 I welcome everyone to the 7th meeting of the Public Petitions Committee in 2019. We have two items in the agenda this morning, consideration of one new petition and three continuing petitions. It is my intention, however, to begin with petition 2, and we will go back to the first petition after we have dealt with the continuing petitions. The first continued petition for our consideration this morning is petition 1678, on a national strategic framework for countryside range of services in Scotland, lodged by ranger Robert Reid on behalf of the Scottish countryside ranges association. The clerks note provides a summary of the submissions received since our last consideration of this petition back in October 2018. The Scottish Government repeats its acknowledgement of the services that Scotland's ranges provide, but that its position has not changed in so far as it still believes that it is a matter for local authorities as to how they distribute funds. In response to the committee's specific question on the use of returns and reports from local authorities to provide an overall picture of the level of ranger services throughout Scotland, the Government says that, while such reports can be useful, local authorities are under no obligation to gather and collate such information. In its submission, Scottish natural heritage provides a full note of the meeting of the rangers development partnership held in January 2019. It refers to that meeting as positive, with much lively discussion. It adds that, at a subsequent meeting with COSLA, it was agreed that there is a need to raise awareness of the profile of ranger services in local authorities. It considers that, rather than focusing on the impact of individual budget decisions, the profile of ranger services can be improved by looking at the benefits provided by those services across a range of local authority activities. Scottish natural heritage refers to a positive meeting held between its chair and the Scottish countryside rangers association, which concentrates on ways to move rangering forward. That includes a 2030 vision to look beyond the current period of significant change, budget and certainty, with a further meeting to be held early next year to review progress. SNH states that, over the course of the next 12 months, it will work with the rangers association and the ranger development partnership to refresh the policy framework for rangering in Scotland. Review options for reporting on ranger services and the benefits that they provide co-ordinate the development of a training and development programme and to support the establishment of new junior ranger programmes. The petitioner on behalf of the Scottish countryside rangers association has also provided a further submission. That submission is identified in the clerk's note, sets out the scratch aspirational outcomes from the petition, including a working group to identify any reasons for what it refers to as a, quote, significant decline in ranger service posts, an update of the strategic framework that is at the core of the petition and to secure future funding of ranger services. That submission makes clear that the SCRAD does not consider SNH to be a suitable agency to lead any working group and adds that it believes that ranger development partnership does not carry sufficient authority and lacks the clear leadership required to look objectively at the various issues. Paragraph 12 of the clerk's note identifies other issues of concern highlighted by the SCRAD and I wonder if members have any comments or suggestions for action. Angus. Thanks, convener. I think it's a matter of concern that the SCRAD don't have a lot of confidence in SNH, but that's, you know, possibly understandable given the history of the issue. It's also a bit concerning that COSLA didn't manage to get along to one of the meetings that was arranged, although they do seem to be engaging now with regard to preparing a paper with SNH on the future of ranger services. I think that there's a wider issue here, and it's captured by the rangers themselves when they mentioned in the past the issue of preventative spend, and I think that's an issue that the whole of the Parliament and Government should be looking at in the future. The demise of the ranger service certainly seems to be counterproductive when it comes to preventative spend, so I'd be keen, convener, to perhaps set up a round table and ask all the stakeholders in to discuss a way forward at some point in the not too distant future. Anyone else? I agree with Angus, because if the SCRAD believe that SNH is not suitable to run the working group, I think that we need to give SNH the opportunity to respond to that, and also for other stakeholders to then respond, particularly COSLA, about the funding, about the postcode lottery and about the way that there are ranger posts still not filled at the moment, and there are lots and lots of questions and there's some really informative submissions from a number of people, but I think that we need to drill down with bringing those people in together. I was quite struck by, I think that there's an acknowledgement of this significant decline, but the Scottish Government's saying that, well, it still should be a matter for local authorities, and I think that that's problematic, and there was actually a small point about the small introductory jobs around rangers that people could do, which had then allowed a career path, but they're saying that there's now not a career path, so that in itself must create further decline in the longer term. Are we agreed then that we should look at doing a round table and it would afford the opportunity, I think, to really explore what the job is, why it's important, why there are challenges to it being sustained, and if there's to be a group that's going to ring folk together, who would be the leader in that if it's not SNH? It would be useful to establish that. Is that agreed? Angus? Yes, certainly agreed, convener, and I would hope that the cosla would be included in the round table, but could we also try and identify a local authority that still has support for rangers and ask them to join the round table and give us a positive spin on the job? Just as a subnote to that, I think that I totally understand the Government position saying that it is the responsibility of the local authorities, but surely they still must have an interest in understanding what's going on at that level because it can't just be pushed to one side and allowed to decline in that way. I would share that the Scottish Government do have an interest in that. I think that, certainly, in their submission, they do make it clear that they value the service, but they're still saying that having handed this over to the local government, they want it to be determined at a local government level. There's a logic to that, but if the consequence to that is that it's not sustainable in the longer term, I think that there's a problem. I think that if we can agree to take evidence and make it in a round table format and allow that kind of dialogue, that would be very useful. Rachael Y Llywydd. Do we need to sort of agree who we're bringing in? I did also notice that National Trust for Scotland and Historic Environment Scotland were mentioned within the rebranding exercise, which is an important part of the inconsistency. What we'll do is, with the clerks, we'll get a suggested list of people to come along with your permission. I'll take the authority to do that to make sure that we get that broad range of people who are available and willing to participate. If that's agreed, we can move on to the next continuing petition, which is petition 1698 on medical care in rural areas lodged by Karen Murphy, Jane Rental, David Wilkie, Louisa Rogers and Jennifer Jane Lee. I welcome