22 April 2004

S2M-1184 Mental Health

Scottish Parliament

Thursday 22 April 2004

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Mental Health

The Presiding Officer (Mr George Reid): The next item of business is a debate on motion S2M-1184, in the name of Malcolm Chisholm, on mental health, and three amendments to the motion.


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Stewart Stevenson (Banff and Buchan) (SNP): It is always entertaining to listen to Frank McAveety first thing in the morning, but it is slightly disappointing that his statement has abbreviated this debate.

The SNP welcomes the chance to debate mental health one year on from the passing of the Mental Health (Care and Treatment) (Scotland) Act 2003. We find it easy to welcome any initiatives that will improve the mental health of people in Scotland and we support any measures that will reduce the stigma attached to having a mental health problem, especially if those initiatives can lead to reduction in suicide among Scotland's people.

Our amendment recognises that resource constraints will severely inhibit the progress to success. At the time of the act's passage through the Scottish Parliament, we focused on the need for adequate resources to promote successful implementation. We share the minister's vision for improving mental health services in Scotland, although we do not necessarily agree about all the ways in which he seeks to do that. Sandra Grant's findings show that much needs to be done.

On a personal note, it is 40 years ago this month that I started work in a psychiatric ward during my time between school and university. For many people, mental ill health is an intensely personal experience during which sufferers experience stigma, employment difficulties and health support that is poorer than health support for almost any other segment of people who are treated by the health service.

Over the past five years, a number of MSPs past and present have suffered bouts of mental ill health. No segment of society is immune. The socially disadvantaged suffer greater ill health than average, although mental ill health shows slightly less socioeconomic bias.

We do not try to manage health provision on the basis of how many people each winter have a cold, which is a self-limiting disease. Similarly, the 70,000 or so who consult their general practitioner for depression each year are but a fraction of those who suffer from that debilitating illness. Assessing the need for mental health provision is quite significantly different from other types of assessment and we welcome the fact that the Executive is consulting on a draft code of practice and regulations under the act.

Sandra Grant's report is disturbing. The minister said that the report was much as expected, but that is pretty disappointing, given that we have one year to go until the full implementation of the act. Let me quote the words of the patients whose comments are included in the report and which are highlighted in the Scottish Association for Mental Health briefing:

"You can sit in your room alone all day and no one will come and see how you are."

Another comment was:

"cups were unwashed and stained, patients just stubbed their fags out on the floor—it was a hellish place".

Another patient commented:

"At one stage I was lying on the ground because I was so distressed and sad. All the staff did was walk over me in the corridor."

I absolutely accept that NHS staff are dedicated and that, at its best, the NHS is very good. However, those quotes show that, at its worst, the NHS is very bad. As a caring society, we must judge our performance by the worst. We must narrow the gap by raising the performance of the worst, not by lowering the performance of the best.

Dr Jean Turner (Strathkelvin and Bearsden) (Ind): The report gives an honest picture but, in fairness to NHS staff, the NHS creates mental ill health because it does not look after its staff. We have too few people doing the job. Too many people are ill treated when they have workplace grievances and end up leaving due to mental stress.

Stewart Stevenson: Jean Turner makes an important point. It would be interesting to know what the incidence of mental ill health is among NHS staff compared with in the population. Perhaps the minister can enlighten us on that.

Stigma is also an issue. More than 100,000 Scots are denied work because of their mental ill health. Fewer employers would consider taking on someone with a mental illness than would consider taking on a physically disabled person. In the wider community, 41 per cent of those who live with mental health problems have experienced harassment in Scottish communities, compared with 15 per cent of the general public. That is why initiatives such as the see me campaign are a welcome sign of the Executive's commitment to change society's attitude. The minister said that the campaign has achieved good recognition and impact, but the question is whether it has changed the experience of people who suffer from mental ill health.

I welcome progress on reduction of self-harm and suicide. Like others, I will have been touched by suicide at some point in my life. I also welcome the signs that the focus is turning to younger people, who have been neglected in the provision of health services.

The NHS boards have formidable new burdens under the act. We have perhaps not yet seen progress in supporting health boards. The act's implementation must not be half-baked. We must not see the introduction of community-based compulsory treatment orders as an excuse for inadequate levels of hospital services. Such orders are not a sticking plaster or a cheap alternative. We need both community-based and hospital-based provision being driven by patients' wishes.

Sandra Grant's report highlights the fact that funding is not ring fenced and much has to be provided from existing money because new money has yet to be allocated.

On staffing, 9 per cent of consultant psychiatrist posts are currently vacant and some 5 per cent have been vacant for over six months. Between 400 and 500 student nurses specialise in mental health each year, but there is a chronic under-recruitment of 10 per cent.

The report's summary refers to some significant issues that Jean Turner mentioned earlier:

"There are major staff morale, attitudinal and cultural problems which, unless attended to consistently, will inhibit full implementation of the underlying principles of the new Act ...

Workforce gaps are probably the most difficult issue to address in the short-term".

There ain't a magic bullet, but we need to hear more from the minister. Solving staff shortages cannot be done quickly. Our amendment refers to the lack of psychiatrists, which is a surrogate for a broader problem. We find it possible to support the other amendments, which have merit, as does the motion.

I conclude by drawing the minister's attention to the fact that none of the Executive's 14 health objectives makes any reference to mental health. Let us hope that, after the scheduling of today's debate, we see a welcome shift up the priority ladder for this rather forgotten corner of the NHS.

I move amendment S2M-1184.1, to insert at end:

"while expressing concern that the large number of vacant consultant psychiatrists' posts represents a significant barrier to delivering much sought after improvements."


Stewart Stevenson
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