Listening first: interview with mental wellbeing and social care minister Kevin Stewart

Given the focus on both social care and mental health as a result of the COVID-19 pandemic, Kevin Stewart, the new minister for mental wellbeing and social care, has a pretty significant portfolio on his hands.

This includes a consultation on the creation of a national care service, one of the Scottish Government’s highest profile first 100 days commitments, as well as the need for improvements to mental health waiting times and social care services generally – the latter brought to the fore by deaths in care homes and discussions of poor pay in the sector.

It’s a bit of change from his previous portfolio of local government. But Stewart is looking forward to it.

“Nobody can say that I don’t like a challenge,” he says. “And I have to say that I am very, very excited about helping to shape a national care service.

“You know, I think that this is probably the biggest change in our public sector landscape possibly since 1948, since the formation of the National Health Service. So that’s very, very exciting indeed.”

Stewart says he already has a “fairly good understanding” of social care, having previously been local government minister and before that, convener of the local government committee, but on the mental health side “it would be fair to say I have a little bit of a learning curve”, although he brings his own life experiences to the role.

But Stewart is very clear that he won’t be making any decisions in either side of his portfolio without first hearing from the people affected by them.

“In this role, like in my other roles in the past, one of the things that I am very keen to do is to ensure that the voices of those folks with lived experience are brought to the fore and heard, whether that be in the mental wellbeing side or in the social care side.

“I think in my previous ministerial role we’ve seen some real differences in terms of homelessness policy and legislation, and I think if we hadn’t had the voices of lived experience at the table, then we might not have got all of that right.

“And, you know, I’m not saying that everything is perfect, because we always need to tweak, but a lot of the things that we have done in recent times in that area has greatly benefited from the experiences of people. And I want the same thing here.”

With the creation of a national care service being so high profile, there is a risk that could dominate over everything else, but Stewart says he will not lose sight of the need for improvement across the board.

“We’ve got to get this absolutely right in terms of the national care service, but that’s not going to blind me or stop me from dealing with what we need to do in the here and now,” he says.

“As you can well imagine, I’ve spent the last number of days talking to a lot of folk, in particular, the civil servants, and I’ve made it very clear in all of this that we have got these top lines, key policy planks that were in our manifesto, and we must deliver on them, but also, we need to continue to look at the service delivery on the ground and how we can improve that, even before we reach the stage of a national care service.”

And given that the Scottish Government recently went through the process of setting up another national agency, Social Security Scotland, from scratch, under the leadership of former health secretary Jeane Freeman, Stewart says he will also be seeking to learn lessons from that.

“I think it would be fair to say that I’m likely to have a fair few conversations with Jeane Freeman and others who were at the forefront of that. You know, there is absolutely no point in trying to reinvent the wheel.

“I will go to the offices of good folk, even those folks who have supposedly retired, and seek their advice and views.

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“That is the right thing to do without doubt. So Jeane might get a bit sick fed up of me over the next wee while. I hope that’s not the case.”

On the mental health side, there are a number of commitments to spending, including a 25 per cent increase in mental health funding over the course of the parliament, bringing it up to 10 per cent of the total health budget – a “big shift”, Stewart says – and, in the short term, £120m has been allocated for the Mental Health Recovery and Renewal Fund, of which £34.1m is going towards improving child and adolescent mental health services (CAMHS).

Discussions are ongoing about how best to use the remaining unallocated funding and Stewart is clear that he wants to take the time to see that used well rather than just out the door quickly.

Mental health charity SAMH has called for an end to CAMHS rejections. When asked about that, Stewart says that he will “have to look very carefully at what is currently going on out there”.

He notes that as a constituency MSP he was previously getting a lot of complaints about services in Grampian, but there seems to have been an improvement there that perhaps could be learned from.

“I want to see that best practice exported so that we get this right for people, so that we can see folks’ satisfaction rates go higher and so we have less folks saying, we’ve gone through this and yes, we’ve had the help but that last bit of the jigsaw they feel is missing.

“Let’s see if that last piece of the jigsaw is really missing first of all, and if it is, what do we need to do to make that improvement.”

