Chamber and committees

MHOs are critically important as they protect and safeguard the rights of vulnerable people with mental health conditions.

MHO workload pressures have no doubt been exacerbated by the COVID pandemic, but we are aware of a number of issues that are having an impact. These include significant numbers of applications for guardianship orders under Adults with Incapacity legislation, supporting hospital discharges when there is an issue with incapacity, as well as the challenges of working on detention and compulsory treatment orders during the pandemic. MHOs also provide ongoing advice for other professionals, users of services and carers about the use of mental health legislation when planning care and treatment.

While it is the responsibility of local authorities to ensure they have the appropriate levels of MHOs in place, we have been working, with COSLA, local authorities, the Scottish Social Services Council and others since 2019 to improve MHO capacity across Scotland.

We are committed to addressing a shortfall in the MHO workforce by 2023 as part of our wider Integrated Health and Social Care Workforce Plan (2019) and we are investing £1.5 million over 2019-2022 to support Local Authorities and Health and Social Care Partnerships in training additional MHOs. Additionally, we are currently evaluating with COSLA options to support new MHO posts and decisions will be made in due course.

I have asked Teresa Medhurst, Interim Chief Executive of the Scottish Prison Service (SPS), to respond. Her response is as follows:

Addictions Prevalence Testing has been reviewed and renamed Drug Trend Testing. Along with the testing of individuals being admitted and liberated from SPS custody in a given month, results from Rapiscan machines will also be analysed as part of Drug Trend Testing (DTT) in the SPS. DTT will take place in January 2022.

The decision about which treatment to prescribe is a clinical decision made by the prescriber in discussion with the patient, taking into account the individual’s condition and medical history.

Guidance is available to assist prescribers and Scottish Government is in the process of reviewing its “Quality Prescribing for Chronic Pain – A Guide for Improvement” which will include information on addressing the issue of over-treatment with a focus on self-management and non-pharmaceutical treatment of long-term conditions, highlighting the issue of high strength opioid medicines misuse and encouraging clinicians to discuss concerns openly with patients.

Over the period covered by the University of Aberdeen study, steroid injections (a commonly used therapeutic option for Osteoarthritis awaiting surgery) were reduced on advice from Royal College of Rheumatology due to the risk of activation of latent Covid 19 and risk of immunosuppression and susceptibility to the virus, this could have led to an increase in opioid pain medication prescriptions to compensate. Analysis from Public Health Scotland (PHS) shows a marked reduction in the number of corticosteroid injections between March 2020 and April 2021 before returning to previous levels. Analysis from PHS, however, does not indicate an overall increase in opioid pain medication prescriptions over the same period.

As the national agency for sport, sport scotland invests Scottish Government and National Lottery resources to help the people of Scotland get the most from the sporting system. sport scotland works in partnerships with Scottish Governing Bodies of sport (SGBs), local authorities, leisure trusts, sports clubs and community organisations, schools, colleges, and universities to provide greater opportunities for all to participate in sport.

sport scotland’s investment in each local authority area, in each year, since 2012-13 can be found from the Scottish Parliament Information Centre (Bib. number 62729)

This data covers investment by sport scotland, in both the local authority and other organisations in the local authority area, including investment for Active Schools, Community Sport Hubs, Sport Facilities Fund, National and Regional Facilities, Transforming Scottish Indoor Tennis Fund, Cycling Facilities Fund, Cashback for Communities, Active Places Fund, National Lottery Awards for All, Direct Club Investment, COVID-19 Ice Rink Funding, COVID Loss of spectator funding, and Get Into Summer.

The Scottish Government recognises that the lack of a national platform for group therapy has been challenging for services, that is why we have been working with the software developers, Attend Anywhere, to develop their platform Near Me as suitable solution to undertake patient facing group video consultations. Developers are currently testing the Alpha version of the Near Me group platform and it is anticipated that a Beta version (testing by clinicians) of the system will be available for testing with patients in November with full release shortly thereafter.

Meantime, we have issued guidance for NHS Scotland on the use of video consultation for group therapy using existing platforms, available from the Technology Enabled Care Scotland webpage. Use of Video Consulting in Group Settings for Mental Health Guidance | TEC Scotland

Consultant Psychiatrists across NHS Boards

The latest quarterly NHS Workforce stats (published 7 September) provide a data snapshot of the number of consultant psychiatrists across Mental Health and Learning Disabilities (MHLD) services within NHS Scotland and in each of the NHS Boards.

As at 30 June 2021, there are 547.8* whole-time equivalent (WTE) Consultant Psychiatrists across all specialities in NHS Scotland. This is a 23.2% increase since September 2006. The number of WTE consultant psychiatrists across all specialities in each NHS Board as at 30 June 2021 are:

The Mental Health in Schools Working Group have sought to establish a comprehensive approach to supporting children and young people’s mental health and wellbeing through schools. The publication of the whole-school approach framework provides guidance on setting mental health and wellbeing at the heart of the ethos and culture of schools.

This approach is also reflected within the new professional learning resource, which has been specifically developed for use by school staff, as part of a strategic approach to enhancing understanding of supporting children and young people’s mental health and wellbeing in schools. The new professional learning resource is available online and can be used by any member of school staff.

I have asked Teresa Medhurst, Interim Chief Executive of the Scottish Prison Service (SPS), to respond. Her response is as follows:

Whilst this is primarily an operational matter for the SPS, the SPS and Scottish Government have been in communication regarding the reported tampering of mobile phones used by individuals in custody and security measures in place. A solution was identified with the provider in relation to the concern of illicit SIM cards being used in prison issued mobile phones and it is currently being implemented across the prison estate. This solution enables the SPS to blacklist handsets on various network providers rendering the handsets unusable with a non-prison issued SIM. The security measures in place will continue to be monitored by the SPS.

Following closure of the Lowit Unit at the Royal Aberdeen Children’s Hospital in 2014, a programme of CAMHS redesign started in 2015. This included all services for children and young people with mental health issues being redesigned to support children aged 0-18 years.

During this redesign, the majority of staff were co-located in a new purpose redesigned CAMHS building funded by the Scottish Government. The remainder of staff are now based in Moray as part of a Hub and Spoke model of care. This includes Unscheduled Care and Tier 4 staff to support children, young people and their families. All Tier 4 patients are cared for by a Multi-Disciplinary Team, using a Care Programme Approach. The CAMHS service in NHS Grampian is now also part of a North of Scotland regional Tier 4 network with Tayside and Highland and in-patient beds can be accessed within the Young People's Unit, if required.

It is for individual Health Boards to ensure that they provide mental health services in line with the needs of their local population.

NHS Grampian is currently meeting the CAMHS Waiting Times target of patients starting treatment within 18 weeks, with compliance at 90.8% in the last quarter. Waiting times performance since the whole service redesign in NHS Grampian was completed shows the positive impact this has had on access and care.

I welcome the efforts of Plus Perth, Dundee Healthy Minds Network, Angus Voice and the Tayside Independent Inquiry Stakeholder Participation Group in producing this survey and report. I recognise the value that it has provided to David Strang in informing his progress report on Tayside's mental health services which was published in July. I met with representatives of the Stakeholder Participation Group to hear more about their experiences and recommendations for Tayside Mental Health Services in September and have made clear to Tayside partners that the voices of lived and living experience on mental health services in Tayside is critical going forward.

The Scottish Government is working to establish independent scrutiny of Tayside’s Mental Health Services, an action that is strongly supported by the survey report.