 The next item of business is a member's business debate on motions 17253 in the name of Alec Cole-Hamilton on trauma recovery and support for first responders. The debate will be concluded without any questions being put, and with those members who wish to speak in the debate, press the requests to speak button now. I call on Alec Cole-Hamilton to open the debate.ili a chwaetholion i ddigon i Fyloon i amsgolion i sgolion i'r Llwst Gwladys i ei ffilmu yng ngôl ond, o fameun ac oedd yn sefydliadol o'r ffordd a gweld. Fodol iawn i ddigon i ddweud yr oedd yn gael o'r ffordd ac yn...... Fodol iawn i ddigon i ffordd ac i ddim yn i roi am gael gwladys i gael o'r ffordd i llawer o'r llwyf yn gwyllwyr ac yn hallu i gael. On any given day in Scotland, people die in the arms of strangers, but we seldom stop to think about the strangers after the fact. Those inflection points of crisis can have an impact on the psychology of an individual similar to combat stress, yet we often expect those individuals, be they professional or bystander, to carry on with very little in terms of support or access to services. For our professional first responders, that stress is reaching crisis point. Research by Unison published recently found that 25 per cent of ambulance staff rate their job as 10 on a 1 to 10 stress scale, with many thinking of leaving the service. Almost all, 98 per cent of paramedics have experienced violence and abuse while working, and almost three quarters of respondent describe morale as poor. Aside from the regular stresses of working antisocial hours, those workers regularly attend events of acute trauma where they may encounter multiple fatalities, sometimes involving children. In my first months as a member of this Parliament, I met an emergency worker who had attended the casualties of the Lockerbie bombing. He told me of the nightmares he suffers to this day and the fact that at no point was he offered any kind of support. I know of one 40-year-old paramedic in my constituency who was recently medically retired with post-traumatic stress disorder. There is a cumulative effect as well. Andy Cunningham is my constituent. He works at the National Risk and Resilience Centre as an ambulance worker. He came to see me recently about the mental pressure that he and his colleagues are under. He summed that up in a story that he described to me about how he recently retrieved the body of a young woman at Leith Docs, which made him realise that he needed help. I asked if I could use his words to describe that to the chamber, and he agreed. He said that I felt nothing, no feeling at all at the time, other than that I nearly lost her trying to hook the body in. That night, I reflected on why I had become so numb to death that I had seen hundreds of dead people. By that time, I had lost my father, two close friends and a cousin to suicide. I knew that what I was feeling was not right. I felt so numb, so alone, and it did not feel good. I knew that it was not normal for one human to feel nothing for another, and that is when I knew that I needed to speak to somebody. I was lucky in that I took some time off. I found a councillor who listened and helped with my perspective that, in time, I was able to return to work. I see that young girl's body every day, and I will do so for the rest of my life. Others are not so lucky. They are so traumatised by what they see. They are broken. They are broken for life, but the lucky ones survive. Remember that one in four ambulance responders have considered ending their own lives. Dark thoughts to make the pain and trauma disappear. This cannot continue, and we need to care for the carers. I want to thank Andy for having the courage to share his story with me and giving it permission to share it with you. His words speak to a trauma experience by those in our professional emergency service. We blidly expect them to be there when we most need them, but rarely consider the impact of what they bear witness to and the emotional baggage that they carry. In a public policy context, we are beginning to understand so much more about trauma, so getting assistance to our emergency workers should be routine, but it is not. Nor is it readily provided to members of the public caught up in those events. Almost universally, the immediate first responder at the scene of any trauma will be a bystander, often unknown to the victims of that trauma and often untrained in any form of first aid, but most will try to intervene. In March 2015, I was walking through the city centre when a man very sadly took his life from a tall building and died on the pavement beside me. I was the first responder at that scene, and I remember the trauma of that moment. I see it to this day. I still have nightmares about it and I have a triggering response whenever I hear workmen scaffolding overhead because it reminds me of his screaming before he jumped. I was joined at the scene by Janice Malone, who I was recently reacquainted with. Janice was equally distant from the man when he fell, and the scene was like something from a war zone. I was very lucky. I got some counselling immediately after in terms of trauma recovery, but Janice had had a much harder road back, and she was diagnosed with post-traumatic stress disorder. To her credit, she has taken her experience and the depression that she had to battle through to come back from it, to foster a new desire to help people like myself and Janice who witness terrible things, and she and I