Rhoda Grant from the consideration of the petition. At our previous consideration of the petition on 22 November 2018, we agreed to write to the Scottish Government and the Scottish Rural Parliament, members will be aware that those submissions have been received alongside the petition's response from Karen Murphy. Issues have been raised with regard to the remote and rural GP working group about its transparency and the scope of its work. We have recently received correspondence of a troubling development that has taken place, whereby the vice-chair of the Rural GP Association of Scotland, RGPES, has resigned from the working group. It is a committed decision that I should resign from the SLWG working group and for RGPES to withdraw from further working group work. We need to see more tangible and convincing commitment to addressing the issues affecting our members and our rural communities in Scotland. Despite the questions that are asked and the submissions that have been received, there are still a number of issues that require further scrutiny, namely issues relating to the calculation of the Scottish workload allocation formula and the implications of the new GP contract. The most recent submissions from the Scottish Government states the background and intentions of the new Scottish workload allocation formula, but the specific issues raised by the petitioners are not addressed sufficiently. The lack of clarity appears to be the case on this issue and the other issues raised by the petitioners. You will note that, for general questions today, relating to this topic, we have questions from Gail Ross to ask the Scottish Government what steps it plans to take to re-engage the rural GP association with its remote and rural general practice working group and Donald Cameron to ask the Scottish Government what action it is taking to support GP practices in rural areas. I wonder how members have any comments or suggestions for action. The Health and Sport Committee is doing quite a piece of work around the GP contract. Just so happened last week that we had a rural NHS board in and asked a specific question about the acceptance of the GP contract and how that has been accepted by the GPs. They were not quite so candid as I would like them to be, but what they did say was that there was only, although 70 per cent of respondents to the GP contract were positive, it was only 30 per cent of GPs replied. The inference seems to be that there is an issue around the GP contract in the rural area. It would be good to get the cabinet secretary to ask her opinion on that, but cross-referencing with the work that has been done in the Health and Sport Committee would certainly help. Can I ask Rhoda Grant to come in at this point, since you have been working with the campaigners and then I will bring other folks in? As you know, convener, I cover the Highlands and Islands, and that is a really big issue in my area, because there are a lot of rural GPs. I do not have the figures with me, but I understand that there was polling done of rural GPs and how many had supported the contract, and that was a very low number. Most were against the new contract. It does not recognise the differences of how people operate in rural areas. There might be a larger number of home visits, for example, because they are keeping people out of hospital. Rather than having elderly people sent away, they have much more hands-on caring, and that is true when GPs are responsible for local hospitals such as Campbelltown, Galsby and places like that. They have additional work that is not recognised in the contract, and it is very specialist work. The way that the contract has been drawn up has really impacted on the morale of rural GPs who often work above and beyond and therefore do not feel valued at all. It also flies in the face of what we all recognise as issues with health inequalities, in that it has not worked for rural areas and neither has it worked for deprived urban areas. It looks at the number of appointments available and it also looks at the age profile of patients in a practice. We all know in deprived areas that there can be a 10-year life expectancy gap, which means that deprived areas get less because their patients do not live as long as other areas. It seems to have moved funding in the opposite direction to where it was understood that funding needed to move. To that extent, I think that the whole contract needs looked at, but it certainly does need looked at with regard to rural GPs because we struggle to fill those posts. If the contract goes unchanged or without an addition that deals with rural practice, we will see that getting worse in the cost of localities is extremely high for rural health boards. There seems to be a disagreement between the Scottish Government's submission in which it stated that the new formula gives greater weight to older patients and deprivation. I represent a rural constituency as well. I think that it is concerning, first of all, the number of GPs that have fed into the health and support committee, but also the high level of people who are dissatisfied with the Scottish workload allocation formula. I think that there is a disagreement here between what the petitioner is saying and what the Scottish Government is saying. I think that we do need to tease that out somehow. My recollection of my last discussion is that the kindest is counterintuitive to have more money coming into the system and it takes money out of poor communities and it takes it out of rural areas. I do not know whether it takes account of, if you count it by appointments, we know that in more deprived areas people bring more problems with them, so there may be comorbidities and other issues that they bring as well as the presenting problem. It is also very struck by the petitioner's submission, expressing frustration that some of the very significant questions that they were flagging up were simply not answered in the Scottish Government's submission. There seems to be a process issue and I do not pretend to understand it properly, but the fact that the technical advisory group on resource allocation was not consulted, which would be the normal process, and the question is why. I think that that is the kind of thing that we would want to explore. I do think that it would be useful to bring the cabinet secretary in and I hear what Brian is saying about looking at the contract, but it looks as if there is a specific issue about a subset of those who are GPs, which is the rural GPs, for example. In a big practice in the city you will have other staff that can do various different things for you. You do not have to do them, but in a rural practice there is not going to necessarily be the folk with that. The range of people who could do those other jobs for you, so it obviously increases the pressure on you. They do flag up the whole question about rural proofing, which I was quite interested in how that feeds itself into Governments, so that the Government understands what rural proofing actually is, or the island proofing. What does it mean in practical terms when you are making that kind of decision, when you are making a provision for a service right across Scotland? How do you make sure that, in my case, deprived urban areas are supposed to all urban areas, rural areas and remote and fragile areas are how they are factored in as well? I have two very strong things. The fact that the short-life working group was not allowed to revisit the contract and itself was not responding to the question that the petitioners were raising, but that, secondly, they feel that their questions have not been answered. That is quite a big issue there. To follow on from what you said, one of the other things that is early in the investigation, which is obviously coming out, is the