Criminal Justice Committee

Meeting date: Wednesday, March 1, 2023

Official Report 535KB pdf

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Scottish Mental Health Law Review

Our first and main item of business is to consider the criminal justice issues raised in the Scottish Mental Health Law Review. As members will recall, the Scottish Government established the review to examine existing Scots law, with a view to improving the rights and protections of people who might be subject to mental health, incapacity or adult protection legislation by virtue of having a mental disorder.

We are joined by Professor Colin McKay. Professor McKay, who is based at the centre for mental health and capacity law at Edinburgh Napier University, was a member of the Scottish Mental Health Law Review team. Welcome.

I refer members to papers 1 and 2. I intend to allow around 45 minutes for this session. I invite Professor McKay to make some brief opening remarks.

I thank the committee for the invitation. I am delighted by the committee’s interest in the work of the Scottish Mental Health Law Review; I think that the Criminal Justice Committee is the first committee to look at it. It is great that the review is starting to be noticed.

The review was large and complex. As a visual aid, I have with me a double-sided, single-spaced print-out of the report. It is probably the largest review in this field, because it not only covers the Mental Health (Care and Treatment) (Scotland) Act 2003, but covers adults with incapacity and, to some extent, adult support and protection. As the review was wide ranging, I can only scratch the surface of what it is about in my opening remarks.

We made more than 200 recommendations, but there are three broad themes. The first is strengthening the voice of people who use mental health services, whether that is people with a mental illness, a learning disability, dementia or whatever. The second is reducing the need for and the use of coercion in health and care systems, whether civil or criminal. The third and perhaps most important theme is giving effect to the full range of human rights—including economic, social and cultural rights, such as the right to health and the right to independent living—to everybody in the system.

It is not possible to do that using the law alone. As we did our work, it became apparent that the law needs to be changed, but if the law is to secure the full range of human rights, there also need to be changes to the culture and shape of services and to how services are held accountable.

I will say a couple of words about the forensic aspects of the review. In line with our remit, we started by looking at the specific forensic disposals in criminal law, which derive mostly from the 2003 act. We make some significant recommendations about those disposals. One of the starkest things that we noticed was that, although there are fewer than 100 of those mental health disposals a year, there are thousands of people with a mental illness or a learning disability in the criminal justice system, and there is a lot of evidence that the system does not always meet their needs. Therefore, we felt that we had to make some recommendations across the whole system.

Starting with the initial police contact, we followed up on the work that the committee did last year through its round-table session on policing and mental health. We recommend the development of new models of crisis support to fill the gap between prison and psychiatric hospital.

When people with a mental disability are charged, we want there to be more systematic diversion out of the criminal justice system, as well as greater support for accused persons and, indeed, for victims in court processes. We have called for changes to avoid people being remanded in prison for lack of a bed or, if they are sent to hospital, being kept in hospital indefinitely, awaiting a trial, for many months.

We think it important that there is the option of a specialist mental health disposal for offenders who should be supported and treated in hospital. We are concerned by the evidence that some people, particularly those with learning disabilities, who receive such disposals can spend far longer in hospital than they might otherwise have done had they received a prison sentence and gone through the ordinary system.

We propose keeping the special category of restricted patients for the most serious and risky forensic mental health patients, but we make a number of recommendations to give more powers to the Mental Health Tribunal for Scotland to oversee those cases and to reduce the oversight role of ministers for those cases.

We do not say much in the review about prisons, but I urge the committee to consider that. When I worked for the Mental Welfare Commission for Scotland, we saw some very distressing examples of women with serious mental health needs being placed in prison where that was not meeting their needs. That was drawn to our attention by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, which tells you something about the seriousness of that.

My final point is that we are not the only review in town. Our work comes on top of the Rome review of learning disability and autism in the Mental Health (Care and Treatment) (Scotland) Act 2003 and the Barron review of the forensic mental health system. There is also a recently published review of diversion from prosecution. In addition, an assessment of mental health needs in the prison population came out around the same time as our review. There are many reviews and a lot of work is being done to review the system. We might now be at the point when we need to stop reviewing stuff and start a systematic programme of change.

I hope that that is a helpful outline of our work. I am very happy to answer questions.

Thank you, Professor McKay. That has been a very helpful overview.

