Chamber and committees

We have not yet defined the timescale for exactly the reasons pointed out by the individual who contacted you. There are some real complexities that we have to work through. Employers are committed to sitting down with trade unions as soon as possible to work through the detail of those. Once we have the timescales, we will be open and transparent, and we will make them public.

That is a really good question. There are a few areas to mention. As you will see from the most recent strategy, which was, as I said, co-designed with COSLA, there is a significant focus on tackling the social determinants of suicide.

Literature upon literature and academic research after academic research makes the link between social determinants such as the inequality that exists and the unfortunate completion of suicide. We are working exceptionally hard on the issue, but we can do more in that workstream.

You will also see in the strategy that a lot of work is being done on pre-crisis intervention—getting to people before their situations escalate to becoming specialist mental health challenges.

Regarding my assessment, it might be better to take that off the table and to get an answer to you in writing with more detail on each workstream and the assessments that have been made. The most recent published strategy, “Creating Hope Together”, gives a good indication of what we think has worked and of where we need to go further collaboratively with local partners. I hope that you get the chance to look through the strategy in detail.

Does Hugh McAloon or anyone else want to come in to add to what I have said? I know how involved you were in the strategy with COSLA.

Obviously, we have publicly said that we are attempting to reach that target by March 2023, which will be challenging—it is an ambitious target, to go back to my previous point. We will set ourselves those ambitious targets in order to push the entire system to help us to meet them.

It is a common theme, I know, but, although I am confident that some health boards will meet that target, there are other health boards—including one of the health boards that the member has cited regularly to me—that are very unlikely to achieve that target, so we are giving them more intense support and getting improvement plans from them. We are not accepting the fact that they will not meet the target by March 2023, but we are saying, “How can we help you to get there or as close to there as possible?” There are a myriad of challenges. As the member knows, although we have done well on workforce recruitment, that will be different in rural areas, urban areas, island communities and so on. That target for spring next year will be challenging, but I am committed to doing everything that we can to get us there.

Alexander Stewart understands that urban areas and large population centres have their own challenges. Urban areas often have areas of higher deprivation in large concentration. We have talked about those social determinants that can have negative outcomes for people’s physical and mental health. Urban areas have their own challenges—as do remote, rural and island communities—which are usually centred around access to services, as he rightly says, but also the workforce, which is not unrelated to that point, and the recruitment and retention of the workforce.

I should say that NHS 24 has a mental health hub—as, I am sure, the committee is aware. There were some challenges when it first started, but we saw improvements across all the metrics in 2021. The demand for the NHS 24 mental health hub has remained consistently high—I spoke to the chief executive a couple of weeks ago—and the service has not seen much of a dip since July 2020. There have been peaks and troughs, as you would imagine, but demand has been consistently high at more than 2,500 calls per week, and thus far it has responded to more than 200,000 calls.

We will continue to invest in local services. In remote and rural areas and island communities, in addition to ensuring that people have access to the important statutory services, I am particularly keen that we work closely with the third sector, which has an important role to play. It plays that role across the country, but, in remote and rural areas of Scotland, we can utilise the third sector to help us with some of the challenges around access. That is not to say that statutory services should not do what we need them to do, but there is an ability to use and invest in the third sector more than we currently do.

Obviously, we want to prevent as many suicides as we possibly can. That is a core part of the strategy. A lot of work is going on with the third sector in relation to the support that we can offer to families that have suffered—and not just families, as we understand that suicides have an impact on entire communities. In my Glasgow Pollok constituency, throughout the course of the pandemic, there were a number of tragic cases of young men and women completing suicide, and entire communities were rocked by that.

We will be working on the bereavement support, but a lot of the work is on the preventative side and, because the statistics tell us that a disproportionate number of young males are completing suicide, a lot of focus is going into that space. Hugh McAloon can say a bit more on the pilots.

You will know, convener, that I was Cabinet Secretary for Justice before I was in this role. It is a real failure—I do not use that word lightly—in our approach to have police officers attending somebody who is in distress and be with them for five hours. That is not good for the individual who is suffering that distress, because the police officer—who will do an excellent job, given the circumstances—would be the first to say that they are not the best person to help with mental health needs. It is not the best use of the police officer’s time, and it is not the best approach for the individual involved. It is not good for the system as a whole in relation to the response that we are giving to people. In itself, it is a failure of approach and lays bare some of the failings that the petitioner spoke about when she gave evidence on Luke’s case. I know—I do not suspect—that Luke’s case is not an isolated one.

