Mental health strategy for Scotland: worth the wait?

Mental health by Dierk Schaefer

The Scottish Government may well have been disappointed by the response to its long-awaited ten-year mental health strategy.

After all, it was announced by the first dedicated mental health minister in any UK nation, Maureen Watt, and contained the ambition to give mental health parity with physical health through a human rights-based approach.

Will the strategy make a difference to the lives of people experiencing mental health problems, though?

“Everyone has mental health: for all of us, our health has both mental and physical aspects, but they are not always thought of in the same way,” Watt told MSPs. 

“We want to create a Scotland where stigma related to poor mental health is eradicated and where prevention and early intervention are central. We want to be a nation where mental health care is person centred, recognising the life-changing benefits of fast, evidence-based treatment.”

This is the kind of language campaigners have been hoping to hear for decades. Often those suffering mental health problems have faced stigma and misunderstanding from the very services which are supposed to be helping them.

It is thought that up to half of all mental health problems may be established by the age of 14.

But aside from a £35m pledge to invest in 800 extra staff and a new managed clinical network, questions were asked how more preventative measures such as counselling in schools and other earlier interventions would be funded.

“Who will be the recipients of mental health training in schools and how will this be resourced?” asked Children in Scotland’s head of policy, Amy Woodhouse. “We believe it is vital that this includes pre-school settings.”

Watt committed “more than £300 million” of “direct investment” in mental health, but much of what she announced was through NHS services.

And official figures released only weeks earlier underlined the scale of the problem. 

While more people than ever are seeking support and help for their mental health, in the last quarter of 2016 only two health boards met the 18-week referral to treatment standard for psychological therapies.

During the same period only half of health boards met the 18-week guarantee for children and adolescent mental health services (CAMHS). 

And campaigners say spending on mental health services by health boards is in decline, down from 8.6 per cent of the NHS budget to just eight per cent.

Local authorities, too, have pointed to their shrinking budgets and voiced their frustration through their umbrella organisation COSLA. 

Last-minute changes to the document meant council leaders could not sign it off as a joint strategy, it was revealed.

The Mental Welfare Commission for Scotland said roles of responsibility would need to be identified.

Chief executive Colin McKay said: “To ensure the strategy has a real impact on people’s lives, the next step is to bring clarity as to how its actions will be delivered, and by whom. It is also vital to have measurable outcomes. There must be a shared and effective process of monitoring the strategy, and whether it is effective.” 

When she was interviewed by Holyrood last year, Watt adopted the ‘ask once, get help fast’ slogan coined by third sector support organisation, the Scottish Association for Mental Health (SAMH) which proposed increased investment in prevention.

She also mentioned it in her statement. 

“In primary care, we are developing new multidisciplinary models of supporting mental health. That will help to achieve the ‘ask once, get help fast’ principle and better equip people to manage their own health and encourage recovery,” she said.

But in his reaction to the final strategy, Billy Watson, SAMH chief executive, questioned whether the ethos could be achieved without a commitment to more funds.
“We welcome the launch of this new 10-year strategy – it is long overdue,” he said.

“We are pleased to see that some of our recommendations have been accepted and areas of focus in the plan are to be welcomed. However, we are disappointed it lacks the ambition and investment that Scotland deserves, especially for children and young people.” 

Commitments in the strategy include an audit of why over 17,000 children and young people were turned away from CAMHS in the last three years and what happened to them. 

“SAMH believes that an investment in non-CAMHS services that focuses on early intervention is required so young people can access appropriate help quickly,” said Watson.     

“CAMHS does the job of supporting young people with a mental health diagnosis but GPs, teachers and parents need more options when presented with a young person who is mentally unwell.

“We need to make mental health a priority across all government departments if Scotland is to be bold and innovative once again.”

Children’s charities, too, questioned the commitment to prevention.

In a joint statement, Children 1st, NSPCC, Aberlour, Includem, Barnardo’s and Action for Children said: “Whilst there is more of a focus on the role of schools and early intervention, there is a distinct lack of detail in the document about what actions will take place to tackle the growing problem of poor mental health in our children and young people.”

A lack of timetables and accountability was also concerning, the charities said.

“We need to see national leadership now to ensure policy commitments are matched by adequate and sophisticated public investment in people, resources and relationships to support the delivery of preventative services and promote positive emotional wellbeing and resilience.”

Andrew Strong, assistant director at the Health and Social Care Alliance Scotland (the ALLIANCE), raised “serious concerns” to Holyrood last August about the engagement with third sector partners when the strategy was out to consultation.

Members had questioned the scope of the new vision, the level of consultation undertaken to date and its potential impact, he wrote, adding: “We can’t accept a situation where Scottish mental health policy, once a world leader, is not effectively influenced by the voice of lived experience.” 

After its publication last month, Strong welcomed the new ten-year strategy, but told Holyrood it would need to be matched by a plan of action.

“This will require not only additional investment in mental health support and services but also detailed guidance on how, at a local level, health boards, local authorities and health and social care partnerships can adopt human rights-based approaches in practice,” he said.

“Our members tell us that the weakness of the previous strategy was a lack of focus on improving the experiences of people accessing support and services.  

“As such, we would expect the Scottish Government to outline a much more detailed plan for achieving each of the actions in the new strategy, co-produced with people with experience of mental health problems, unpaid carers and third sector organisations, in order to give particular emphasis to their rights, support and outcomes.”

In her statement, Watt suggested the strategy is in itself a starting point, not the solution. 

“It is just the beginning,” she said.

“The voices of stakeholders and service users have been key to the development of the strategy, and I am determined that they will also be key to its implementation. That is why, to help me to steer the strategy, I will be convening a bi-annual forum of stakeholders. 

“In that forum, I want to hear stakeholders’ views and get their help – now, and in the future.”

How this bi-annual forum and measurement framework will operate will be an important factor in whether people with lived experience of poor mental health play their role in measuring success and driving change.

But when many conditions such as depression often go undiagnosed as people confront both internal and external stigma, in turn leading to unhealthy coping mechanisms, meaningful engagement will be a challenge.

The Scottish Recovery Network urged the Government to look beyond “traditional mechanisms” to allow people to manage their own recovery.

Director Frank Reilly said: “We often hear the statistic that one in four people experience mental illness. That distinction is both unhelpful and untrue.

“To make mental health recovery real for everyone in every community, we have to recognise that distress is universal, not unique, and that this distinction is a barrier to early intervention.

“We would encourage the Scottish Government to look beyond traditional treatment and support recovery communities which are led by people with lived experience."