likelihood of a rural GP having that team around them, having a physio, having a mental health expert, having a pharmacy around them is much less likely than in an urban area. Without question, there is a big disparity there, and I think that the contract itself is not addressing that, I think, so it would be good to get a comment. I suppose that the other question that I would raise would be that, even if it were special pleading, which, obviously, if people are negotiating, they are going to make their case, if the consequences that we are not attracting people into rural areas or GPs will get a major problem, and some of the submissions, I think, make that point very strongly too, because it then has consequences for the sustainability of those communities. It does make that point in saying that there is limited reassurance and there could be knock-on effects in terms of recruitment and retaining GPs. We are already experiencing that in rural practices where GPs have their lists, patient lists have actually increased because the number of GPs that they are attracting is, in some circumstances, non-existent. If we have a philosophy of primary care without national jumping immediately to acute services, then that is also important that that GP provision is sustainable. Excuse me, thanks, convener. We shouldn't forget that there were significant concerns from rural GPs even before the contracts were introduced. Given the continued concerns that have been raised not only by the petitioner, including not just concerns but frustrations, but also by the Rural GP Association of Scotland, who has stated in their submission that the serious concerns that the GP contract is not fit for purpose in rural communities, there are quite a number of questions that need to be answered by the Government. I think that we should consider inviting the cabinet secretary in to give evidence on this specific issue. Any final points, Rhoda? Just a point that you made yourself, but just to emphasise it about the working group. The working group was set up to sort this out. Now, if the people that are on the working group have no confidence that that is going to happen, then I think that it is important to bring that to the attention of the cabinet secretary and see where we can go to make sure that the problem is solved. In that case, we are agreeing that we do invite the cabinet secretary for health and sport to provide evidence to the committee in the matters that are raised. The submission has received a date, and I think that we would hope to do that speedily because we realise that this is an on-going issue. As long as it is not resolved, it is going to have consequences for the broader health provision in rural areas. I thank Rhoda Grant for her attendance. If we move on to our final continuing petition for consideration today, which is petition 1705, lodged by Alex Millan. The petition calls for a review of legislation relating to investigation of and penalties applicable to wildlife crime in Scotland. The clerk's note refers to the Scottish Government's submission in which it states that it intends to bring forward legislation to increase penalties relating to wildlife crime. The petitioner has welcomed this intention and has indicated that he would respond to any consultation that the Government brings forward to inform any primary or secondary legislation. The petitioner has also provided what he considers to be potential solutions to the current difficulties in presenting video evidence in the context of wildlife crime. He notes that those challenges were recently discussed as part of the environment, climate change and land reform committee's consideration of the wildlife crime annual report 2017. I wonder if members have any comments or suggestions for action. Thanks, convener. The petitioner rightly highlights the issue of video evidence. As a member of the clear committee, we have been looking at this issue for some time and there has been video evidence that has not been used for various reasons, but it is concerning that it can be used as evidence. Given that the clear committee recently took evidence on the wildlife crime annual report for 2017, because we are always kind of a year or sometimes two years behind on the annual reports, given that the issue of wildlife crime has been very much on the clear committee's radar since the committee was formed and its predecessor committee, the RACI committee, took the issue extremely seriously. I think that there is a good argument to refer the petition at this point to the clear committee so that it can give the time and concentration to it that it perhaps deserves. Okay. Any other views? Everybody is agreeing, then, that we want to thank the petitioner for the very substantial response that he provided for the consideration of this petition, but we would agree to refer the petition to the Environment, Climate Change and Land Reform Committee for its consideration as part of its on-going work in relation to wildlife crime and for any potential scrutiny of relevant legislation in this session. Is that agreed? We want to thank the petitioner. I think that there has been significant progress made as a consequence of the petition. Obviously, he will be able to follow the consideration of the committee in its work as it continues to look at the issue. Can I suspend briefly? If I call a meeting back to order, can we now turn to the consideration of a new petition? The new petition is petition 1716, which calls for a full review of mental health service provision across the NHS in Scotland to ensure that policy and practice is delivered consistently across the country. I welcome Monica Lennon to the meeting for this item. The petition was lodged by Karen McKeown and Gillian Murray. The background information explains the circumstances that led to the petition. Members will also be aware that those circumstances have been addressed here in the Parliament at First Minister's Questions and have also received significant media coverage. The note prepared by Spice and Eclats provides some data and statistics and outlines the range of strategies and action plans that have been taken forward by the Scottish Government. Members will recall that, at our last meeting, we took evidence from the Minister for Mental Health and at that meeting, the minister restated her announcement of the independent overarching review of the Mental Health Act and incapacity legislation. For consideration of the petition today, we will take evidence from one of the petitioners, Karen McKeown. I thank you for attending this morning, Karen, and I want to welcome you. Would you like to make an opening statement? I thank the ministers for considering their position and for giving them the opportunity to be here today. I also thank the sympathetic and caring support by the petition clerks during this process. Luke was my best friend, he was my partner, he was my rocking soulmate, he was a devoted father to our two wonderful children, Luke was a hard-working, kind and generous person. Chargically, he took his own life and I feel that this was a preventable death. During December 2017, Luke began to act totally out of character. I started to notice that he had become mentally unwell and I was desperately concerned for his safety. He began to have visual and audio hallucinations, he was unable to sleep and that lasted over three weeks. I became more and more concerned that I was unable to keep him safe and he was unable to keep himself safe. One day, Luke left the house, when he returned, he was acting very odd. Luke told me that the voices in his head were going to kill him like murder and it would be put down to suicide. My concerns grew and Luke agreed for me to call the NHS 24. He advised me if I was concerned for my own safety to call the police