We often talk about mental health being on a par with physical health and, from the Government’s perspective, that is true in terms of priority, but I do not think that we see the evidence of that cascading through the entire system. The example that you give is good, which is why we have in recent years set up the NHS 24 mental health hub, so that people have access nationally to clinical specialists for the mental health distress that they face.

I go back to the common theme of pilots. A number of pilots that we have run across the country—some of which have now been evaluated—have shown us a much better model. I think back to the one in Govan in the south of Glasgow, where, if a call came into the police because somebody was worried about the possibility of another person seriously harming themselves, the police officer would go with a specialist community psychiatric nurse to attend the incident. I will not quote exact figures, but if I remember correctly, the amount of officer time that was then spent on such a situation reduced by more than half.

Perhaps I would be better passing to Dr Cook, who will be able to answer your question from a clinical perspective.

I will perhaps hand that question over to clinical colleagues and others. We have certainly had that discussion. It is very difficult to say and, given that we are still not quite out of the pandemic, it is challenging to do so.

In relation to mental health, one of the key concerns that I and, I think, every member at table had was about access, or lack of access, to services during the pandemic. We have put a lot of work into suicide prevention. Even at the most difficult times during the pandemic, when we were under significant legal restrictions, we still tried to ensure that vital services—in which I include suicide prevention and mental health services—were as accessible as possible.

Of course, suicide prevention has been a mission of this Government for many years, and we see some positive signs that things are going in the right direction, if we look at recent trends, but we are nowhere near where we want to be, which is why we have the suicide prevention strategy that was co-designed with the Convention of Scottish Local Authorities. Alastair Cook might want to come in on that.

You are right to suggest that we need to wait for the figures, and I do not disagree with your assumptions around the issue. We will always set ambitious targets to stretch ourselves in order to ensure that we are going as far as we can.

I commend to you the most recent strategy that has been developed in conjunction with COSLA. I am certain that Paul Sweeney will, if nothing else, have seen and skimmed through it. “Creating Hope Together—Scotland’s Suicide Prevention Action Plan 2022-2025”, which is the long-term suicide prevention strategy and action plan, looks at the trends over past years and asks how we can improve. We have a goal in the plan to reduce the number of suicide deaths in Scotland while, importantly, we tackle the inequalities that, as Dr Cook mentioned, contribute to suicide rates. That is why we were so keen to produce the strategy alongside COSLA.

We have not managed to go as far as we wanted on reducing suicide deaths, but there has been positive progress. The new strategy takes into account the good that we were doing, and says where we need to go further, how we can work with local partners and, importantly, how we can further reduce inequalities, because we know that disparities and inequalities are, beyond a shadow of a doubt, disproportionate contributing factors in respect of deaths by suicide.

I will address the general issue and come back to the specific question.

It has been my view since I came into post that, although we have a suite of quality standards for measuring and monitoring outcomes for child and adolescent mental health services, we do not have similar for adult mental health services, so there is a gap. A range of work is on-going to develop that suite of quality standards to improve the quality and safety of mental health care and support, which definitely includes adult secondary mental health service standards and the delivery of psychological therapies, interventions, eating disorder standards and so on.

Hugh McAloon might have the specifics with regard to the dates and our intentions in relation to the outcomes framework. Because we have co-designed the strategy with COSLA, we are trying to ensure that anything that we do in that space is done collaboratively with COSLA and local authorities.

Hugh McAloon will come in on some of the specifics. We will, of course, evaluate the projects that Alexander Stewart rightly cites and look to see how we can upscale them.

I am the first person to say that, far too often within Government, we suffer from pilotitis—the inability to go from a pilot to upscaling. We have to be better at that, and I think that we are getting better at that. If the pandemic taught us anything, it is about the need to have a slightly bigger risk appetite in relation to upscaling things. Not everything will work when you upscale it, but the desire for perfection should not get in the way of progress. There may well be faults and glitches that we will have to work through, but, generally speaking, we should be able to upscale far more quickly than we currently do when things are going well.

On the other matters that you raise, a lot of that is within the strategy that we referenced. Can you remind me of your very last question?