Lib Dem Mental Health Summit 30 July 2015

Jim Hume MSP, Health Spokesperson for the Scottish Liberal Democrats, invited a number of mental health organisations to attenda summitat the Scottish Parliament on 30 July 2015. The College in Scotland was ably represented by Dr Eleanor Brewster, Intellectual Disabilities Consultant, Dr Wojcik Wojtek, Liaison Psychiatry Consultant and Carolyn Papakyriakou, Carer Representative on the RCPsychiS Executive Committee. The Policy Manager and Policy Administrator also attended as observers.

Organisations represented included: the Mental Welfare Commission; Penumbra; See me; Scottish Recovery Network; Mental Health Foundation; Bi Polar Scotland; Alzheimer’s Scotland; Who Cares Scotland; Falkland School; Mindroom; British Psychological Society; British Association of Counselling and Psychotherapy; Support in Mind Scotland; SAMH and Kindred.

The discussions at the summit were wide-ranging but the themes that emerged most strongly fromthe majority of participants were:

  • A lack of mental health education and emotional literacy in children and young people(potentially resulting in lifelong difficulties). Teachers often reluctant to engage in difficult discussions with pupils, there is a lack of knowledge regarding what to do with sensitive information disclosed.
  • Stigma and discrimination
  • Long waits for psychological therapies, and GPs struggling to cope withthe high demand for help with mental health problemsand their role as the most common first port of call for those seeking guidance/referrals (?).
  • The need for further investment in the early years and prevention agenda
  • The lack of specialist beds for children and young people with learning disabilities and also for the under 18 forensic patients.
  • Transitions between age-services like Child and Adolescent Psychiatryto General Adultare often difficult, and there is a general lack of adequate link-up between services
  • The role of the third sector in jointly working with statutory services, for example, Dr Wojtek outlined an innovative idea to have third sector workers in Accident and Emergency departments to helpsupportpeople who are emotionally distressed but not physically ill. However, the third sector representatives – whilst very receptive to the idea - stressed the need to be adequately resourced in orderto do this.
  • The third sector - as well as unpaid carers -are delivering many hours of care but yet are often not included in case conferences or consulted about an individual; when in fact they mayhave the most contact with that personand therefore be able to provide valuable insight.
  • The third sector organisations present made strong representations about thehighly detrimental effects of cuts to funding for vital community projects;demonstratingthe significant difference these projects can have on an individual’s life.
  • On integration, participants noted that the fundamental nature of the activity was not intended to be about structures, but at the momentit feels very much like that;with the majority of the parts of both thehealth and social care services appearing to berepositioning themselves without any real shift in culture or thinking. In some areas, there is anotable lack of third sector consultation orinvolvement. However, it was noted that in some areas integration is working well so far, for example, NHS Ayrshire and Arran.
  • The group observedthat it would have been helpful to have had a representative from social work or a local authority present at the Summit.
  • The important role of employment in an individual’s lifewas outlined; and how perhaps some interventions at population level (which could make it easier for people to access work without being compelled to do so) could address some of the “social drift”.
  • There was quite a lot of discussion on the risk-averse culture of the NHS and both sides of the debate were well put. From a nursing perspectivethere are clear reasons whystaff are risk averse,withso many regulators and inspection bodies to inform when something does go wrong;however,a balance needs to be found between allowing a degree of risk for best practice, whilst still ensuring patients are safe. From a service user’s perspective, staff being risk-averse can lead to defensive practice, and staff should, where possible,be able toreflect on their own practice and take into account service user feedback.
  • One of our representatives pointed out that the workforce pressures in the NHS just now are actually increasing risk-aversion. Clinics are becoming busier and trainee psychiatrists are in short supply. There was a brief discussion on psychiatric recruitment and how this is a major concern for the College right across the UK. Representatives highlighted particular areas of Scotland that are struggling, such asTayside, Highland and Grampian. The importance of putting in place methods to encouragemedical students and young doctors to become psychiatrists was stressed. Service users need consistency and continuity and it is hard to give that when the system is so short-staffedfocused on efficiency. Pressures in General Practice recruitment and retention were also highlighted.
  • The challenges of delayed discharges and the problems of moving people back into the community when they no longer medically need to be in hospitalwas also raised. There was a brief discussion on the increasing numbers of patients with dementia and the difficulties in finding enough placements in care homes who specialise in dementia care (and the additional pressure this is placing on an already strained system).
  • Nigel Henderson, Director of Penumbra and one of our Scottish Mental Health Partners, asked if all policies in future could be proofed in terms of whether they are “mental health improving”, thus preventing a potentially detrimental impact on those suffering mental ill health, for example, in housing policy. This idea originated fromdiscussions at one of the early SMHP meetings.
  • In terms of legislation, there was little discussionother than the MWC raisingthe issue of the General Comment on UN Convention Article 12and how it says potentially challenging things. They also asked if it was possible that politicians could return to previous laws and assess whether they were working well, for example, Self Directed Support. Perhaps this approach could be preferable to looking at entirelynew legislation. MWC also said there are complexities around the use of the Adults with Incapacity (Scotland) Act, particularly in the way courts are interpreting it. There is currently no good model to help people with impaired capacity to be more involved in decision-making. Advance statements and advocacy can help to address this, but advance statements are under used and the increasing demands for advocacy and the cuts to its provision are causing significant access problems.
  • Lack of funding for mental health research was mentioned, in particular the challenges of using research to demonstrate the value of preventative measures rather than interventional.
  • Health inequalities and how to address multiple complex problems
  • Lack of referral options for GPs – of 27000 referrals made to mental health services, 5000 were deemed not appropriate. There appears to be a gap here, better join up with third sector services and appropriate support in the community could help to alleviate this

Karen Addie

Policy Manager

RCPsych in Scotland

From left to right

Dr Wojtek, Ms Papakyriakou, Dr Brewster

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