or take look to accident emergency. The first time I took look to accident emergency was on 29 December 2017. Between 23 December and 29 December, we tried in vain to get help from the hospital on two occasions, the CPNs and addiction services. I begged every service to help us or point us in the right direction of support or even just to give him medication to ease his symptoms every time we were turned away and abandoned. I also called NHS 24 on a further three occasions. We also had the added issue of Luke being removed from his GP practice prior that year. I phoned every GP surgery within our area and asked them to help us and begged for appointments. I even begged my own GP surgery to take look on as a temporary patient but, as it was a Christmas holidays, no practice was taking new patients on at this time. Every professional I spoke to, I made very clear my concerns that Luke was planning to end his life. Time after time, I pleaded for help begging. I knew by Luke's odd behaviour he was unable to keep himself safe any longer and my concerns just grew. Every time we were dismissed and turned away. On 29 December 2017, I woke at 2am to find Luke hanging from my stairs, feet away from where our children were sleeping. The events of that night has shattered my world. I will relive that memory for the rest of my life. It will never leave me. My children have been left without a father to care and guiding throughout their lives. Me, my children, our wider family and local community has felt this loss. After Luke's tragic death, I made a formal complaint. I was shocked to read that in their findings that they said Luke showed no signs of mental illness and was not suicidal. The report concluded that staff had followed the correct procedures, even though on every occasion I dealt with professional I voiced serious concerns of Luke being suicidal. Once again, I was told that the correct procedure was followed not admitting Luke to hospital. If that was the case, I asked if current procedures are fit for purpose. I also asked why a fatal accident inquiry is not automatically carried out to ensure that lessons are learned. I would like to see a review of the mental health service to ensure consistency and quality of our NHS. Luke's case is not unique, far from it. The same failures are happening up and down the country. Lessons must be learned. Crisis support needs to be available 24 hours a day, 365 days a year. Most importantly, family concerns must be listened to and not dismissed. We understand those we live with, but we know there's something just not right. Nothing I can do will ever bring Luke back. It's my duty to look as his partner and mother to his children that I continue to campaign for change. We urgently need a mental health service that is fit for purpose. I need to look at my children in the eye and tell them that their dad did not die in vain. Luke's legacy will prevent other families from going through such horrendous pain and distress as we all have went through and continue to do so. We need action now, and this is for everyone who has lost their life to suicide, including Luke. Gillian Murray, Cairns co-petitioner, is not able to attend today's meeting, but has provided a statement that has been circulated in members and with her permission, which will read out for the record. Most of us are aware of David Ramsey's story. David Ramsey, my uncle, was failed by NHS Tayside and took his own life following a breakdown that resulted in psychosis. Despite three suicide attempts in four days, David was sent home after a second emergency assessment at Cairnsview Centre, and consequently took his own life. Thankfully, the Scottish Parliament listened to me last year and inquiries under way into NHS Tayside mental health services, due to the sheer volume of similar cases to David's. What struck me from my campaigning is that those mental health failures, although they seem to be more concentrated at NHS Tayside, are not unique to Tayside. The same failures are repeated throughout Scotland and, most concerningly, no lessons ever seem to be learned. I do not want another family to go through this pain. I do not want to become another statistic myself. I cannot be there in person today because I am now unwell due to the NHS failures that cost my uncle's life. I have been diagnosed with post-traumatic stress disorder. The impact of my life has been enormous. I have had zero help from the NHS despite working and paying into the system, other than a repeat prescription of medication. How can it be acceptable that my uncle was failed and now I am being failed? Why are no lessons been learned? Why is the ripple effect allowed to continue? Why is it a postcode lottery, whether you have access to a mental health service that is fit for purpose? Why are bereaved families having to campaign and fight for parity of esteem and for justice? It cannot be right that a prisoner who takes their life in jail receives an automatic fatal accident inquiry, yet patients under the care of the NHS are taking their lives in a secure psychiatrist ward, yet no fatal accident inquiry takes place. We can now move to some questions. We will explore some of the issues that you have highlighted and then we will look at what we want to do with the petition. We do appreciate just how difficult this is for you and how personal it is for you. You have always highlighted some of the things that have already been done and the fact that Monica Lennon raised the first minister's question. There has been some reporting of what has happened in the media and I know that people will be familiar with the background of your petition. You indicated that you had a meeting with the minister for mental health and I wonder if you want to say a little about that when that meeting was. Has there been a follow-up to that? I met with the minister. It was early in October last year. She listened to what I have just told you, but that was all she had done. There was no follow-up, no action, nothing else came out of that meeting apart from the minister listening to me. That is all that I can really say about that. Thank you very much for giving us your evidence. In your petition, you stated that your loved ones asked for help a number of times. I did your family's expressed concerns, but those concerns were dismissed with no offer of health support. The dismisses are quite a strong connotation. How did the NHS staff feel about that? The dentist did not even give his medication. When I was asking him, could you give his medication ease his symptoms, he just dismissed that he was mentally unwell altogether. He was not suicidal, he was not mentally unwell, there was nothing wrong with him, he was a healthy man according to them, so that is why I feel that I was dismissed. I feel very strongly that it was dismissed, that Luke's concerns were dismissed, my concerns were dismissed and it was dismissed. Just for clarification here, the NHS staff that you saw did not recognise any issues? That actually became quite confrontational when I was telling them my concerns. I came from a background of nursing, so I have some understanding of mental illness. I came from that background and I have also come out that I have been assist trained and I have been safe talk trained, so everything that I learned in that training told me that there was severe warning signs there. When I was trying to explain that to the staff, they just dismissed, I did not know what I was talking about, Luke did not know what he was talking about and he was not mentally unwell. Outside of the healthcare service, are there third sector organisations that could potentially help? Did you seek help from them or did you get any feedback from them? At that point in time, when I was researching and trying to find somewhere to help us, I