Chamber and committees

Royal College of Psychiatrists submission of 20 October 2021

PE1871/F: Full review of mental health services

1. What progress, if any, has been made in the provision of mental health services since the previous petition was closed in 2019 and the impact of such progress;

While acknowledging we have so much more to do to deliver parity of esteem between physical and mental health care, the College and its membership has successfully advocated for and helped facilitate developments which can improve the provision and availability of specialist mental health care for those who need it. This includes:

• A Managed Clinical Network to develop perinatal mental health services for new and expectant mothers, backed by £50m.
• The creation of a Personality Disorder National Improvement Network to ensure our mental health services can better meet the needs of people with this condition.
• Developing a CAMHS service specification which maps out expectations for patients and their families as to the support, care and treatment they can expect across the various tiers of CAMHS.
• A national review of eating disorder services, which is now in the process of having its recommendations delivered by the Scottish Government.
• The creation of a Workforce Specialist Service for registered health and social care practitioners, recognising the stigma they can face when seeking mental health services’ support.

We hope these developments create the capacity for better and more person centered care for a number of those with severe mental ill health.

2. The extent to which the Covid-19 pandemic has impacted on the Scottish Government’s ongoing work to address issues identified in the petition; and

There are a number of issues now impacting those with severe and potentially enduring mental ill health to a greater extent than before.  This reflects the pandemic’s particular toll on this group, and we support the calls from Scotland’s Mental Health Partnership for a radical refresh of the current Mental Health Strategy in recognition of this increased need.

Those with moderate to severe mental ill health were already marginalized and had a 20-year lower life expectancy than the rest of the population and, due to a lack of understanding of their conditions, are often overlooked in policy discourse.

Based on the Scottish Government’s latest mental health tracker:

• Over a quarter of those with a pre-existing mental health condition (who are likeliest to require specialist care) reported suicidal thoughts, compared to 8.5% of the rest of the population
• Nearly two thirds (63.5%) reported depressive symptoms, compared to 17.5% of the rest of the population
• Over half (52.8%) reported levels of psychological distress indicative of a psychiatric disorder. Of concern is that 29.43% of those without a pre-existing condition also reported this.

The negative trends in the mental health workforce have also been exacerbated by Covid. After a period of incredible strain, the increased demand illustrated above will further stretch a tired workforce, in in-patient settings and beyond.

Initiatives the government had underway therefore need to be fast tracked, such as safe staffing legislation, as well as proposals around a healthcare workforce strategy and a mental health workforce plan. 

The problems cannot just be addressed at the specialist end either. We require a whole-systems approach that ensures, for young and old, clear pathways to the right care and support, in the right place, and at the right time are in place. 

3. Whether the Covid-19 pandemic has impacted on access to mental health services and ways in which this could be addressed.

Across mental health services, there have been issues with accessing services during the pandemic. 

This includes those who rely on group therapies, which have not been able to run physically since the outbreak of the pandemic. The development of a national online platform that is accepted in all health boards has yet to be finalised, meaning a postcode lottery for people who need kind of therapy.

While the development of self-help material like Clear Your Head has been widely welcomed, this does not meet the needs of this population. They need the kind of group therapies that can only be offered through an easy-to-use national platform, and their inability to access this will likely have led to their condition worsening.

The other group who have seen particular adverse impacts are young people transitioning from CAMHS to adult mental health services. A report from the Scottish Transition Forum during the height of the pandemic found that 70% of families whose child had a disability (including severe mental ill health) hadn’t had a transitions meeting and nearly nine in ten families didn’t have a transition plan.

At what is a critical stage in that young person’s life, support to ensure they can adapt to a new care setting and that their needs are understand requires a robust transitions planning process. 

That’s why we’re calling for the Scottish Government’s commitment to a national transitions strategy for children and young people with mental ill health to be prioritised. This should be done with the voices of lived experience and the clinicians who provide them care at its heart. We would also urge consideration for how other such transitions can be better handled across the lifespan.