Malcolm on the perils of large biomass plants for low-carbon energy in Edinburgh Northern & Leith
Debate on mental health Malcolm Chisholm (Edinburgh Northern and Leith) (Lab):
I generally welcome the draft mental health strategy, which builds on previous and continuing work and suggests 14 distinct outcomes that define the actions that the Scottish Government will endeavour to take over the next four years. However, I will have time to consider only the first two.

I am very pleased that up front, at number 1, is the key issue of protecting and promoting mental health. Ten years ago, there was a major drive to develop a mental health improvement agenda, which was spearheaded by the see me and choose life campaigns. It has always been a matter of regret to me that the Scottish public has never fully appreciated the groundbreaking nature of that work, a central part of which has been to combat stigma. In that regard, I pay tribute to the continuing work of see me, which during mental health week in a couple of weeks, will have 250 stalls across the country.

As a recent study by see me showed, stigma can manifest itself in the kind of disgust that prevents sufferers of conditions such as anorexia and bulimia nervosa, for example, from seeking the support that they need. Broader society still misunderstands those life-threatening mental illnesses, so in broaching the subject and forcing it into public discourse, see me does an immense service for the hundreds of young Scots who suffer in silence every day. It gives information to family and friends on how best to intervene safely, and its material highlights the severity of the conditions. Without raising awareness of the complexity of mental health problems, we would find it impossible to achieve the objective of removing stigma; only when we have broken down the stigma surrounding poor mental health will we truly realise the potential of our community services to provide a route out of social exclusion and marginalisation.

Clinical treatment is only half the solution. Often, what is needed most is the knowledge that someone to whom a person can relate understands their situation and is ready to talk and listen. That is the worth of community-based services, and I hope to have time to mention some that are based in my constituency.

That community focus is also relevant to the suicide prevention strategy called choose life, which, like see me, was developed in 2002. It aims to equip organisations that have direct links to sufferers of poor mental health with the skills to detect suicidal tendencies and to offer appropriate assistance. By training a proportion of the population, it will ensure that more skilled and confident helpers are available to explore thoughts of suicide and to intervene. In that connection, I note the recommendation of SAMH that suicide prevention training should be expanded beyond the statutory sector to encompass people who work in the community.

In its “Foundation Stone” document, SAMH makes the important comment that a mental health strategy should not be located solely within the health department, because mental health is fundamental to wellbeing, to the ability to remain in employment, to criminal justice, to social work and to many other areas. What appeared to me to be a slight weakness of the Government’s draft strategy as I moved to outcome 2 is that, although a great deal of work is being done and is proposed for the early years, none of it is joined up with the CAMHS focus of that section.

The CAMHS work is essential for those who need intensive services, but it must be complemented by greater investment in early intervention across communities. I warmly welcome the £500 million for preventative spend that was announced last week, but I would have preferred that the majority of that money be spent on the early years, particularly nought to three, rather than being spread too thinly across a range of areas. As Dr Philip Wilson told the Health and Sport Committee in 2009, work in America suggests that it is possible to predict by the age of three as many as 70 per cent of the children who will end up as in-patients in psychiatric hospitals or in prison.

On the detail of outcome 2, I note the reference to the very important standards for integrated care pathways, but there is no mention of implementation support, whereas question 13, which refers to adult services, asks:

“What support do NHS Boards and key partners need to put Integrated Care Pathways into practice?”

If integrated care pathways were implemented in CAMHS and adult services, many of the other questions that are asked in the document would be answered.

I note, too, that although the overarching improvement challenge 2 refers to “developmental disorders”, no definition is given. The implication seems to be that it refers to such disorders in adulthood. It is certainly the case that no mention is made under outcome 2 of important disorders that affect children, such as attention deficit hyperactivity disorder, developmental co-ordination disorder and autistic spectrum disorders. It is not clear, either, why £10 million has been set aside for autistic spectrum disorders alone, rather than for developmental disorders more generally.

As I said earlier, there are some great community projects based in my constituency, which I now want to mention. The stress centre in West Pilton is an outstanding example of a project that is user led and which keeps services in the community. Along in Royston is women supporting women—another superb project that, unfortunately, has had its budget decimated over the past few years. I fully understand the financial problems of local authorities, but I remind them of their duties under sections 25 and 31 of the Mental Health (Care and Treatment) (Scotland) Act 2003, which require them to provide care and support for, and to promote the wellbeing of, people with mental health problems.

In Leith, there is the crisis centre where the minister launched the strategy a couple of weeks ago, which was campaigned for by the Edinburgh Users Forum over many years. AdvoCard on Leith Walk does individual and collective advocacy work. At this point, I should mention the concerns of advocacy organisations that the strategy contains nothing on advocacy, even though advocacy is essential, as well as being a requirement of the 2003 act.

Also in Leith is the Junction - a superb base for young people which, over and above the wider health work that it does, offers a safe and friendly environment for young people to talk about difficulties that they may be experiencing. I should also mention Saheliya, which is an outstanding example of a community-based organisation that recognises the specific issues that affect the wellbeing of ethnic minority communities and is therefore directly relevant to outcome 9. I pay tribute to all those excellent voluntary sector organisations in my constituency. Without them, the work of the statutory sector would be far more difficult than it already is.
September 28th 2011