Hansard

I draw members’ attention to my interests as a fellow of the Royal College of Psychiatrists, a member of the British Medical Association and a chair in psychology at the University of Stirling.

I welcome this as the first health debate of the new Cabinet. I hope that it will be one of many, because we have had a paucity of mental health debates in the past. I also welcome Jamie Hepburn to his first debate as a minister. I welcome the tone of his speech.

The unequal and false division into mind and body as separate entities occurred over a century and a half ago, and it has dogged the biological model of medicine ever since. We know that general practitioners treat most patients with mental illness and do so holistically, but they are confronted with serious difficulties in not having the time to manage complex mental and physical morbidity. That is particularly the case in deprived areas, where mental health problems are massively more prevalent. The deep-end practices have reported that as part of their view of the inverse care law—the fact that resources are applied in inverse proportion to care needs.

I welcome the appointment of the six link workers, but that is just the beginning. A much more dynamic and radical approach to primary care is needed if specialist services are not to be even further overwhelmed. Malcolm Chisholm will speak a little more about primary care later in the debate.

The 1997 mental health framework started by saying that it was written

“to assist staff in health, social work and housing agencies ... to develop a joint approach to the planning, commissioning and provision of integrated mental health services.”

It was also intended to assist the people who use those services, those who care for those people and staff in voluntary and other agencies

“to play their part as partners and stakeholders.”

That introductory message is as relevant today as it was then. However, the framework was directed mainly at the problem of severe and enduring mental illnesses. Much progress has been made in the management of psychotic illness and dementia, but less has been made on dealing with personality disorder and developmental disorders.

Much has happened since 1997. The closure of old and unsuitable hospitals has continued, and with the help of public-private partnerships—I know that the Scottish National Party does not approve of PPP, but I presume that the similar non-profit-distributing model will continue—the closure and replacement rate has intensified.

We passed the Adults with Incapacity (Scotland) Act in 2000—Mary Scanlon will remember our debates about it. The Millan commission reported in 1999, when it enunciated 10 principles, which were incorporated in the Mental Health (Care and Treatment) (Scotland) Act 2003. That was the first time in my professional and political life that a Scottish act was not simply a tartanised version of a UK act. It led the way, was hailed in Europe as a piece of far-thinking legislation and was eventually copied in England.

Further attention is now being paid to the human rights of patients with mental illness. I suggest to the minister that that might require a larger review of the interaction of the existing acts than was possible under the rather limited McManus review, whose proposals we are considering.

The minister referred to the see me anti-stigmatisation programme, which Malcolm Chisholm established when he was a minister. In its first four years, it began to transform public and—in part—media attitudes. Regrettably, as the minister said, the social attitudes survey of 2013 shows that some attitudes have not continued to improve and in some respects have gone backwards. What has been titled the refounding of the programme, which is overdue, places far too great an emphasis on very short, one-year programmes. We are beset by one-yearitis in our projects, whereas we should build on what has worked far more.

Under Labour, the 2006 follow-up strategy “Delivering for Mental Health” introduced standards and integrated care pathways for severe and enduring illness. The benefit of that was reflected in the initial 25 per cent reduction in readmissions within a year. That reduction has continued under the present Government and is very welcome.

The HEAT—health improvement, efficiency, access to services and treatment—target for reductions in suicides that Labour introduced has also been continued by the present Government and has led to a substantial reduction even if it has missed its target. It is to the Government’s credit that the rate has not increased during the recession as has happened in many countries.

The HEAT target for antidepressant prescriptions has wisely been dropped. It was in part a proxy for psychological treatments, but better quality prescribing has meant a rise in the amount and length of treatment. We commend the Government for changing that HEAT target.

The 2010 90 per cent referral-to-treatment HEAT target for psychological therapies has not been met. There has been quite good progress, although, as the minister said, that progress masks huge variation, with Lanarkshire and Glasgow performing well into the 80s, while the figure for Lothian and Forth Valley—the area into which I introduced community psychology for the first time in Scotland in 1982—is depressingly low at 40 per cent. That is why we call again for rigorous inspection and clearly agreed plans of action to match the improved reporting that is demonstrating that these matters are hugely variable.

Dementia diagnosis has improved and the standards for support have been effective, but serious problems of failure to undertake or record cognitive assessment have been noted in Health Improvement Scotland inspections of acute elderly care. Staff might feel that cognitive assessment is not a priority, but it really is—it is very important.

Progress in a number of other specific areas has been slow. Health inequalities have increased not decreased. As the minister has accepted, CAHMS is still a major challenge and I welcome the tough targets that the Government has set although, as Mary Scanlon said in her intervention, they have not been met. If we are to achieve those targets, it will be necessary to support the lower-tier services because they will reduce demand. In the last two quarters, referrals to CAMHS increased hugely and they will continue to do so unless lower-tier services are improved. For example, the recent spread of the Place2Be service from the cluster of Niddrie primary schools in Edinburgh to more deprived areas in East Lothian and Glasgow is welcome, as are home start, the positive parenting programme and family nurse partnerships, but it is not enough.

I hope that this is the first of many debates about mental health. We have not covered many areas, such as prisoners, forensic psychiatry, substance abuse and veterans. I welcome the fact that my amendment has been accepted.

I move amendment S4M-11975.2, to insert after “physical illness”:

“but notes that, while there has been progress toward the targets on child and adolescent mental health, the targets have not been met, psychological treatments waiting times remain very challenging and primary care teams are under substantial and increasing time pressure to deliver holistic care, particularly in areas of deprivation where there is a greater amount of mental illness; further notes that, after initial progress in improving public attitudes to mental illness with the See Me programme, this welcome trend has stalled and there is a need for more robust monitoring and inspection of the variation between NHS boards”.