will be working with organisations such as Samhach and the Samaritans to start to build a package of support around those people who are caught up in terrible events. I want to thank her for her courage and the work that we are going to do together. There are many thousands of individuals, like myself and like Janice, like Andy Cunningham, who carry the trauma of what they have seen with them. Yet, in public policy terms, we do not often stop to think about the ripple effect that those events and incidents can have. That is why I am calling for the creation of a national first responder trauma recovery strategy that will help to begin the process of healing the tens of thousands of our fellow Scots, both professional and civilian, who have seen terrible things and have been caught up in catastrophic events. As I said at the start of my remarks, people die in the arms of strangers every day. We need to start thinking about what happens to those strangers afterwards. Thank you very much, Mr Cole-Hamilton. I now call Gillian Martin to be followed by Brian Whittle, Ms Martin, please. Thank you, Presiding Officer. I want to thank Calico Hamilton for bringing this debate to the chamber and for his very moving speech. My focus on this is adverse childhood experiences and I guess the role of those working with children. I want to thank Barnardo's for their briefing ahead of this debate. Yesterday, I was having a meeting with Tom Fox from the Scottish Prison Service about the Family Visitor Centre at HNP Grampian in Peterhead. During a wide-ranging conversation with Tom about the victims of crime, he was relating to me that so many young offenders in Poland have experienced multiple believments that we maybe cannot even comprehend. He believes that those traumatic experiences and the psychological harm that is a result of that trauma, left untreated, is in large part the root cause of their offending behaviour and that many of those people are actually victims of crime themselves as well, but certainly victims of childhood trauma. Many of those children are also care-experienced, a lot of them get into foster care after losing a parent. Barnardo's make mention of the service that he offered at Pallment, the Heath and Now service that he runs to support young men and women. The centre briefing is too often to be heard from young people that they just wanted someone to listen to them, someone to talk to, someone to be with them and alongside them through their experiences, and I found that absolutely heartbreaking. Not many of us can imagine what it would be like as a child to witness a parent's death, but for many children that is the trauma that they are living with. A neighbour of mine, who no longer lives in my street but was reasonably close, was a foster carer for some years back. She became a foster mum to a young man who had previously been adopted after he was witnessed to his mother's murder by his own father when he was around five years old. In a decade on, his relationship broke down with his adopted parents as he found himself reliving the trauma again as he is approaching adulthood. He is an incredibly bright young man, a compassionate chap and a lad that she should have been looking forward to his future at college and beyond, but that future and that experience in college was very rocky for him when he kept on dropping out because he was a very damaged young man who, as he approached 16, it is clear that he could not enter adulthood unsupported. Many children like him would now not be in the position of facing a cliff edge of foster care ending at 16, but more than that, he is exactly the kind of child who, without mental health interventions, could face a very uncertain future. I have been thinking a lot about him this week as I have been preparing for this debate. I wonder where he is now as an adult and what, if any, specialist help he got throughout his childhood. I wonder what specialist help training his adoptive parents or my foster carer neighbour had to help him. The work that has been done by the Scottish Government and partners like Barnardo on developing the Scottish psychological trauma and adversity training plan will be crucial in giving everyone who comes into contact with trauma experienced children the support that they need to work with them and react to any kind of, I suppose, result of that trauma that they see presented to them. The kind of trauma that I have just described with my neighbour's foster son is always going to leave a mark, of course it is, but with trauma-informed training and, I guess, extra interventions, like school councillors in place to relieve the pressure on adolescent mental health services, we can, I hope, assist those children to cope with that trauma and lead a life that does not result in further tragedy. Thank you very much. I call Brian Whittle, followed by David Stewart. Mr Whittle, please. Thank you, Deputy Presiding Officer. I add my thanks to Alex Cole-Hamilton for bringing this debate to the chamber. I think that one of the things that we are talking about today is the fact that trauma is not always physical. I was attended and spoke at the Police Scotland wellbeing conference earlier on this week, which was quite timely because I knew this debate was coming to the chamber. One of the things that they discussed there was the idea of the vicarious trauma, in which they were saying that that sort of process of change from empathetic engagement with trauma survivors, anyone