We move straight to questions. I will kick things off with a question about section 297 of the Mental Health (Care and Treatment) (Scotland) Act 2003, which deals with an issue that I have been interested in for a number of years. That makes provision for an officer to take a person from a public place to a “place of safety”. The review highlights that much police time is spent dealing with such issues. You referred to the fact that, in May last year, the committee took evidence on that issue. You will know that many people who are in distress are in their homes and therefore in a private place.

The review report outlines a range of issues. That includes noting that the police are not best placed to respond to those situations and that the provisions of the 2003 act are being used to respond to people who are in distress, rather than those who are experiencing acute mental illness, as section 297 of the act refers to.

We note that your review makes some recommendations about that. One recommendation in the report is that the Scottish Government should

“work with health and care agencies to develop alternative places of safety for people who are in distress and at risk”,

and might not necessarily need psychiatric care.

Another recommendation is that the Government should

“review whether the place of safety powers should extend beyond suspected mental or intellectual disability to other people who may be at serious risk.”

That is a rather long-winded introduction to asking you to outline a little more about the review’s work on that particular part of the 2003 act.

The work on place of safety links to the broader work on the scope of the act and on issues of coercion and the use of state powers to keep people safe.

A broad theme comes through the work of the review. The system works for the people that it is designed to work for, which is people who have an acute, treatable mental illness, such as an episode of bipolar disorder or schizophrenia, and need to be in hospital so that they can get medication, recover and be re-integrated into the community.

It does not work so well for all the people whom that does not quite fit. That is people with personality issues, comorbidity of substance use disorder and people who absolutely have mental health needs but do not necessarily need to be treated as in-patients in a psychiatric hospital. As psychiatric care has developed, a smaller and smaller number of people fit the bill for acute in-patient treatment in a psychiatric hospital.

We took evidence from a wide range of stakeholders, including from people who use services, people who provide services, third sector organisations and advocacy organisations. A general theme runs through the review not just in relation to policing issues but around child and adolescent mental health services, for example. The whole system is geared towards getting a referral to the CAMHS system, but a lot of people end up being rejected because they do not meet the criteria, so there is a big gap.

In a way, mental illness is perhaps the wrong focus. Dr Heyman, who gave evidence to you, highlighted the idea of what I think she called the medicalisation of distress. We heard the same evidence as the committee around the police’s concerns about the amount of time that they spend dealing with people who appear to be in great distress, particularly people who are at risk of suicide. They feel, as the chief constable suggested in his recent statement prior to his resignation, that the police having to fill in for other agencies is not sustainable.

Obviously, it is not our place to allocate budgets between the police and the care agencies, but the gap between in-patient psychiatric care and other services that other people might need was—most of the people who gave evidence to us agreed with this—starkly evident.

Section 297 of the 2003 act was designed to address the situation in which the police find somebody who appears to be unwell and in need of care. In those circumstances, they will take that person to somewhere that they will be looked after. However, the reality is that, for too many of those people, there is nowhere that they will be looked after. Certainly, an acute psychiatric ward or accident and emergency department is not the best place to look after them. The police are left holding the baby as a result. They spend a lot of time getting the person to A and E or psychiatric hospital and hanging around waiting to see what will happen only to be told that the person will not be admitted and they are left with a problem.

It is not that we think that there are no alternatives. There are other ways of conceiving crisis services. Many of those would be places where people might go into voluntarily or to which they might self-refer. There are one or two examples of crisis services in the country that could be more widely spread.

We talk in the report about coercion, but we also talk a lot about the preventive approach. One thing that we want to do is to reduce the amount of coercion in the system. Often, by the time that we get to the crisis, there is not much else that we can do but use coercion of some kind, whether that is through the police or through mental health detention. However, that crisis often could have been prevented if people had received support earlier or there had been somewhere that they could go to. Therefore, we talk a lot in chapter 9 of our report about the development of alternatives, such as safe spaces where people can go to if they feel increasing distress, peer support and all sorts of other ways of thinking about services.

Perhaps I will come in at that point.

Yes, you should probably stop me—I am probably going on a bit long.

We will come back to what those alternative options and places of safety could look like. I am conscious of the time, so I will bring in other members now and hand straight over to Russell Findlay.

09:45  

Good morning, Professor McKay. Your report is six months old. By my count, it makes 205 recommendation over 115 pages, and many of those recommendations have sub-recommendations—for example, recommendation 8.10 has 11 specific asks. It is a huge piece of work, which I had not appreciated as I had no real involvement with or knowledge of it.