could not find anywhere that was available at that point in time. Since Luke's death, I have found some amazing organisations, there are farms, there is Christy's house, there are some amazing organisations out there but I did not know about them at the time. That was something that I brought up at the suicide review. I brought up and asked if the NHS staff could not help us, why did not the point be in the direction to Christy's house, which is not even a mile away from where Bishop General is. How could the point be in the direction? I got told that they do not endorse charities and that that is not something that they can advocate. I was disappointed myself. The reason that I asked is because I have a constituency case exactly the same and it has been difficult to find the services and there are fantastic services locally and it has been difficult to actually point them in that direction. Thank you very much. I wanted to ask you a little bit about some of the asks that you put into the petition. One of them was that you felt that the assessment tools are inadequate. I wondered whether you could expand on that a little bit but also tell us whether you believe that, since you have been speaking to Christy's house and farms, that they share the same views? I do feel that the assessment tools are lacking because, in the investigation and stuff, all the risk assessments were apparently carried out and they were all in place for a look according to the NHS but the assessment tools should have recognised that he was suicidal just like I recognised he was suicidal. They are missing key aspects and the assessment tools are really lacking people. Some of the questions that they ask do not actually get to the root of the problem. They are skimming about the issues and the most serious questions are getting missed and they are not getting highlighted and I think that is where the problem falls. The fact that we risk assessments as well is that it needs to be a generalised system so that if the social work, the health organisation, the justice team, they are all putting their risk assessments into one central system, right now they have all got their own systems. Risk assessments that were carried out in a look at previous years, it says that he was a high risk agon to self-harm. They were missing when we went to accident emergencies so that is where I am talking about the assessment tools all need to be looked at and a heuristic approach. You are talking quite a long time frame here from when Luke First was assessed and you are clarifying that basically for A&E they had seen that risk assessment that perhaps they could have had more information and that is what you are asking for. On the risk assessment that was done for a look at that time, I have seen that I have got his medical records and I went over it and I do not necessarily agree with the answers that they gave. They said on it that he had not suffered a recent loss of bereavement and that is not true. He had lost somebody very close to him 13 weeks before he died so that obviously had a massive impact and that was missed in his risk assessment. The risk assessments need to be addressed and I think they need to be more robust because when we were in that accident emergency room there is no way he done a risk assessment in the time when Luke was in with him because he was in maybe 10, 15 minutes. There is no way he has done a risk assessment. There is no way he has done a safe plan. There is no way they have done any of those kind of things but what the nurses are doing is they are doing it after the patients leave and I do not think that that is good enough. I think that they need to be done there and then. The timing on Luke's records when his risk assessments were done are a long time after from when we left accident emergency. Can I just ask one little question? Karen, you talked about Chris's house and you found that after Luke had sadly died but when do you speak to other people in these circumstances and they say similar things about the assessments and about how they are not joined up together? A lot of organisations feel that the mental health system is failing. I know there are a lot of organisations out there that have tried to get help even like contacted patient services trying to get patients' help. They are feeling as if they are up against it as well. It is not just kind of me that is feeling like this. All the organisations out there are feeling the same. The assessment tools need to be looked at, they need to be more robust and they need to be more patient-centred as well. It is very much still running the nursing model and we need to get away from the nursing model. It is no work for years and we need to change. As other organisations are feeling the same way, I thank you, Karen. Angus MacDonald, you have also said that you want to see a review of crisis support services outside office hours. I am curious as to who you would want to carry out or be involved in such a review and what, in your opinion, are the main issues that should be looked at? I think that mental health services need to be available 24 hours a day. At the present time, the majority of hospitals in Lanarkshire, in particular, I know here, Myers and Monklands currently do not have psychiatrists that sit in the hospitals after office hours, particularly over Christmas period and holiday period. It is a skeleton staff, so the psychiatrists and stuff that are not available are what they are through office hours. I would like to see a central hub set up so that it takes it away from accident emergency. Everybody is not going to accident emergency for mental health, because going to accident emergency can be quite distressing for the person in itself because they are experiencing all this torment and so sitting in a busy environment is not the place. It needs to be a central hub away from the hospital and somewhere a mental health nurse will be sitting and you can go as a crisis. I think that all crises need to be brought into that, including drugs and drug psychosis and things like that. I think that mental health is so wide and the crisis is getting worse for all mental health aspects. I think that your suggestion of a central hub seems to be an ideal solution and we will make sure that that is fed in. Do you know of any concerns that are shared by others such as the mental health support groups that you mentioned earlier? Have you discussed them? They are the first non-medical 24-hour help service that is out there, so if they did not feel that there was a need for that market, they would not be there. They are 24 hours a day, you can call them at any time and they will give you support that way. They have already started to go that way, they already feel that there is a central hub needed and it just needs to be wider spread throughout the Fully Scotland and the Fully Lanarkshire and it needs to be available. There needs to be consistencies through different health areas as well because a lot of things that other health boards do, such as NHS Lanarkshire does, and there is no consistency. From one health board to another, it is night and day. Even going from your camp services, from Motherwell Ebell Sull, is a massive difference. Some camp services do not even take over 16s, they shut you off and then adult services do not take them on to 18s, so there is a gap in the service there as well where crisis help needs to be addressed. Of course, there is the issue with signposting that you mentioned earlier. You were not aware of services? I feel that if we were maybe signposted to places such as Chrissie's house and farms and some of the other amazing organisations out there, that could have maybe made a bit of a difference. That could have maybe been somebody for Luke to talk to. Maybe their opinion turned