who engages empathetically with survivors of traumatic incidents, torture and material relating to their trauma, is potentially affected. It stays with us, as Gillian Martin highlighted in her presentation, discussing ACEs and how that single traumatic event in an early life can come on to affect the rest of an individual's life. I spoke yesterday again about the problem of drug and alcohol consumption. It is linked into the way that we protect our children and it links into that as well. Gillian Martin said that it is more likely to have issues of problem drug and alcohol consumption, and it is more likely to have poor outcomes if those are not addressed. My first response is that there are those people who choose to put themselves in harm's way to help others. There have been several major incidents in recent years that I have seen the emergency services deal with hugely difficult situations. The Scotland stopling plastics explosion, when the Glasgow bin lorry crash, which feels to me that all of us were somehow involved in that, because we saw the pictures of that and even some video of that, when the Cluther helicopter crash, which I think is even more difficult for the emergency services to deal with, because their colleagues were among the victims. It is not just major incidents that can be traumatic. First responders can encounter the aftermath of violent crimes and can, themselves, be assaulted or attacked. I think that the wellbeing champions conference in Police Scotland has some great work being done inside Police Scotland through their wellbeing team and their wellbeing champions, recognising that need to give even just somebody to talk to and somebody that will listen. The child bereavement UK attended that conference, which I think is hugely important, because, again, we forget that our first line responders have to attend and break news in that terrible way. We are looking at the way that the Police Scotland use of trauma risk management. Some of the things that came out of that conference, some of the behaviours, the warning signs that they suggested were things like finding it unusually difficult to support clients, as you normally would. More mistakes, making more mistakes than usual. Reduction in your normal self-care activities—I think that Alex Cole-Hamilton highlighted that very well on his speech—is the idea of signs of compassion fatigue and burnout. There are physical signs such as exhaustion and insomnia, headaches, frequent minor illnesses and insomatisation—that physical manifestation of psychological concerns. The behavioural signs—the use of alcohol and drugs, sickness absences, anger levels, avoidance of clients, decision making, personal relationships breaking down, reduced compassion care for clients and depleted parenting and even changed changing eating habits. The signs of trauma that we should all be aware of and recognise and perhaps in a conclusion, is that idea that we need to look beyond the NHS, look into our third sector and look into ourselves and how we can support those who have potentially experienced trauma themselves. Thank you very much. Thank you, Presiding Officer. I start by congratulating Alex Cole-Hamilton on his success in bringing this important debate to chamber today and, if I say so, for his very moving and insightful speech. Apologies, Presiding Officer, that I may need to leave at 1.30. I've got a meeting with some health officials if the debate does go on and I'll let you to apologise to chamber for that. My quote that often gets repeated in the wake of public tragedy is, look for the helpers. It was the late American children's TV host, Mr Rogers, who said, when I was a boy and I would see scary things in the news, my mother would say to me, look for the helpers. You always find people who are helping. To this day, especially in times of disaster, I remember my mother's words, and I'm always comforted by realising that there's still so many helpers, so many caring people in the world. Immediately after seeing the scenes that all too often are on the news, like the Grenfell tower disaster, the terror attack at Tower Bridge, like the Manchester Arena terror attack, we need to find comfort in seeing the good in other people. Seeing strangers risk their lives to help those in need is an important part of that, and these days, with the rise of social media, those people are sometimes able to be applauded and cheered across the globe. There, of course, should be celebrated. Selfish acts of bravery and kindness are often all we can do to cling at times of tragedy. What happens after? Witnessing trauma, whether a one-off terror attack, or watching a loved one die, or whether sustained, like domestic abuse, or active service in the armed forces can have a long-term lasting negative effect on mental health. Those effects might show immediately, and they might not become apparent for some time. All too often, they go hand-in-hand with other health concerns, such as drug and alcohol misuse, broader mental health conditions and poor wellbeing. Unresolved trauma and stress can cause psychological harm for many years, regardless of whether it's triggered by a single incident or a complex trauma. First responders vary from those who work in the front lines, particularly those in the emergency services and those in the third sector, as well as members of the public who step up when they see people in need. With waiting times in NHS mental health being alarmingly high, many