Hansard

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 written evidence to the Health and Sport Committee; they are listed in annex B of the report.

My colleagues on the committee unanimously took the view at the beginning of this parliamentary session that the committee should, as a priority, hold an inquiry into mental health. On behalf of the committee, I thank our clerking team and the Scottish Parliament information centre, who were very helpful.

Mindful that the scatter-gun approach would get us nowhere and that mental health is such a wide and diverse area, we narrowed the inquiry down to child and adolescent mental health. Members will note from the title of our report that we broadened the term mental health to include wellbeing, in order, we thought, to reflect more accurately the range that mental health encompasses, from diagnoses of schizophrenia and bipolar disorder, for example, to people feeling depressed and low, having low self-esteem or being emotionally not well. I note that, in its briefing for the debate, Action for Children Scotland supports that broadening of the definition of mental health.

Very few committee reports set the heather alight, and this one will be no different. However, the inquiry and report should engage the attention of at least 25 per cent of the Scottish population, be they new mums, farmers, plumbers, teachers, politicians or the press—who are notably, but not unexpectedly, in absentia. Why should such people's attention be engaged? It is because one in four of us will, at one time or another, suffer from one or another form of mental illness, or our mental wellbeing will not be good, which will, of course, impact not only on ourselves but on our families, friends and colleagues and on our ability to work or even deal with day-to-day mundane matters. It costs society in terms of the loss of an individual's contribution in pounds, shillings and pence. It costs the national health service and the justice system, and it costs the individual in terms of enjoyment of his or her life.

So, where were we to start? The committee split into groups and made informal visits to various and varied projects, which are listed on page 2 of our report. After those visits, the remit of the inquiry was defined with a set of key questions. One was about identification: how do we recognise children and adolescents who are potentially at risk of developing mental health problems, and how can those problems be prevented? Another question related to obstacles: what gets in the way of the identification of children and adolescents who have mental health problems, and can those obstacles be overcome? Another question was about action: what is being done to aid early intervention when potential mental health problems are identified, and what else can be done? Another issue is access. Who can access the services and can on-going support be improved? Finally, with adolescents, are there particular problems around moving from child and adolescent mental health services to adult mental health services, and how can the process be improved?

It is frequently said that child and adolescent mental health services are the Cinderella service of the national health service, so the question for the committee in our report, which we published in June 2009, was whether that is the case. Despite the devotion and efforts of individuals in the statutory sector and the voluntary sector—which plays a particular role in such services—and despite the policy commitment of present and past Governments, the committee's overall view is that there is still a need for more drive in implementing policies, especially from national health service boards and local authorities. That is the general point.

I turn to specifics. Committee colleagues will no doubt highlight and develop the conclusions in our report, so I will refer to only a few of them, starting with the implementation of the child and adolescent mental health framework. An important question is this: who is in charge and where does the buck stop? First, I stress that the framework appears to be the right way to go. At no point in our evidence taking was there any suggestion that the framework needs to be improved or otherwise revised. The outstanding issue is the timescale in which the framework is being implemented. The committee's report recognises that progress has been made, but we state our concerns about who is taking ownership of its delivery. On that point, paragraph 25 of our report states:

"According to the Framework, ‘responsibility for ensuring delivery of this Framework rests with both NHS and local authority Chief Executives'. There should, therefore, be no doubt about with whom the ownership and responsibility rests: these are the people who should be championing the Framework. Whilst it was evident that the Framework was a priority for the Scottish Government, as it had been for the previous administration, it appears that this sense of priority has not transferred more widely into the delivery of services and has not, therefore, translated into a momentum for effective implementation of the Framework. … Whilst the Committee notes the Minister for Public Health and Sport's statement that ‘there was nothing to suggest that any implementation activity was off-target', the Committee is concerned that 2015 is a very far-off target and that there may, therefore, be some complacency amongst those responsible for delivering the target. In the interim, NHS board annual reviews are unlikely to be an adequate monitoring mechanism for ensuring steady and consistent progress. The Committee recommends, therefore, that the Scottish Government establish further and more detailed interim targets"—

just to keep people on the ball—

"and milestones by which implementation may be actively measured."

