Associate feature: A look at Scotland's mental health services

Pandemic

Fully into the second year of the pandemic, many of us are reflecting on what was done well and what was not.

Reports are emerging from government and organisations showing the pressure that everyone in a position of decision-making was under last spring, and the steep learning curves they faced. That is understandable. But what is also emerging in those reports – including our own – is the frailty that was there in some parts of the health and care system anyway, before we’d heard of Covid-19.

Our recent report on authority to discharge people from hospitals to care homes showed an endemic lack of understanding of the law when decisions were being made on behalf of very vulnerable members of our community. Since publication, we have seen a real willingness from across the sector to strengthen the system and give staff the training and support they need.

For years, children and young people have been facing long waits to be seen by mental health services, despite strong commitment from government. This has been exacerbated by pandemic restrictions, and must remain a priority.

Law Reform

Scotland’s mental health laws are decades old. The ongoing Scott review to improve the rights and protections of people who may be subject to the existing mental health, incapacity and adults support and protection laws are welcome. There have been major changes over the years in how mental health, learning disability and care services are structured and delivered in Scotland, with many more people supported in the community.

Attitudes and approaches to human rights and people with mental ill health or capacity issues have been enhanced in other countries, and reflected in their legislation. The key issue is to ensure people’s rights and protections are firmly at the centre of any reformed legislation.

Re-open mental health and care services

Before 2020 there were already significant pressures on community mental health and learning disability services. In the last year many people have found that their contact with services has been via a phone or a computer screen. Concerns have been raised that mental health and care services might not reopen as before. It is vital to reinstate in-person services that people desperately need as soon as it is safe to do so; enhancing them where need be. And to do that with adequate funding.

Scottish Government

If this year has taught us anything it is that mental health and social care are often inextricably linked. The reframing of the ministerial portfolio is hugely reassuring and creates new opportunities for change. As we emerge from pandemic restrictions, a challenge for government will be to address the different needs of people with mental illness, learning disability, dementia and related conditions and those who strive to maintain mental wellbeing. These are separate issues and the distinction is something we would like to discuss further, as policy develops.

Our priorities this year

As an independent statutory organisation, our role is to protect and promote the human rights of people with mental illness, learning disabilities, dementia and related conditions. We do that by visiting people on hospital wards, young people’s units and other locations across the country and publishing reports on what we find.

We also examine specific areas of care in detail, and this year are exploring dual diagnosis of mental ill health and substance misuse. We want to know more about care and treatment for those who struggle with this issue. We are also visiting people who use mental health services in prisons, pandemic restrictions notwithstanding. We are working on a national report on mental health services and people from ethnic minorities – the first of its kind in Scotland.

Our ongoing roles include monitoring the law and publishing our findings on how it is being used to care for people with mental illness or incapacity. We offer advice and guidance to people who are unwell, their families or carers, and to professionals working in mental health, learning disability and social services. We investigate cases of poor care or treatment where we see opportunities for national learning, and this year we will focus on women with mental ill health in prison.

Call to politicians

Members of the Scottish Parliament can have great influence over public debate and our wishes for a better society. The increasing awareness in our parliament of mental illness has been notable and we ask that - amidst many issues competing for attention - our politicians keep this subject high on their priority list.

Sandy Riddell is the chair of the Mental Welfare Commission

This article was sponsored by the Mental Welfare Commission