the hospital that Luke this man is genuinely unwell. Maybe they would have listened better to somebody like that than they listened to me because they were not listening to me and they were not listening to Luke because Luke told him who was in the well, Luke told him who was hearing voices, Luke told him that he was not sleeping, Luke told him that he needed something to help him and they did not listen to him, they did not listen to me, so maybe an organisation like that they would have listened to. OK, thanks, Karen. David Torrance. Good morning, Karen. You have suggested that a fatal accident inquiry should be conducted if a person dies by suicide and has been in contact with mental health services in the previous three months. Can you expand on this, please? Yes, I feel that the suicide review that it got carried out by NHS Lanarkshire and then the complaint after that, it was gathering the information, it did not investigate what actually went wrong here, where was Luke actually failed, was it the assessment tools, was it the staff attitude, where does the lessons need to be learned in this case. I feel that the only way to gather that information is a fatal accident inquiry and I also feel that if somebody is being in contact with the services that close to their death then definitely a fatal accident inquiry because if somebody dies in prison it's automatic, so how is it not the same it should be the same consistency as if somebody's been in the care of the NHS and then went on and took their own life and I feel that that's kind of a big one for me as a fatal accident because I feel as if a fatal accident inquiry takes place for Luke and David's case, then maybe lessons would be learned, maybe if they started to learn lessons from previous suicide it would save more people's lives. So I'd say the fatal accident inquiry is definitely a big one for me and that's the kind of one that I really want for Luke as a fatal accident inquiry, just so that lessons are learned. You put a timescale of three months on the fatal accident inquiry and can it be shorter, longer, what's your opinion on it? I would, I just kind of said three months because I knew you wouldn't be able to say if they've been in contact with him the last year, that's unrealistic so I think three months is maybe a bit realistic or even maybe a month but Luke was in contact with the mental health services the day before he died, we were at the addiction services on Thursday the 28th and he took his life at two o'clock that next morning, before that we were at the 27th we were up at accident emergency so that's for him to be in contact with the mental health services so close to his death and then going to take his life. I don't know why I feel that accident inquiry hasn't been happened, it kind of baffles me, I feel as if it should have automatically been done anyway and that's kind of why we're here today. Good morning, convener, committee. Karen, I feel quite privileged to be here today in support of Karen, Angeline Murray and the petition and their campaigning and they're just both so courageous and I'm just so full of admiration in many respects. Karen's not just a constituent now, she's a friend and I wish I didn't know her so well but I'm not as brave as Karen but Karen emailed me not for the first time in touch about another issue but during Christmas recess in 2017 my office was technically closed, my staff were on holiday and I was the person monitoring the inbox and you joke that oh well it'll be a quiet time unless there's a flood or something locally that there won't be much happening. I checked my inbox very early on the morning of the 30th of December, it was a Saturday morning and Karen McEwen had emailed me at 7.42 a.m. to inform me that the look had died at home by suicides so that was really the start of my journey working with Karen and her family and I'm grateful to Karen's sister who's in the gallery today because I think without having immediate family support I don't know how people can continue in it and I think it is such an injustice that Gillie Murray can't be here today because she now is struggling with her own mental health and is experiencing post-traumatic stress disorder. We, in my office, we've spent a lot of time with Karen, we've been in touch with NHS Lanarkshire, we've progressed the formal complain and you know the ombudsman and so on and I'm aware that in Parliament and in government there's lots going on nationally in terms of different reviews and different strategies but what Karen's talking about today isn't so much about legislative change, partly it is about culture change, it is about the attitudes and I know Karen won't mind me saying this but having studied all the information about Luke's case and about Karen's experience I think partly the reason why Karen was dismissed by professionals is perhaps because she's a young working class woman, someone who's seen as just a mother, just a partner who doesn't have the right insight, the right knowledge and I think as Karen has shown very powerfully today is that she's right you know if you love someone, if you love the family member, you know that person inside out she was able to see the changes in Luke's behaviour and new medical history and I think the fact that we don't have integrated data, integrated health and care information shows that when there are those gaps people fall through those gaps so Karen's already touched on some of the points that I wanted to make and I'm grateful to members here for your very considered questions. I know as a central Scotland MSP that even within Lanarkshire there are inconsistencies but as we know from Gillian Murray's testimony and taste side and I'm sure other members will know from their own areas that there is inconsistency right across the country so I just want to ask Karen given that you've been able to work closely with Gillian Murray and organisations like Christy's house that brought you into contact with other families. At a national level we say that people should ask once and they'll get help. Are there areas in the country that are doing this really well and are learning the lessons and we can look to that good practice or do we really need that national approach where we have to make sure that in terms of guidelines, in terms of the out of our services that you've mentioned we really need to look at a whole sale approach. I would say from speaking to the people that's contacted me through my campaign I've no kind of heard any positive feedback from the mental health service but what I can say from my own experience with my son as CAMHS but from going from a service that Vic said that he didn't fit the criteria and then going to a new service who is I honestly cannot fault the CAMHS worker that he's got at the minute. She goes above and beyond, she's really helping, she's really there for me and stuff like that so I can't actually fault so that is the only kind of good experience I've had. I would say out to everybody that's told me I don't think there's any services that are actually getting it right part of the charities and there is some amazing charities out there like Chris's house, FAMHS and then in our local area there is a new one that's just kind of opened up in the one of the local high schools so there is some amazing charities. I would say that the charities are the best way to go forward because they're the ones that are actually out there pushing and campaigning and actually understanding the people because I don't feel as if the NHS are getting it. Can I pick up on the question around the ministerial meeting that we had? I was with Karen at that meeting and we did have high hopes because it's great that Scotland does have a mental health minister, it's a dedicated role and the current minister has a mental health