The report makes reference to an implementation gap. There is an understanding that what the Government seeks to do and how that is delivered might be two different things. Six months after delivery of your report, can you give me a sense of the Government’s position on those asks? Do you have a general sense that some of that will never see the light of day? Has there been a favourable reaction to the recommendations? Roughly, where do you think that the report has landed?

I cannot speak for the Government, but I think that it is taking the report seriously, and it has officials working on it. The statement that I heard from the civil servants is that they hope to publish a more detailed response in the summer; whether that is civil service summer, which takes us into October, I do not know.

The report does not come out of the clear blue sky. A lot of what we recommend builds on other things that are already in the system. For example, the recommendations that we make around scrutiny and accountability services link in to other work that the Government was already doing as a consequence of the investigations into mental health services in Tayside. As I said, other work is being done on the forensic mental health system.

It is a big and complicated issue. The recommendations are not totally new, but some of them are quite radical. My sense—we say something about this in the report—is that the Government should do some things quickly. There are one or two areas where there is a risk of European Court of Human Rights challenge—for example, around deprivation of liberties—so there are some areas where the law needs to be fixed quickly. Some things around service provision could be done now, but we acknowledge that other things could take a long time—around five years down the line, I would suggest—and a lot of work to develop.

Some of the stuff is happening anyway, some of it can be done in organisations through cultural change and some of it might require legislation.

Yes.

It might be worth asking about the possibility of an online action tracker, so that individuals involved in the report, people in the professions and members of the public could see where we are on each of the 200-plus recommendations. Would you support that, or have you asked for that? Has there been any discussion of that?

We have not asked for that specifically. The review team has done its job and has disappeared, as it were, and the chair of the review is now a judge. Within Edinburgh Napier University, we are helping to support discussions about some of the implementation of the review, and Government officials have been very willing and supportive of that.

I absolutely agree that it would be helpful to have a systematic response to each of the recommendations. I have seen work that the Royal College of Psychiatrists is doing to categorise the recommendations from “That’s obvious; who could disagree with that?” down to “Bloody hell; that’s a really crazy idea.”

There could be a traffic-light system to show that something has happened, like we in the committee do with reports.

Chunking it up into a programme of change would be very sensible.

Good morning, Professor. I will ask you about chapter 5 of the report, which is on support in the criminal justice system, in relation to communication with people who have learning difficulties or additional support needs.

A constituent of mine has a petition going through Parliament; the Equalities, Human Rights and Civil Justice Committee talked about it yesterday—my colleague can confirm that. It relates to a member of their family who has experienced great distress trying to communicate with the police—and carers, actually—because she uses the Makaton signing system. My constituent is trying to promote that system and says that legal advocates and those who deal with people who have those needs should have that ability—or at least that some of them should. What is your view on that?

In relation to the expectations of the United Nations Convention on the Rights of Persons with Disabilities, which is one of the things that has guided us, it would absolutely be the case that, if people have augmented support needs to communicate, particularly on something as serious as a police case, that need should be met and supported. In fact, even in basic equality legislation, that should be the expectation for people who have particular support needs.

There are perhaps two different issues, one of which is about the ways in which people might be supported to communicate. I would not see a difference between that and translation services, for example. You would expect that a person who could not speak English—

—would have an interpreter, yes.

—would have an interpreter, so if a person uses Makaton to communicate, that should be facilitated and supported.

The other issue in the criminal justice system is the weight that you attach to the evidence of people with intellectual disabilities and the extent to which we can say whether they really understand what they are telling us. Again, the focus should not be on trying to find a way to exclude some people from the system, as it were, but around how we can support people to give their evidence, just as we now take children’s evidence much more seriously than we used to. Therefore, I personally support the idea that those kinds of augmented communication aids should be available, and that would reflect our obligations under equality legislation and under the CRPD.

Would legislation be required to introduce that, or is it more of an operational matter, with, for example, the police training a certain number of officers in Makaton or British Sign Language?

In practical terms, yes, it is perhaps an operational issue, and we already have the Equality Act 2010. To answer the question, legislation might help, but the primary thing—and obviously the quicker thing—would be that it becomes part of an operational expectation.

As you will know, we already have legislation around the appropriate adult system, which ran for about 25 years on a non-statutory basis. It is now statutory. I would see that as part of how the appropriate adult system should be supported.

That is very helpful, thank you.

Fulton MacGregor, do you have a follow-up question?

