Mental Health

Lisa Cameron Excerpts

Wednesday 9th December 2015 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on initiating such an important debate. It is a privilege to contribute to it.

I must begin by declaring a professional interest, having worked as a forensic and clinical psychologist for 20 years in the NHS and beyond, specialising in mental health, at consultant level for 10 of those years. I continue to maintain my skills and engagement in line with the professional requirements of my registration with the British Psychological Society and the Health Care Professions Council. Earlier in the year, I had the privilege of contributing to the evidence taken by the Youth Select Committee during its inquiry into child and adolescent mental health services.

I want to say a little about three topics: the adult mental health service and strategy, child and adolescent mental health services, and mental health services for veterans. Mental health is an extremely wide field, ranging from major mental illnesses such as psychosis and depression and anxiety disorders to trauma and eating and adjustment disorders. Developmental disorders such as attention deficit hyperactivity disorder and autistic spectrum disorder are also sometimes included in the sphere of mental health, and I would welcome future debates about those important conditions, because I fear that we shall not have time to do them justice today.

The British Psychological Society has reported that one in four people in the UK will experience a diagnosable mental health problem, with mental health problems accounting for up to 23% of all ill health in the UK and being the largest single cause of disability. In Scotland the figures are currently one in three. Mental disorders are strongly related to risk of suicide, and it should be known that high levels of comorbidity with substance disorder and physical ill health are prevalent.

Mental health services across the UK are not the finished article wherever you go. We are continually striving towards improvement, and that should always be guided by patient need and by research underpinning most effective clinical practice.

When I started practising in the 1990s in Scotland, the funding of mental health services severely lagged behind other areas of NHS funding. That resulted in far too few practitioners and what seemed to be never-ending waiting lists for both patients and clinicians. At the start of my career, patients routinely waited to see psychologists in mental health specialties for six to 12 months, and in some areas for over a year. That was clearly ineffectual, often meaning that problems were exacerbated over time and that a mainly medical model persisted. That is not what patients wanted, nor did it fit with best practice; evidence indicates that patient recovery is improved with access to talking therapies alongside medical management. That is evidenced clearly in National Institute for Health and Care Excellence guidelines.

In 2014, the HEATs—health improvement, efficiency, access targets—were adopted in Scotland and across the UK, meaning that patients should be seen from referral to assessment in 18 weeks. In Scotland in 2014, 81.6% of patients were seen in 18 weeks and the number of people seen was 27% higher than in the same quarter the previous year. Demand is increasing, which is a good thing: it means that we are starting to tackle stigma and that access is improving.

Matched stepped care involving psychological therapies and practitioners at differing levels, depending upon clinical effectiveness of therapy type for different disorders, was rolled out in all boards within NHS Scotland, and NHS Education for Scotland took a primary role in workforce capacity modelling and training. Use of self-guided help has also been developed. Technological advances are important in terms of access for patients in this modern world and in relation to early prevention. Suicide rates have been brought down and the target met of training high levels of front-line staff in suicide prevention and risk identification. Quality ambitions have also been developed as benchmarks in relation to person-centred, safe and effective care.

I fear, however, that demand on mental health services will continue to increase dramatically. Evidence suggests that recession increases mental health problems, including depression, suicidal behaviours and substance abuse. Unemployed individuals, particularly the long-term unemployed, have a higher risk of poor mental health compared with those in employment. Stress is now the most common cause of long-term sick leave in the UK and the more debt an individual has the more likely they are to suffer a mental health problem. A social and policy climate of austerity, affecting the most vulnerable to a greater degree, is a likely aggravator of mental ill health.

I welcome pledges from both the Westminster and Scottish Governments to increase spending on mental health significantly: the figure is £100 million in Scotland. Mental health services, however, have not achieved parity with physical health services over the decades since I started in the field and we need to be clear that much more is needed to fill the gap. I commend Ministers and MPs to visit mental health services and spend quality time with clinicians on the front line. Managerial statistics often occlude a multitude of issues and it is only with that front-line insight that the true patient journey and daily clinical barriers can be identified. Those often include excessive paperwork, repeated reviews and service changes that diminish morale.

Mental health problems in childhood are extremely serious. They can destroy educational potential at worst and impede it when problems are less severe. Difficulties must be assessed and recognised at an early stage. HEATs for child and adolescent mental health services were set at 18 weeks as of December 2014. NHS Scotland data suggested a significant reduction from 1,200 waits of over 26 weeks in 2008. In the quarter ending June 2015, 76.6% of CAMHS patients were seen in 18 weeks and the average wait was nine weeks. In the past two years, there has been a 35% increase in demand due to productive work completed on stigma and in improving access, and since 2009 £16 million has been invested in the CAMHS workforce; it is at its highest ever level. To improve waiting times further, £15 million more has been pledged to CAMHS in Scotland. Widespread staff training has been undertaken in modalities such as cognitive behaviour therapy, family therapy, interpersonal therapy and specialist interventions such as for eating disorders, with a focus on seeing patients as close to home as possible. More progress is required across the UK and in Scotland to meet the 90% target.

