforce across the board.
However, none of that can be at the expense of specialist CAMHS staff, not least because those staff train the wider early years workforce. I will focus on the staffing recommendation because it is clear that for many other issues, such as waiting times, staffing is the most crucial—but not the only—relevant element. The spotlight in the report is on the NHS and the figure of 20 specialist staff per 100,000 population, but we should remember the role of local authorities. In Edinburgh, several jointly funded posts were the result of changing children's services fund money. There are great concerns about the continuance of the local authority's contribution to those posts, and the fact that many of those staff in Lothian have temporary contracts is a particular concern.
A wider issue is council funding for mental health services in the voluntary sector. If we do not support the voluntary sector and other support services for mental health, the burden on CAMHS staff becomes all the greater. A superb project in my constituency that was funded by the fairer Scotland fund, called women supporting women, lost half its funding last year and is existing on a lesser service this year. That project has helped hundreds of women with young children in my constituency. Without that support, they and their children might well have had to access psychiatric services. We need to remember the wider funding situation, as well as the specific NHS money.
Of course, I welcome what the minister said about increased NHS funding for specialist CAMHS staff and the announcement a few weeks ago about clinical psychologists, but psychiatrists have told me that expanding the psychiatric workforce is an issue. The Government says that lots more psychiatrists are in training, but what guarantee do we have that they will obtain permanent posts? NHS boards must create the posts, which is a concern for some psychiatrists. The committee also raised the issue of research.
I should not really be mentioning the next subject just in my last 20 seconds, but it is clear that a key issue is the mental health improvement agenda. I note that SNAP's former chair, Graham Bryce, highlighted the failure to step up that programme, which must be central in the work against stigma, to which I know that the Government is strongly committed.
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...