Thanks, convener. I am a member of the Equalities, Human Rights and Civil Justice Committee that Rona Mackay referred to. Yesterday, the committee again considered the petition that she referred to and has agreed to do some further work around the area. Was the review team aware of that petition and, if so, did it take it into consideration?

I have to confess that I was not aware of it. I do not know whether any other members of the review team or the secretariat were aware of it, but I was not aware of it, I am afraid. When was the petition lodged?

It was a while ago, was it not?

It was lodged in 2020 and then it was referred to the Equalities and Human Rights Committee.

I apologise that I did not pick up on it.

No, that is fine—I just thought that I would ask.

Good morning, Professor. I want to focus on some of your comments in your opening statement around the role of policing and the role of police as first responders. You are certainly right to echo comments by the departing chief constable on his concerns about the increasing use of the police as a first port of call for incidents where there is clearly a mental health element—or where that is the substantive element of the situation—how police deal with those situations, how they are prepared to deal with those situations and what happens thereafter when someone has to be removed from that location to another place and where they go. There has been a lot of discussion about that over the years but it seems to me, certainly anecdotally if not evidentially, that it is increasing substantially.

Will you talk for a few moments about the work? It is a big report and there is a lot in it—chapter 9, for example, went into some of the issues—but will you sum up what the problem is and what the Government should be thinking about?

Gosh. In relation to the police, it is a complex, multifactorial problem. It is partly to do with the way that services have developed. This came out in evidence to the committee but, as things get tough, people look to their own bases and stop working together so much. They feel that they can hardly help the people who they are supposed to help so they decide that they will not take on other people who might not fit or that they will not do other things with another agency when they are struggling to do their own job.

The scope for multidisciplinary working has diminished, the complexity of needs has increased—that has always been a problem but, for a number of reasons, the complexity of presentations has increased—and local authority services have had huge pressures on them, so the kind of services that might have been available in the past are not there. Part of the issue is just about the level of resourcing in the system and part of it is about the targeting of it towards the people who do not fit well into the boxes that the system provides for them.

There are practical things that can be done to improve the system. The Mental Welfare Commission for Scotland looked at psychiatric emergency plans. Each health board has one. A lot could be done to make those more consistent and cover some of the bases that we are talking about, particularly matters such as what happens if there is a difference of view between the police and the health services about a person’s needs or—this is a huge complicating factor—what happens if a person may have a mental disorder but is also intoxicated or has obviously taken something and what you do while you are waiting to assist them.

There are a number of practical steps that could be taken. I guess that that needs co-ordination and central support and encouragement. The law can play a part in it but, to be honest, it is not the biggest thing that needs to be sorted out. It is much more about interagency working and perhaps trying new things. We encouraged examining what people have done in other places and trying things out. The evidence that we had and that the committee has perhaps had is that there are pilots around the place but they never seem to become mainstreamed. They just bubble up and disappear.

A lot of the solution is about better joint working—all the things that we have been talking about since the Christie commission, I suppose.

Absolutely. It is evident that many of the social services that local authorities, NHS boards or integration joint boards provide are very 9 to 5, Monday to Friday and, outside of that, there is little scope to support people. That is why other emergency services are sucked into that vacuum and have to respond.

There was some discussion of, and a lot of interest in, some of the pilots in which, when the police attended situations in which there was perhaps no crime being committed but there was a suspicion that someone was vulnerable or a danger to themselves or others for the reasons that you mentioned, they would be supported by other bodies or agencies to provide an on-the-spot triage system that identified the best place to take that person. At the moment, a lot of those people seem to end up in police cells for their own safety as opposed to the safety of the public. That does not sound like an ideal place to be taking people in that situation.

No, it is absolutely not. You are right that there have been some positive developments. I think that Glasgow used mental health nurses working alongside police officers, so that, where there appears to be some kind of mental distress, the nurse can intervene in a way that it would be difficult for the police officer to do.

10:00  

I am not an expert on the outcomes, but some of what I have seen suggests that they do not often go on to use the statutory powers to admit or detain people, because they are able to de-escalate the situation or to get other help for that person.

One fundamental thing about section 297 of the act is that the majority of those people do not go on to long-term detention in the mental health system. They are the there for some other reason and need to be in some other place. That is the gap that should be looked at.

I have one more question, which is about prisons. It is evident that there is a worrying trend in the statistics about those in the prison population who have long-term mental health conditions or a history of self-harm, depression, anxiety or the abuse of alcohol and drugs. There are some interesting statistics in your report, which shows rates that are in some cases almost double those for people who are not in the prison population.