Other pressing issues in mental health include following up on the Eating Disorders Services Review, which was published in March and included 15 recommendations for action, including an urgent request for COVID funding, and an updated suicide prevention action plan, due this year.

Stewart says he’s “not going to be pushed into timelines” on responding to the recommendations around eating disorders, having only been in the job one week at the time of the interview, but being a close friend of former SNP MSP Dennis Robertson, whose daughter died of an eating disorder in 2011, he will make sure that they do the right thing.

“You will know that I’ve spoken in a number of debates in parliament on the subject of eating disorders.

“You’ll know that Dennis Robertson, former MSP for West Aberdeenshire, and I were the greatest of buds. And obviously, I know about the Robertsons’ family experience of all of this, which is extremely sad.

“And I said to Dennis when he left parliament that I would continue to highlight these issues, and a number of colleagues have done likewise, because obviously hearing that first-hand experience on a regular basis keeps that up there.

“So I’m going to make sure that we do the right thing so that others don’t have to face the kind of pain that Dennis and Anne Robertson have faced, and the family have faced.”

We both get a bit teary talking about the Robertsons’ experience, and I note that it is an emotionally challenging portfolio Stewart has been given.

“I think you can look at these things a number of ways,” says Stewart. “And some folk have looked at the remit that I have and gone, ‘Oh my, I could never do that.’

“However, the thing is that somebody has to do these things.

“And the key thing for me in all of this is that we all have had experiences of folk that we know that had been affected by poor mental health.

“I know folks who unfortunately have committed suicide. And it’s sometimes very difficult to understand why they took that course of action.

“And, you know, I think that we need to do all that we possibly can to improve mental health and support in this country.

“I think in some regards we’re in a better place now because people are more willing to talk about their own mental health more.

“Not everyone. I think we’ve still got a long way to go in terms of destigmatising some aspects, some views of folk, but we have come a long way in what I think is a fairly short time… And we need to get to a stage that we talk about our mental health much, much more.

“And where bad things happen, rather than box it up and keep it to yourself, we have to be able to have that release and be able to talk to one another about how we’re feeling about these things too.”

Stewart is unsure whether he has suffered poor mental health as such, but he can certainly relate to the experience of struggling emotionally.

Asked about his own experiences, he says: “I’ve never been diagnosed as having any poor mental health, but, you know, it’s often difficult to say, not having a diagnosis of depression.

“Have I ever been depressed? And the answer to that is probably yes.

“You know, I spoke a number of times during the course of the equal marriage debate around about how I’d kept myself closeted for too long and I talked then about my unhappiness.

“Now, was that just unhappiness or was it something more? I don’t know, is the answer. I don’t.”

But he is also influenced by the experiences of others he knows.

“The fact [is] that all of us know someone who has either been diagnosed with depression or has gone through various other things.

“I don’t want to identify people… but I know folks who have been diagnosed with a number of things and sometimes hearing the journey that they’ve been on to try and get, first of all, recognition of what it is, and then the right treatments, and often the treatment in some cases is not quite so easy to get to either, and some of that, it’s very tough to listen to.

“A lot of those bad experiences are from yesteryear, and you do hear much better outcomes for some folk now with similar difficulties, so again, I think we’re getting better, but we need to continue that improvement.”

With regards to what he personally wants to focus on in the new role, Stewart says that’s a luxury he doesn’t have.

“I don’t think that you can have the luxury of choosing your own personal favourite things in any portfolio.

“I think our manifesto sets out a clear pathway around about what we need to do.

“Obviously, the 100 days stuff is extremely important, but that wider commitment of delivering over the course of this parliamentary term, there will be a major focus in that.

“However, I come back to the point… [that] this is about continuously improving delivery. Because at the end of the day, whether it be any of the mental health services or whether it be delivery of social care, you know, we are talking about people.

“A frustrating thing for me always is, sometimes people talk about numbers, you know, everything is a stat, but the key thing in all of this that we canna lose sight of, that I can’t lose sight of, is that we are dealing with people, and we need to get these services right for folks.”