needing psychological help are left wanting. Not only are we unable to thank the helpers by helping them in return, but the NHS is struggling to even help the mental health of its own staff. Those people have gone above and beyond the call of duty, and then, when they need our help, they have to wait months, sometimes years. Just for clarification, the NHS has a duty of care to its staff, and it has access to in-house counselling services that staff can access via occupational health, and they can do that on a confidential basis. David Stewart I thank the minister for intervention. Obviously, I'm aware of that, and, as the minister knows in the joint visit that we did recently to New Craigs in Venice, staff themselves in the front line can also experience trauma and emotional difficulty, but I do understand the point that the minister is making. I support the motion, and I'll call Hamilton's call for the Scottish Government to bring forward a national first responder trauma recovery strategy. It's time for us not only to look for the helpers, but to help them too. Thank you. Thank you very much, and I call Alison Johnstone, who is followed by Tom Mason. Mr Mason is the last speaker in the open debate. I would like to thank Alex Cole-Hamilton for giving us the opportunity to debate this important matter. His motion calls on the Scottish Government to bring forward a national first responder trauma recovery strategy, and I'm pleased to support that call. I know that we're all hugely appreciative of our first responders. We're beyond grateful to all who intervene to save lives. In some cases, they're not professional, and they step in until trained first responders arrive at that scene. One of my brothers has been a firefighter for 22 years, and I asked him about his experience of accessing such support if there were any barriers in what they might be. He has good support at home. His wife is a neonatal nurse, and she's ideally placed to understand that desire to protect and to preserve life, because that's what they've chosen to do as a living. She knows him well enough to understand what kind of day he might have had without the need to go into detail, a detail that he might not be ready to share at the end of a shift, and a detail that might take some time to come to terms with. When I ask him how he's getting on, he'll tell me about station banter, about communal cooking, on shift, how busy it's been, but he doesn't really go into detail. As you can imagine, in a career, an on-going career, of more than two decades to date, he has seen what he describes as horror stories. I know that he was sent to the Clutha helicopter crash that Brian Whittle mentioned. Most of us will never come across a badly burned body. We will never see a body hemmed in and slumped over a steering wheel, never to move again. We may have seen loved ones as they have passed away. This is never easy, whether unexpected or not. However, it is exceptionally demanding when your everyday work is focused on helping people in the most challenging of circumstances. My brother, it seems to me, appears to take much of this in his stride, and that is testament to the training provided by the Scottish Fire and Rescue Service. Clearly, there are occasions when he and his colleagues are faced with demanding, uncertain events and outcomes that devastate people, families and communities. His experience in the fire service is that if there is a fatality, if there is a critical incident, a question error is received at your home address. It is sent there to give you so that you have the space and time to complete it if you feel that you wish to. It is voluntary. In 22 years of service, he is filled in this four-page questionnaire on many occasions. He says that it is very well designed to elicit the information required. In 22 years, he has requested to use the counselling service once, as he has been experiencing flashbacks following a critical incident. It is clear that the counsellor he saw was hugely helpful to him in processing the particular experience that had sent him there. He is clear that it is vitally important that counsellors have the appropriate skills, as he feels that there is the potential to hinder, rather than help. He is hugely grateful to the excellent staff at the rivers centre in Edinburgh. He understands that, at times, what might be seen to be, or even called, bottling it up, can in fact be a perfectly understandable coping mechanism, but that, at other times, professional assistance to share that information, to process it in the most helpful manner, is essential. He told me when he went to the rivers centre that he was expecting to meet people in white coats, but it was the polar opposite. He said that he could take your partner, your wife, your friend to the appointment. Clearly, he is speaking as a member of the fire service. He cannot speak for all first responders and for our other essential emergency services, but he firmly believes that such services must be available to all first responders in all emergency services and without. Individuals who intervene in traumatic situations—social workers may experience situations that we cannot comprehend—need that help to be there. He is content for me to share his experience today in order to help to ensure that no one hesitates to ask for help when they require it. It is important that first responders and our emergency services do not feel that we all expect them to be superhuman, dealing with