We also know that there is a disparity in the provision of mental health care and mental health nurses across the prison estate. The report includes statistical data showing that the figure varies from one nurse per 53 inmates to one nurse per 177, depending which prison someone is held in, which is a postcode lottery. The sad outcome of that is an unfortunately high rate of prison suicide, often among remand prisoners who have not even been convicted and do not have long-term sentences.

Did anything come out of your investigation that the Scottish Prison Service should take note of or that the Government should address?

There is a lot in that question. We did not look at that issue in as much detail as we might have liked to, but there is other evidence, particularly the assessment in “Understanding the Mental Health Needs of Scotland’s Prison Population”, which was published in September 2022 and hits the nail on the head. That credible report talked about

“inconsistent and somewhat arbitrary service resource allocation”

and about support being directed to the “acutely mentally ill”, leaving large numbers of others without support. It refers to “limited cross-agency partnership working” in the system, which is something that I came across when I worked with the Mental Welfare Commission for Scotland. There was too much emphasis on the need for the person to engage and to say, “I am feeling suicidal,” or, “I am feeling unwell,” when there are all sorts of reasons why a person might not say that, including what might happen to them if they are put on suicide watch. The assessment calls for a “fundamental change” in how prisons approach mental health care.

There is an issue with the small number of acutely unwell people who need to be in hospital, who certainly need to be out of prison, but the wider issue is that people who are in prison are far more likely than not to have a mental health need. We are not talking about a small subset; this is a large proportion of the prison population. There are big gaps in the evidence, particularly regarding neurodevelopmental disorder in young people. There are also areas of particular risk, such as the remand population. That is a big cluster of issues.

That assessment that I mentioned recommends the same things as we do: a focus on the needs of that group, multidisciplinary working; different ways of moving people through the system; better ways of listening to people so that we understand when they are in distress and may need some kind of intervention. That must be a priority. The Mental Welfare Commission also carried out a review of its visits to prisons, which tells a similar story.

The next questions will come from Colette Stevenson and Pauline McNeill.

Good morning, professor. In addition to prisons, I want to touch on the sentencing aspect. The report stated that there was very little use of community disposals, particularly for people with mental health conditions. Do you think that that is in relation to the forensic mental health system or criminal justice more generally? What do you feel needs to be done about that?

There seem to be some quite complicated systemic issues. In a way, it is not that we do not have the legal options, because a number of different community-based disposals could be put in train for people with mental health needs who offend, which include: community payback orders, with the condition of mental health treatment; compulsion orders, which could be in the community; and guardianship under the Adults with Incapacity (Scotland) Act 2000, which might sometimes be relevant, particularly for offenders with learning disabilities. However, when we count the number of those orders that are actually used, it is often in single figures in a year, so they are not much used, and there are a number of reasons why that might be. Sometimes, there is a view that, because we cannot compel somebody to take mental health treatment, such orders are pointless and toothless sanctions. In the report of the joint review of diversion from prosecution, it was striking that the inspectorates identified that, sometimes, having a mental health need or learning disability was a reason for being excluded from diversion. There is a sense that we do not have the options for those people, so we are not going to use those powers.

Fundamentally, we need a system that provides and develops good options that people could use. One of the reasons for those disposals not being used is that, over the years, criminal justice social work and mental health social work have slightly diverged. They are almost two different professional paths, and maybe we need to think about bringing them a bit closer together.

A sentencer, such as a sheriff or judge, might be happy to consider those disposals, but they need to see a practical option in front of them and for somebody to say, “This is something that we could offer, and we think that it has a reasonable shot at working.” It is really around the design and development of bespoke alternatives for people who have those kind of needs.

On that subject, I had a conversation with Wendy Sinclair-Gieben, HM chief inspector of prisons, and one of the things that we were talking about was alternative disposals and electronic monitoring and taking that a step further. I know that, in England and Wales, a sobriety cuff is used, but our conversation was more about tapping into technology, such as a device to monitor a person’s sleep or an electronic tag, which would not only make sure that the person was at home for a certain length of time, but alert them about when they should go and speak to their social worker. Have you come across anything like that? Was any work done on that?

I am certainly aware that there are apps that people can use to monitor their mental health, which have triggers that tell them that they are becoming unwell. There is quite a lot of work and research being done on that as a way of helping people to maintain their mental health and to know when to seek help because, obviously, when someone is becoming ill, that might be when they decide not to seek help. I have not heard about that in a criminal justice context, but that is an interesting idea that might be worth following up.

