Mental health

Part 1 CAMHs

Background

This aspect of wider mental health is the area most raised by members during the Scottish Parliament debate on 7 June. A previous inquiry into CAMHs by the Health and Sport Committee in 2009 made a series of recommendations in relation to child and adolescent mental health and well-being. Research indicates that 10% of children and young people (CYP) (5-16 years) have a clinically diagnosable mental health problem Such problems disproportionately affect persons from lower income households and areas of deprivation.

On mental health generally the Scottish Government are working towards producing a 10 year mental health strategy this Autumn, which once produced could provide an opportunity for further and wider inquiry.

Child and Adolescent Mental Health Services (CAMHS) cover the range of services across the agencies that contribute to the mental healthcare of CYP.  Services include mental health nurses, child and adolescent psychiatrists and social workers as well as GP’s.  CAMHS has 4 service tiers:

  • Tier 1 is the identification level, generally by teachers or GP’s, with services provided by practitioners working in universal services who are not mental health specialists.
  • Tier 2 is a combination of some specialist CAMH services and some community based interventions including primary mental health workers.  At this level identification of severe or complex needs requiring specialist assessment and intervention leading to treatment at a higher level can occur.
  • Tier 3 provides a service for CYP with more severe, complex and persistent disorders.
  • Tier 4 consists of specialised inpatient CAMH units and intensive community treatment services for those at most risk.

The previous Committee inquiry found that children and young people were experiencing long waits for access to specialist services. Not long after this inquiry, the Scottish Government established a waiting time target that 90% of children and young people should be seen at tier 3 services within 26 weeks of referral. This was later reduced to 18 weeks. The most recent data from Scotland Performs shows that at the end of March 2016, across Scotland, the target was met in 84.2% of cases. There was also significant variance across Health Boards. This represents around 700 CYP’s in the last quarter not receiving timely support.

The inquiry is likely to identify reasons why significant variations continue to occur across Scotland and the extent to which good practice is being exported and adopted by Boards. It may also highlight:

  • What factors are currently constraining meeting the target time of 18 weeks for all children and young people being seen at tier 3?
  • How are these factors being addressed and over what timescale?
  • For those Boards who are meeting the target what were the principal factors that had to be met?
  • What support is provided to children and young people while they are waiting for a stage 3 referral?

Part 2 Adult Mental Health Strategy

The previous mental health strategy ran between 2012 and 2015. The Scottish Government is currently consulting on a new 10 year strategy, with the expectation this will be published in the autumn.

The strategy contained 34 commitments within 27 themes across 4 key change areas:

  1. Child and adolescent mental health
  2. Rethinking how we respond to common mental health problems
  3. Community, inpatient and crisis services
  4. Other services and populations e.g. offenders, veterans, people with neurodevelopment disorders

A balanced scorecard was adopted in relation to CAMHS but not for the other areas despite pressure from some stakeholders.  In the absence of such measurement it is not clear how successful the previous strategy was and on which areas the new strategy should be focussed.

The Committee could ask the Scottish Government how they have evaluated the success of the previous strategy and which areas were most and least successful.  Stakeholders could be asked for their views on the success and failure of the previous strategy.

The results of such an exercise could be used to determine the parts of the strategy with the least amount of progress. If conducted in the autumn this could allow the Committee to feed its findings back to the Scottish Government and help determine the priorities of the new strategy.

Over the summer the Committee issued a call for written views. 

Written Submissions

On 27 July the Convener wrote to the Minister for Mental Health seeking an update on progress since the 2009 report. 

On 31 August the Minister for Mental Health responded to the Convener's letter.  

On 15 December the Convener wrote to the Minister for Mental Health.

On 12 January 2017 the Minister for Mental Health wrote to the Convener.

On 23 January 2017 the Minister for Mental Health responded to the Convener's letter of 15 December.

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