extreme situations on a daily basis, but unable to admit that they need to take care of themselves, not just us. We need to ensure that that help is there as a matter of urgency when it is needed. That is the least that we can do. Alex Cole-Hamilton I thank Alex Cole-Hamilton for securing this debate today, but I also thank him for sharing his deeply personal experiences with us. We quite likely pay significant attention to the injuries and deaths on our streets, be they accidental or not. However, it is fair to say that we often do not provide adequate support for those who are first to the scene. Usually, members of the public are making a dreadful discovery or emergency services staff who do incredible jobs in the most trying circumstances. There is no doubt that, in previous generations, mental health was not given the care and attention that it was due. As a result, society could probably be somewhat dismissive of the psychological trauma that results from the situations that members have described. For example, last year, I saw the opening of the new major trauma centre in Aberdeen. That was a welcome step forward for treating serious injury, but I cannot help but wonder what staff there have to witness and how that has affected their own lives. For those who are professionals, for members of the public without training in responding to major incidents, I can only imagine that the effect is compounded many times over. I do not wish to be overly political in this debate, but there are performance gaps that need urgent redress. Statistics released this week show that, for much of March this year, there were more than 28,000 patients waiting for psychological therapy, and 30 per cent of those had been waiting for more than 18 weeks. At the same time, against the 90 per cent target for treatment within 18 weeks, the current rolling without natural average is 77 per cent. While those figures go beyond those first responders affected by trauma, if we want to do right by those people, then service levels must improve. Now, as far as creation of the national first responder trauma strategy goes, I'm supportive of such an idea. I know that the Scottish Government has a specific number of existing mental health strategies. However, if that focuses minds on delivering the right service for those whom we need to do better, then it should be considered. Whatever we go down to address the issue, I think that we must look at the support networks around people who go through such experiences. I'm sure that we all agree that there is much easier to progress a traumatic event if someone has a family and friends that they can speak openly with and who can be leaned on in dark days. Presiding Officer, whether or not it's someone's job to respond to the major traumatic incidents, the idea that people can take something that's that serious in their stride and a soldier on it, as if nothing had happened, is simply not the case. We cannot predict when any individual might find themselves in such a situation, but if it happens, the right support must be there for them. We might not think of them at the same time as the victims or their families, but their need for care can be every bit as acute. I hope that our debate will have the effect that the needs of the first responders are fully considered. If changes need to be made, we will commit to working constructively to making them that aim of a reality. Thank you very much. Thank you, Presiding Officer. I'm pleased to respond on behalf of the Government this afternoon. I thank Alex Cole-Hamilton for securing this important debate, and to Janice Malone for bravely sharing her story. Janice is one of my rather good constituents, and I had the pleasure of meeting her last week. The world we live in is unpredictable. In the past week, a tourist boat capsised on the Danube, and searches continue for mountaineers in the Himalayas. Just beside Edinburgh Castle, there was a horrific fatal stabbing of a young man, Paul Smith, in broad daylight. His family and friends will be struggling to cope with his tragic loss, and the ripple effect will be felt by witnesses and emergency services who responded. Psychological trauma is not just prompted by accidents, disasters or sudden acts of violence. Complex interpersonal trauma is caused in relationships, and this can have a terrible legacy. From coercive relationships and domestic violence, to the cruel, horrific realities of child abuse, neglect and exploitation, and these traumatic experiences have a devastating impact on people. The ripple effect is felt by those caught up in the aftermath, our emergency services, social workers, teachers and others throughout the workforce, or as jurors in criminal trials. Across Scotland, thousands of people offer assistance to strangers in moments of crisis, and we know that exposure to traumatic events can have damaging effects on people's lives. The good news is that people are resilient. Just like in physical trauma, the body has an inbuilt self-repair mechanism that can apply equally to mental health trauma. Most people recover through time, and with the supportive and safe environment of family, friends and support networks. Traumatic events occur in everyone's lives, and those can be of variable severity, and the effects on individuals are dependent on their meaning to them. People's reactions are particular to them, so services need to be trauma-informed. Staff must be comfortable to ask about trauma and understand what