For a lot of those things, we obviously need to get the person to buy into the idea that it is something for them and not just part of a punitive disposal. However, there could be opportunities. Those apps are still in development, and I do not know how many of them are fully evidenced and worked through. There are certainly creative things that could be tried around how we help people to manage their mental health and stop them from getting them into the place that got them into trouble before.

Good morning, Professor McKay. You have been involved in excellent work, so thank you very much for that. My questions follow on from the questions that the convener and Jamie Greene asked, because I am having difficulty visualising what the system might look like—forgive me for returning to a subject that we have covered.

As Jamie Greene said, we have heard from those in the police service that they work 24/7 and have a responsibility to keep people safe, so they have a duty to come out when they are called. Realistically, how is that going to change? Who would take the place of the police in a different system, and where would people be taken to if they were not taken to A and E?

I have been in forensic units, so I am familiar with those, and I used to represent mental health nurses, so I have a bit of knowledge about that. I am thinking about whether we have the places; we might have shut down too many places when we did the big reforms in the early 1990s. I am trying to visualise what the change will look like.

If mental health nurses took over, would they need to change their working patterns and be given new restraint powers? The circumstances might be difficult, and the police are called because they have those powers. Clearly, we want to avoid taking people to A and E. Anything that you can say to help me to visualise what will happen would be useful.

I suspect that there will always be a role for the police. When we spoke to members of Police Scotland, they accepted that the police, including warrant officers, have important powers to act during an immediate crisis. People know who the police are. In fact, the Mental Welfare Commission received evidence from people who had been in crisis, and some of them spoke more positively about the police than they did about some other services. It is not that the police do not have a role, but their role relates to the immediate response. If necessary, the police could get hold of a general practitioner, a nurse or somebody else who could conduct a medical assessment and help them to work out where a person should go. In some cases, the person might not need to go to some kind of special place; instead, it might just be about working out how to help the person to calm down so that the immediate crisis can be managed and they can be linked to services.

There are different service models. There are already crisis services to which people can self-refer—they can say, “This is all too much, but I really don’t want to go to a psychiatric hospital. I just want to go somewhere where I can be quiet and get my head straight for a while.”

At other times, as Pauline McNeill suggested, some limited powers of detention might be needed—that might look and feel a bit different from an acute mental health ward. I am not sketching this out in a great deal of detail, because I am probably not competent to design the—

To be honest, from what you have illustrated, I do not see how things will change. Is there no one else to call when a person is identified as being in acute mental health distress? In circumstances in which the powers under section 297 would be used, who else would be contacted?

It has to be—

Surely, the only way that the situation can change is if there is an alternative to calling 101 or 999, so that people can call someone else. Otherwise, it will always fall back on the police. I cannot see how that could possibly change.

Answering the call is not the problem for the police; the problem is that they then have to spend the rest of their shift following the person around if they cannot get them into somewhere. It is about the police being able to lock into other services—health and social care services, for example—that will pick up the issue and support people. That could be done through the third sector.

An integrated system is needed, rather than the police being the fallback. Evidence shows that the average time that the police spend on such cases is about seven and a half hours, so police officers spend basically a shift dealing with such crises.

The only way that that can change is if the police take the initial call and then hand the case over to someone else.

Yes—well, it is not always the police, but the police take the initial call in a lot of cases.

What service should people be referred to?

Support could be provided by the health service or social work services, but it could also be provided by the third sector.

Would that be quite a radical change to make? I do not know enough to know whether it would be.

Potentially, it would be quite a radical change, but such a thing is not completely unheard of. If we look back through history, we see that there have been examples of more informal crisis services. However, they have tended to disappear as services have had to focus on the more mainstream specialised services.

Do you feel optimistic? Given what I have heard, I am not that optimistic that things will change. We have heard evidence that the police are the first responders for everything, including this. For that to change, there has to be a structural change in service. Otherwise, I do not see how things will change.

One of the arguments is that we are spending a lot of money on doing the wrong things. If we could spend some of that money on doing the right things, there might be a change. However, I agree that it would need structural change in the kind of services that are on offer.

That has brought us nice and neatly to our 45 minutes. Thank you very much indeed, Professor McKay, for attending today’s meeting. Members might have some follow-up questions, and we will write to you with them.

10:16 Meeting suspended.  

10:17 On resuming—