I must say that in-patient treatment for children and adolescents should be a last resort. It takes children away from family and pathologises their difficulties. Best practice highlights intensive outreach approaches enabling children to be seen at home and treated in their natural environment, so maximising key family and peer supports. Children who need in-patient services suffer psychosis, intractable eating disorders, severe obsessive compulsive disorder and a variety of neurological conditions and neuro-developmental disorders. Currently there are 48 beds available in Scotland and this year £8 million was pledged to build a unit for children and adolescents with mental health problems in Dundee. My clinical experience suggests a lack of available beds in forensic and in learning disability child and adolescent mental health services. Constituents who have contacted me have also suggested that further work needs to be done to improve access to specialist eating disorder in-patient care outwith the private sector.

Increases in the number of children presenting with self-harm and receiving brief overnight admission have been high. Clinically, this is quite a difficult decision. Often, clinicians are faced with the issue of sending adolescents for a brief stay miles and miles from their home—which makes it difficult for carers and parents to visit them—or admitting them briefly overnight. Surely the optimum treatment would be to see and assess them and to ensure that children are safe and able to go home with the strongest possible package of care as quickly as possible.

[Chloe Smith (Norwich North) (Con)]

I value greatly the contribution from the hon. Lady, who has huge expertise. I get the feeling that there is much medical expertise to come from the paper she may have been citing a lot in her speech. As the Front-Bench spokesman for her party, could she explain whether she thinks the points made in amendment (a) were valuable? In the absence of that, does she support the motion as it stands? How does she urge Members to vote today?

[Dr Cameron]

I do not support the motion and how it reflects Scottish Government care. As I have said, for children who have mental health difficulties, clinicians have to make a sensitive judgment regarding the length of potential stay, and whether the problems are intractable and the children should be admitted to a specialist unit, which can often be some miles from their home. Many of cases of self-harm attempts require psychiatric assessment and monitoring, overnight care and monitoring, and then a package of intensive home care to try to reduce the chance of another such incident. I hope that answers the hon. Lady’s question.

Recommendations, however, do have to be made in relation to CAMHS. They include having a wider appreciation of children’s mental health beyond any problems, providing education and awareness in schools, and having access potentially to mental health clinicians in school settings and not just clinics. As with diet and exercise, good mental health should be normalised. Those are all fundamental living skills that impact on all aspects of functioning and deserve more of a health and well-being slant, rather than a pathologising label.

[Carol Monaghan (Glasgow North West) (SNP)]

Does my hon. Friend agree that it is invaluable to have these services in schools as that normalises the feelings of low self-esteem that many of these young people are experiencing, and does she also agree that to have counsellors based in the school is very important for young people’s mental health?

[Dr Cameron]

Yes, access to such mental health services in schools is certainly merited, as well as mental health awareness and training, and particularly training for staff in schools so that they can pick up at a very early stage if someone is experiencing a mental health problem and then try to access services at that very early stage. Specialist training for teachers would be a positive step forward so that they recognise the signs of mental distress in children. We also need to modernise our approaches to mental health for children and adolescents and embrace the IT and social media method of communicating with young people, because that is the modern world and that is often where they communicate from.

There is a project in Scotland called SafeSpot, an application, website and school intervention to promote positive coping skills, safety planning and access to information about mental health services for young people. The project is going very well and the app is freely available on iTunes and in Android stores. The SafeSpot app and website will be used within Greater Glasgow and Clyde health board, and Dundee health board is also looking at access to it. It was designed by a clinician, Dr Fiona Mitchell, specialist registrar in child and adolescent psychiatry, and I commend her on her innovative work in that regard.

There remains a lack of empirical data regarding effective interventions for young people with comorbidity issues, by which I mean mental health coupled with learning difficulties or substance use, and that requires to be built upon. Looked-after and accommodated children are some of the most severely disadvantaged in terms of services and magnitude of difficulties, particularly those who also may have violence-risk needs or self-harm needs. Further service provision for specialist groups and underpinning research will be crucial.

Given that the weight of evidence for child and adolescent mental health services is in favour of psychological, rather than pharmacological, interventions for the majority of child mental health presentations, clear structures should be in place to support the delivery of effective, evidence-based psychological therapies for children and adolescents. Those from socially disadvantaged backgrounds have always tended to have a poorer uptake of CAMHS. An assertive outreach may be required so that some of the most vulnerable and disadvantaged children and families do not slip through the net.

Specialist service delivery in areas of developmental disorder such as autism, children in the criminal justice system, and children with comorbidity requires to be thought through and planned, so that those children and their families are able to access facilities without feeling they are being passed from pillar to post. It is extremely difficult for families in particular to access early diagnosis of developmental disorders such as for those with autistic spectrum disorder, which means that their needs can go unmet for years and their attainment may diminish.

I continue to believe that the mental health of veterans is an area that is underfunded across the UK and that those who have been willing to lay down their lives for their country should have consequent health, including mental health, needs prioritised. The Minister agreed a few months ago during my Adjournment debate that much more would be done. I would like to have a statement on what more is being, and will be, done, particularly as we are now in a new conflict and the numbers of those in our armed services who witness or experience trauma will increase.

As a clinician in mental health, I make the following plea to the House. To me, mental health services are beyond party politics and it is crucial we tackle this meaningfully in a cross-party manner that brings about real continued progress on the ground for service users and staff, and that we share best practice across the UK and a “what works” philosophy.

I welcome the announcement of improved access to data, which is also crucial in terms of taking forward and ensuring best practice. I say in conclusion that I sense a real note of collegiality across the House and a will to take this important issue forward. I look forward to fully partaking in that, and my party wishes to see mental health services continue to improve in Scotland, the UK and beyond.