sorts of help are needed. Some individuals will go on to develop post-traumatic symptoms, and those require treatment. After a major incident, this is about a third of people within three months, and primary care can help using mental health resources in their teams and communities. After a major incident, about one in 10 people will have more complex problems that require specialist assessment and treatment. I know that Alex Cole-Hamilton's call to bring forward a strategy to ensure that people are caught up with an incident and get the support that they need. We have a raft of work under way to support recovery from psychological trauma, recognising the impact on first responders and members of the public, and I am going to describe some of that now. Since I became Minister for Mental Health a year ago, we have been working tirelessly to transform our mental health service into a responsive, transparent and effective service that meets the needs of all who need it. Our NHS workforce is at a record tally, and psychological services staff is up 69 per cent since 2007. We have some remarkable services in Scotland specialising in support to people who have experienced trauma. I recently visited the Glasgow psychological trauma centre, The Anker, and the River Centre, as was mentioned by Alison Johnson in her speech. The River Centre is located in NHS Lothian, and it has centres of excellence for psychological trauma. The Anker centre was at the forefront of responding to emergencies such as the horrific Glasgow bin lorry and Clithibar accidents. Experts from the River Centre helped to respond to the psychological impact of the Manchester arena bombing and the Tunisia attacks. Both services work with abuse survivors, refugees, asylum seekers and others exposed to trauma, and they have international expertise and share knowledge generously to inform national guidance and programmes. Scotland has a multiagency preparing Scotland guidance on community resilience to emergencies, including psychosocial and mental health needs. Large-scale incidents of mass violence such as Manchester and the Tunisia attacks demonstrate that all nations must be prepared to cope with the aftermath of tragedies of all scales. With that in mind, the Scottish Government has been working closely with the River and Anker centre to examine the psychosocial response to mass casualty incidents. The Scottish Government has placed prevention of and recovery from psychological trauma at the heart of our programme for government. Scotland has been the first country to develop a robust knowledge and skills framework for psychological trauma. We have invested £1.35 million in a national three-year trauma training programme, led by NHS education for Scotland, aiming at least 5,000 front-line workers, including teachers, prison officers, social workers and the third sector. Within its first year, almost 3,000 people have received training. Regional delivery pilots commenced later this month in Glasgow, Lothian and Argyll and Bute to deliver local priority training. As of May 2019, the national trauma training programme now has service-level agreements in every health board to coordinate training support and supervision to staff. Last month, the Deputy First Minister chaired the first national steering group to identify first future priorities, and a trauma training plan will be published soon. In order to support the public, we must support staff, most of whom have their own trauma history. Our police, ambulance, fire service and mountain rescue workers dedicate their careers to serving the public, and many are exposed to traumatic events. They are the first responders to suicides, to terrorist incidents, to acts of violence or abuse or to fatal car accidents. Our emergency services staff will fare we take very seriously with support from qualified health and wellbeing departments. A wide range of support services are available, including employment assistance programmes and occupational health support, including trauma counselling and pastoral support. There are examples of best practice. Police Scotland is one of the first police services in the UK to implement mandatory mental health and suicide prevention training for all officers, up to and including the rank of inspector. Another example is the Lifelines Scotland programme. Lifelines was established in 2016 by the river centre to promote resilience and wellbeing of volunteer emergency responders supported by the Scottish Government and library funds. Lifelines provides training and online resources for volunteers and their family and friends. People are encouraged to notice their vital warning signs, as is outlined very eloquently by Brian Whittle in his speech. He embeds a supportive culture and know when and where to get support. The programme has been widely acclaimed, and the work is under way to explore roll-outs to all three blue light services. I would like to close by thanking our emergency services and the members of the public who have dealt with and deal with traumatic experiences in order to help others. Your courage and compassion makes a visible and huge difference to people's lives when they are at their most vulnerable. Trauma can touch the lives of anyone at any time, and it is our collective duty to bring about cultural and transformational change to support the people to live their lives well. Thank you very much. That concludes the debate. Nice to spend this meeting of Parliament until 2 pm.