nurse herself with lots of experience in the health service. I think it's fair to say Karen that you didn't ask for that meeting to have a cup of tea and to have more sympathy because there's plenty of sympathy around what you were looking for was action. In the meeting we discussed the fact that there is there are additional barriers when it's perceived that someone has a substance misuse addiction or that they actually do and there's different doors that people are sent to and sometimes it's a case of you have to have your addiction resolved before you can access mental health treatment. Can I just ask you to say a bit more about that because when we've discussed it you've expressed that there is that disconnect. When we asked the minister about it she advised that she was working on the mental health and suicide prevention side of it and the public health minister was working on the addiction side of it. How do you feel about that? The addiction side is it caused a lot of problems, but it looks case in particular and I know it causes a lot of problems for other people because as you said the addiction has to be addressed before they'll deal with your mental health. My opinion is addiction is mental health. You use a substance whatever it may be to black out from what's actually going on in your head so it's just adding fuel to the fire and looks particular case look at actually stopped using substances three or four weeks before he died so he had addressed fair enough it wasn't fully addressed but he had addressed addictions issues and he had he had no longer taken any substances when he in the time he died because in his toxicology report it came back with nothing any system so I'd say the addiction side of things is causing a lot of hassle where people are saying you have to go addictions you have to go addictions you have to go addictions well where's the crisis centre for addictions where's the crisis centre there where is the where is the pathway programme for people that's coming off people that's coming off cocaine where is the recognition that there is psychological effects that there is withdrawal processes easier and it can lead to cycle that can lead to drug induced psychosis which is a mental health condition so although the addiction needs to be addressed it does it is mental health and it does lead to mental health and I think that needs to be addressed wider as well so you've probably seen me back in a couple of months and you've talked about some of the attitudes that you've encountered and no doubt you know you know many the majority of people working in our health services are very compassionate and you know shared the values of the NHS but there is a lot of stigma still around mental health but particularly around addiction that that stigma do you feel that it's still a barrier for people who are trying to access services? I think with the stigma that comes it to say you're addicted to something people automatically assume that it's heroin or alcohol and I think that there's a wider range of addiction issues out there there's the legal highs that are in the up in the crisis it's going to come with that in the coming years it's going to be phenomenal you've got the cocaine epidemic that you throw a stone and you'll probably find somebody that has either took it or has to or still takes it and I think that these side effects need the effects of the addiction and the stigma surrounding it needs to end because it could happen to anybody mental health shows no discrimination addiction shows no discrimination and everybody in any walkie life could be affected and I think that's where the stigma needs to kind of get broke it's coming from the kind of tap is be clear hockey it was that's not my issue that's somebody else's not it's mental health it's everybody's issue it's it's our country and if we want to make our country better we need to start putting things into like mental health and addictions and education and all the other things that really need more attention rather than the pettiness that is getting spent on can I just bring up another point briefly convener Karen as I said emailed me in December the 30th of December 2017 just before New Year's Eve last year so 2018 I had an email from another constituent in Lanarkshire from a father of a young man who's in his 20s and I'm still haunted by Karen's email and I got this other email there were echoes that felt very similar and the reason why I wanted to mention that is because today the committee's touched on the fact that there are times in the year when people are more at risk Christmas can be a difficult time and when services are winding down for Christmas holidays it can be more difficult to get to get support on New Year's Eve I basically had to doorstep NHS Lanarkshire and go down to their headquarters in Boddwell because this young constituent who had been discharged from hospital again wish or general actually discharged in early December after a suicide attempt and he completed psychiatric assessment which I think takes five ten minutes he takes some boxes and and he was discharged but I think it was the 29th of December his father got in touch and they were very concerned and they thought he was at high risk of suicide when I went to NHS Lanarkshire because they were having trouble getting access to the community substance misuse team and I was told that they were reluctant to give me the phone number for the community substance misuse team is a mobile phone number and they were very concerned because the service is really overstretched and they were worried that they might get in a dirty with the call so I promised that I would not advertise the phone number that that was that was New Year's Eve and I was genuinely afraid I was worried that this young man who I can't name because his family are going through hell there's there's drug addiction there's alcohol addiction and he's now going through the justice process but I was worried that he was going to be another look Henderson so it does strike me that at that time of year at Christmas in New Year that's a particularly difficult time I just wonder Karen from your contact your network now of people sadly affected by suicide across the country is that a common experience at that time of year that it can be very difficult to get help it's definitely very common because the skeleton staff that run over Christmas in New Year it's not they're not really full capacity for nearly two weeks sometimes a bit longer depending on where the holidays fall and stuff so it's definitely something that echoes throughout the full thing even I know how but I'm like at Christmas now and like Christmas past there it was horrendous but I'm lucky enough that I have good family and I have my mental health does deteriorate times but I'm lucky enough that I can I'm unable to pull it out I have good supports but no everybody's got that and it's definitely Christmas period there needs to be more support specifically around Christmas in the holiday periods thank you and just one last time to be point convener thank you for your your patience thinking about Karen your own health now and and Gillian Murray and people who have gone through this there is work going on nationally and the Scottish Government are doing good work on this to make sure that all services are trauma informed across the health service it can be quite difficult to go back into the GP practice to go back to to A&E to go back into hospitals when when perhaps that's you know bringing up quite difficult memories and also you feel like you're having to answer all the same questions and sometimes there's a bit of judgment there. Is there any last point you'd want to make about how widespread training needs to be beyond just the mental health specialist? Is it everyone