Waiting room: Scotland's mental health challenges

“My experience of mental health services in Scotland has been mixed,” says Mark, not his real name, a 29-year-old man from Edinburgh. “Although the professional therapists are amazing, the waiting times and access to the correct methods of therapy are not.

“Having attempted suicide on multiple occasions, and having unprocessed childhood trauma, I was made to wait for over 12 months to be seen by therapists. But each time I was given the wrong type of therapy that did not work for myself.

“Doctors would continuously attempt to prescribe medication I had no desire taking to try to counter the long waiting times.

“GPs have ten minutes to assess someone who is essentially one bad decision away from death. It’s not fair on them or their patients.

“Waiting twelve months for the wrong kind of therapy isn’t just stupid, it’s inhumane and can lead to deaths further down the line.”

Behind the headline figures of spiralling mental health treatment waiting times lies the human cost – of relationships ruined, families torn apart, and tragically, the hundreds of lives cut short in Scotland each year due to suicide. And for all MSPs the evidence is clear in their case loads.

“We often see that a person having mental health problems can cause the whole family to go into distress,” said Labour MSP Carol Mochan, “whereas if there was an earlier intervention, particularly for young people, then the family would have coped better.

“So a lot of organisation are saying to me we need more family support, more family services, especially for young individuals with support needs.”

There has been a sea change in attitudes towards mental health, with health boards reporting that more people than ever are overcoming a historic social stigma around mental health and seeking treatment.

However, with the greatest will in the world, these positive cultural shifts are butting up against the cold, harsh reality that Scotland cannot hire enough mental health practitioners to meet the growing demand.

This has led to the state of mental health services in Scotland arguably being defined by the size of mental health waiting lists – every MSP Holyrood spoke to highlighted how much of their casework is dedicated to helping constituents facing mental health crises, but who cannot access treatment.

The Scottish Government has set ambitious targets for waiting times, but has never met them. The government has set 18 weeks as maximum waiting time for patients, and has said that 90 per cent of patients should be seen within that timeframe.

However, according to Public Health Scotland figures, just 65.1 per cent of children and young people seeking mental health treatment are seen within 18 weeks, with adults faring marginally better at 77.6 per cent.

A joint report from the Mental Health Foundation (MHF) and the London School of Economics (LSE), published in February this year, found poor mental health costs the Scottish economy £8.8bn annually.

Most available mental health statistics predate the coronavirus pandemic and the huge impact of multiple lockdowns on mental health, and MSPs from across the parliament are now warning that anecdotally, mental health provision in Scotland has worsened.

“I think this will be one of the long shadows cast by Covid to be honest with you,” said Scottish Conservative MSP Craig Hoy, “both in terms of the delayed diagnosis and treatment, which was there before the pandemic, that’s undoubtedly been made significantly worse by the pandemic, particularly for children and adolescent mental health services.

“When you look at all the key indicators, we're going to have to deal with the backlog, and I think that's heightened anxiety, and depression - and that's partly because of the lockdown, the social isolation, and partly because their children haven’t been in a school environment.

“Cumulatively, that means that we've now got a realisation, cross party, that mental health services have to be looked at and looked at seriously, which is why we welcome the government's mental health strategy, where we pushed for 10 per cent of the health budget to be spent on mental health.”

The Scottish Government published its ten-year mental health strategy in 2017, which announced the government would work “achieving parity” between mental and physical health treatment.

The scale of the challenge in 2017, according to the strategy, was that only one in three people who would benefit from treatment for a mental illness were receiving it, and that people with life-long mental illness were likely to die 15-20 years prematurely because of physical ill-health.

Ahead of the publication of the fourth annual progress report of the strategy, which is due to be published this month and will mark the half-way point of the strategy, there is little evidence that much has changed since 2017.

“I think the biggest challenge is our workforce,” said SNP MSP Gillian Martin, convener of the health, social care and sport committee.

“I think there are two key parts to this. The vacancy rate is high, like it is in almost all aspects of health, but in mental health, there’s a need to recruit more mental health practitioners, and the existing workforce is under a great deal of pressure.

“So it's like a chicken and egg situation, we need more people entering mental health professions, but that takes a long time for people to qualify and to train, and that existing workforce is under a great deal of pressure.

