Scottish Government Debate on Mental Health– briefing from SAMH
6th January 2015
Introduction
We welcome this focus on mental health in one of the first Parliamentary debates of 2015.
This year will see the end of the current Mental Health Strategy, so our briefing focuses on
some of the Strategy commitments which remain unfulfilled, and on the actions that SAMH
wants to see in the next Mental Health Strategy. SAMH welcomed the recent
announcement of a £15 million investment in primary care, mental health innovation and
children and young people’s mental health, and hopes this signals a renewed focus on
mental health.
Psychological therapies
Commitment 13 of the Mental Health Strategy restates the HEAT target to provide access to
psychological therapies within eighteen weeks of referral by 31st December 2014. The
benchmark for success is that 90% of people are seen within this timeframe, but at the time
of writing in December, it appears impossible that this target will be met. The most recent
figures show only four out of fourteen Health Boards meeting the 90% target, with more
than 14,000 people still waiting to be seen across the country.
It is shocking that so few health boards have managed to meet this target, which was
introduced in 2010. It is particularly disappointing given that two-fifths of GPs told SAMH
that they had not referred anyone for psychological therapies recently because waiting
times are too long. So the current level of referrals does not reflect need, and yet still
people are waiting too long.
“We do not have adequate access to non-pharmaceutical treatment options. We have NO
access to psychological therapies in our remote rural area. It makes me very angry”.
“Access to psychological therapies is extremely poor with long and unacceptable wait times.
GPs feel under pressure not to refer people to already stretched services”.
Respondents to SAMH GP survey
The national waiting time for NHS patients seeking treatment for most illnesses is set at 12
weeks. To achieve equality between physical and mental health, talking treatments should
be included in this target.
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How does the Scottish Government intend to deliver Commitment 13 during 2015?
Will the Scottish Government consider reducing the target to 12 weeks?
Mental health and primary care
Commitment 15 of the Scottish Government’s Mental Health Strategy promises to increase
local knowledge of social prescribing opportunities. Social prescribing involves referrals to
programmes like art classes, walking groups, peer support, horticultural and talking
treatments. We see every day that these options can work for people experiencing common
mental health problems and in fact SIGN guidelines1 recommend a range of nonpharmaceutical treatment options. However, we need to make sure that these social
prescribing opportunities are available and are known to GPs.
Research conducted for SAMH’s Know Where to Go campaign found that 75% of people
would turn to their GP for help with their mental health, and indeed one in three GP
appointments relates to a mental health problem. But 85% of GPs told SAMH that there are
gaps in service provision for patients with mental health problems in their area and almost
90% said they wanted more information on local social prescribing opportunities. Almost
half of GPs in Scotland are not aware of, or not sure if they are aware of, the SIGN guidelines
on non-pharmaceutical treatments for depression.
SAMH is currently working with GPs at the Deep End2 and the Alliance to pilot a scheme
siting link workers trained in mental health within GP surgeries in areas of extreme
deprivation. These link workers signpost patients to community services and support,
including social prescribing, and provide an early intervention response to people with poor
mental health. SAMH welcomes the recent Scottish Government announcement that this
pilot will run until 2018 and wants to see this approach rolled out to other GP surgeries. The
recent announcement of a £40m primary care development fund may present
opportunities to do this.
“For mental health it needs to be local, local, local and, as much as possible, face to face”.
Respondent to SAMH GP survey
Health and social care integration may present an opportunity to increase social prescribing,
but we do not yet know how the differences between NHS and local authorities– such as the
fact that social care can incur a charge while NHS care does not – will be resolved.
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What progress has the Scottish Government made in delivering Commitment 15?
How will the Scottish Government make sure that social prescribing increases under
the new integrated health and social care landscape?
Criminal justice
Commitment 32 undertakes to increase the effective use of Community Payback Orders.
These were introduced in 2010 and could prevent many people from going to prison when
they actually require mental health treatment and support. The average cost of a CPO is
£2,400 - half the cost of a three-month prison sentence. But only 74 of the 10,000 CPOs
issued in 2011/12 included a mental health requirement.3
1
Scottish Intercollegiate Guidance Network, part of NHS Quality Improvement Scotland
2
GPs at the Deep End is a network of surgeries operating in the 100 most deprived areas of Scotland
3
http://www.scotland.gov.uk/Resource/0041/00411160.pdf Redesigning the Community Justice System Consultation, Scottish
Government, 2012, Page 13
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What progress has the Scottish Government made with Commitment 32?
What actions does the Scottish Government intend to take to increase the use of
CPOs with mental health requirements?
Stigma and discrimination
Commitment 4 of the Mental Health Strategy undertook to develop the strategic direction
of See Me, the anti-stigma programme. See Me has now been awarded three-year funding
from the Scottish Government and Comic Relief, and SAMH is very pleased to be managing
the revised See Me alongside the Mental Health Foundation. We know that nine out of ten
people who experience mental health problems have experienced stigma and discrimination
through work, education, by health professionals or from family members: indeed, health and
social care is one of the settings in which people report feeling most stigmatised. See Me’s work
is essential and it must continue beyond the current Mental Health Strategy.
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Will the Scottish Government continue to support See Me’s work?
What action will the government take to ensure that the actions of public sector
workforces do not discriminate against those with mental health problems?
Mental Health Bill
The Mental Health Bill, amending the existing Mental Health (Care and Treatment)
(Scotland) Act 2003, is currently at Committee stage. As there will be a Stage 1 debate on
the Bill shortly, this briefing does not set out our substantial concerns about the Bill.
However, our research indicates an extremely low level of awareness among service users
of their rights under the Mental Health Act. Therefore once the current Bill is completed, we
want to see a dedicated programme of work to help people understand and enact these
rights. This would build on Commitment 5 of the Strategy, which commits to developing and
increasing the focus on rights as a key component of mental healthcare in Scotland.
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What progress has the Scottish Government made with Commitment 5?
Will the Scottish Government commit to a specific programme on rights under the
Mental Health Act?
About SAMH
SAMH is both a campaigning charity and a service provider. We provide community based
support services for people across Scotland with mental health problems. Our services are
built upon our belief that people with mental health problems can and should be ambitious
about their futures.
Contacts
Carolyn Roberts, Public Affairs Manager Carolyn.roberts@samh.org.uk 07891 690 396
Craig Smith, Public Affairs Assistant craig.smith@Samh.org.uk 0141 530 1084