In the Scottish Government's response to the committee's report, the issue of interim targets and milestones is not picked up. Perhaps the Minister for Public Health and Sport can address that in her closing remarks. Given the apparently Cinderella status of CAMHS in the past, I am sure that the committee would welcome assurances that, in the difficult times that lie ahead, such services will not be deprioritised and become even more Cinderella-ish.

The early years are also important—the importance of identifying mental health problems in the under-fives was a continuing theme in the inquiry. I quote from our report:

"Dr Philip Wilson of the SNAP group"—

the "SNAP" reference is to the Scottish needs assessment programme working group on child and adolescent mental health that was set up in 2000—

"also talked about the importance of work with this age group, stating that it is the group that should receive the most thought and the most resources. He spoke of the ‘enormous blossoming in the evidence base on ways of identifying early in life the children who are going to follow a problematic and painful trajectory' and of a ‘big increase in the evidence base on what works"—

this puts the point in ordinary language—

"to stop the bad things happening'."

The evidence suggests that early neglect is the strongest predictor of later childhood mental ill health. Neglect can take many forms. The chief medical officer for Scotland examined attachment disorders and the effects of social and emotional deprivation in the context of his annual report, "Health in Scotland 2006", in which he highlighted the "huge influence" of pregnancy and the first years of life on the future mental health of the child and future adult. He wrote:

"Adverse events during this time can lead to irreversible problems for future ability to cope with everyday life and increase the probability of future poor mental and physical health. Such problems can then run on across generations. It is essential that we recognise the need to invest in the health of infants, young people and children as action by effective Child and Mental Health Services and other agencies can reap substantial long-term rewards for our future child and adult populations."

As I trailed earlier, the crux of whether statutory services can identify mental health problems in the very young is how those services are delivered. That key role was traditionally fulfilled by the health visiting profession, members of which would uncover such problems in the course of general unstigmatised interaction with families with young children. The key word is "unstigmatised".

In evidence, strong views were offered on the current state of the health visiting profession and, in particular, on the impact of the Scottish Government guidance "Health for All Children 4", which sets out the core programme of screening, surveillance and health promotion checks that every child should receive. The principle of Hall 4 is to have a universal service involving contact with all children, followed by a focusing in on the children who most need additional attention. However, witnesses told the committee of their concerns about the fact that babies often no longer see a health visitor after the first eight weeks of life. Mary Scanlon, in particular, pursued that issue in questioning. In addition, there has been a drastic drop in the number of health visitors. Fears were also aired that vital mental health and wellbeing assessments and interventions are being missed.

I have been told that because health visitors are no longer required to carry out universal checks on babies and toddlers, but instead target certain family groups, they sometimes encounter the hostile reaction that visiting social workers can encounter—most undeservedly—and may even be stopped on the doorstep. There remains a great deal of concern about the status of health visitors and, in particular, about the importance of keeping their link with health practices, as opposed to linking them to social work departments. The suggestion that the role that health visitors perform in child mental health could be fulfilled by social workers instead could be counterproductive from a public perception point of view, as I have demonstrated.

Although the committee recognises that it is difficult to achieve a balance between the targeted screening that is caused by inevitable limitations on resources and a universal approach, it considers that it is imperative to identify in the early years, through universal screening, mental health and wellbeing issues in the child and the parents or carers that have not been recognised at the time of the child's birth, or in the first six to eight weeks of life. Furthermore, it is vital that standard health and developmental checks be carried out on every child at crucial stages of the early years.

In its response, the Scottish Government said that the revised additional guidance on Hall 4 to NHS boards that would be published in autumn 2009 would make it clear that what is set down in the Hall 4 guidance was the minimum number of contacts that a child should receive. It would be useful if the minister would set out what the current position is vis-à-vis the community health nurse role that is being piloted in Borders, Highland and Tayside.

I hope that our report demonstrates the commitment of not just the committee but the Parliament to mental wellbeing, and our determination to put it on a par with physical wellbeing, given that they are two interacting sides of the human coin.

I move,