“So we’re looking at how you look after the mental health of the mental health workforce, and how we can ensure they get as much support for them to be able to do their job and meet the needs of a population that has increasing mental health needs, mainly as a result of the stresses and difficulties of the pandemic.”

Expanding a high-skill workforce requires serious investment, but according to the MHF, prevention of mental health services can greatly offset recruitment costs by saving the economy billions of pounds.

Shari McDaid, head of evidence and impact at MHF, says that “many mental health problems are preventable, so it is counter-productive to wait until problems arise before providing support”, and that mental health problems are frequently rooted in childhood trauma and experiences of poverty.

“We know that experiencing trauma in childhood is a significant risk factor, said McDaid, “and that you're more likely to experience trauma in childhood if you're living in a family that has roots in poverty.

“You're more likely, as a result, to end up having a mental health problem as an adult.

“If your parent had a mental health problem when you were in early childhood, you perhaps did not have an ideal childhood, as they were not in a in a state of mind to be able to give you adequate parenting, and that can trigger your own mental health problems.

“So there are lots of things that can be done to intervene to support people's mental health at an earlier stage, so that they don't end up having a mental health problem later in life.”

As an example of a cost-effective prevention scheme, McDaid highlighted the joint MHF/LSE report, which found that for every £1 spent on parenting programmes in the UK, £9.30 could be saved in the long-term, through costs saved to the health, education and criminal justice sectors.

“Anti-bullying programmes are also well evidenced as preventing mental health problems,” added McDaid, “even in adulthood in workplaces.

“There are good evidence programmes that encourage people to come forward if they’re going through mental health problems, and then getting them rapid access to psychosocial or psychological support, can save five pounds for every pound spent.

“Even later in life, it's possible to prevent isolation and loneliness from developing into significant mental health problems that require require mental health treatment, by boosting older people's opportunities for social connection opportunities.

“Also very important are the fundamental risk factors that give rise to people ending up with a mental health problem, and poverty is a really big one - the financial strain and the myriad of ways that poverty which can also be linked with insecure housing and with living in a less safe neighbourhood.”

According to Hoy, the Tories’ health spokesperson, prevention needs to be embedded in every facet of Scottish Government policy.

“We've got to think about it as something that is affected by every part of public policy,” said Hoy.

“We know ill mental health is linked to poverty, we know it’s linked to drug and alcohol abuse, we know it’s linked to housing circumstances. We know that people who come out of the Armed Forces often have a higher risk of developing mental health issues.

“Interestingly, talking to the National Farmers Union and the British Association for Shooting and Conservation Society, gamekeepers and farmers have higher rates of suicide than the average population, as they live in rural, quite socially isolated areas and are under immense pressure.

“There’s all sorts of complex thing that go into mental health, so just looking at it as an issue of health probably isn’t the right thing to do.”

As convener of the health, social care and sport committee, Gillian Martin has seen examples of government investment, and a change of approach, paying dividends.

“We have a new CAMHS (Children and Mental Health Service) centre in NHS Grampian’s area, Aberdeen,” said Martin, “which has modernised the facilities, first of all, and has taken more of a community approach and gone out to the communities.

“They are doing a lot better than they were before and their waiting times are down. Young people are getting better access, for all types of mental health problems, to mental health practitioners.

“But then you'll go somewhere else, and that's not the case. What we're looking at is now where intervention, investment and best practice has been flourishing, and how we can spread that learning to other health board areas.”

A holistic approach to mental health, that addresses Scotland’s material needs, such as housing, wages and crime rates, as well as the nation’s mental health needs, is what the Scottish Government needs to focus on, according to Mochan, Scottish Labour’s mental health spokesperson.

“I really think that we're living in a time period,” added Mochan, “where the cost of living is a major concern for people.

“And so we need to as a society, address the of causes of ill mental health, such as low wages, and poverty.

“These things all link into a person’s mental health and wellbeing, and if we can manage to get on top of some of that, then hopefully, we can help them in that way, and also provide the services that people need when they have health problems like that.

“So that is definitely what I would like to see in terms of a change in the way in which Scotland looks at providing services to people with mental health problems.”