across the NHS that needs to be up in their game on this? I definitely say that all aspects of healthcare specifically GP's, I think some of the GP's, I tried to get myself a GP surgery and found myself in a middle of a full blown debate with a GP who told me that had to go grow up. Now I feel that at that point in time I was mentally too well at that point and I needed somebody to say to me right look this is what you need in time I suppose calm me down a bit which a GP should do so I definitely feel that GP's in more healthcare workers have to be more advised on suicide in mental health and the awareness and stuff like that but GP's in particular needs to be more aware of how to handle patients and how to recognise that somebody is in mentally distressed but I definitely feel that it has to be widespread. Can I ask you to think that the problems were compounded by the fact that you had to go to A&E where people, the staff would, I mean is not to excuse any treatment but under pressure not specialists in terms of mental health do you see them being almost like a specialist A&E place to go of somebody's in crisis? That's what I would like to see happen like a specialist NHS place for crisis just for mental health because I feel that mental health is more important than physical health and getting them to go and sit there at an accident emergency where it's Friday and Saturday nights it's jam packed sitting at the door when they're in that much torment that's not they need somewhere quiet secluded somewhere that they can go and afloat and feel safe and secure no somewhere that's like too much kind of going on around about them. Important obviously then even if that were the case giving you the experience that this information provided about how people get the help they need. One last question I have now and I'll just check whether committee members have any final points. You'll know that this committee gets a lot of petitions particularly around mental health and very often sadly tragically come out of tragic experiences and newly covered petitions I've shown amazing courage in that but we know that this is something that is happening across our communities you might be aware that the Minister for Mental Health was here a couple of weeks ago and she had announced an independent overarching review of the mental health act and other associated legislation and I wonder whether I know that you've been sent the information you may not have been able to look at it all yet. Do you have a view on that and how do you think the issues that you've highlighted today should be played into that review or can they be played into that review? I feel that it's good that the ministers review the legislation but in terms of that helping look I don't know how changing legislation unless it's the fatal accident inquiry getting put into that I don't know how that would kind of help in look specific case. I've not really looked too much into it I've read wee bits and I'll need to look into it a bit more but from what I've read in the legislation changes it needs to be more the policies and procedures that are actually in place rather than the legislation surrounding it and I feel as if it's good to talk we can talk until we're blown in the face but unless action starts happening it's no going to change any. I was quite struck by this issue about seeing it as a public health issue around addiction and suicide around mental health when I thought they do feel intertwined I mean logically in our communities anyone who's known anyone with an addiction I don't pretend to understand addiction may come first and then mental health issues but sometimes addiction is a consequence of trouble in somebody's life as well so I'm not quite sure how they can be divided off in that kind of way but that's maybe something that we can pursue with the Scottish Government. I don't have any final questions. I've just got a point really. I think the story really resonates with me I have to say this idea of difficulty to get your voice heard. I've done this, I've gone with somebody that's quite close to me with their partner to a GP with the person having attempted suicide three times and likely of leaving that surgery without getting any kind of help whatsoever. And as a last roll of the dice I said to the GP that if this person does succeed in taking their own life I will make sure that everybody knows that I've been in that GP surgery and raised this with him now that's I'm not advocating that whatsoever but it was only that it was only in saying that the GP then agreed to to take some positive action and I am absolutely convinced if I hadn't done that that person would be with me today and I know the impact that has had in me over a number of years and that person is still here so I'm very brave of you gallant to come in and give us your evidence but you shouldn't need to go to those lengths that I did to keep your loved ones safe and we know we know there's huge issues with pressures under the NHS and we know that an assessment by a GP is subjective but it does strike me that the systems that we have in place are not adequate to deal with the continuing mental health problems that we have. We see them through this committee almost every single month and it's the same within the health and sport committee. We have a system that is under huge pressure and is broken and somehow or other we have to find a solution for this. Thanks for that Brian, I think that it's the issue of my generation I guess that has come to the for and away in the past it wouldn't have been really even spoken about and that where there are lots of people in the system who are doing their best there's something that's happening that's preventing the help getting to people when they need it whether it's how they read someday whether they're under pressure themselves whether they're not trained in that in that field or whatever I think it's a massive issue I do think the fact that the Scottish Government is reviewing the legislation is significant but we should perhaps obviously be in terms of that review ensuring that what you say that what then comes out of that review is not just legislation that we all can be happy with but the policies come behind that. I don't know if there's any last comment you want to make before we finish consideration. Just someone that striped me with Brian said one of the last things that I said to every person when I left that NHS if anything happens to him use will he and me and by God they're here in my new because I don't want to hear another case that their families have tried and begged that this is this is a man that's lost his life this is children that's grown up without a father I'm gonna grow without him beside me so I don't want MDLs to feel that pain and I think that I can just thank you for even giving me the opportunity and listening and just hope that something does come of this and it does save people's lives. I think we would want to thank you because there's no doubt that you speaking out about your circumstances and forming the petition the way that you have done you're speaking not just for yourself you speak very powerfully for yourself and for your loved ones but also I think speak to a broader community that needs help as well we really appreciate that and we'd also want particularly to put on record a thanks to Gillian your co-petitioner and hope that she is able to make a recovery with the support of her family we understand how difficult the pressures are on her. In terms of how we take this forward I think I think we want to write to the Scottish Government and perhaps some of the other key organisations that have been identified to seek the views on the action called for the petition because I'm very struck that you have not just said this is what happened but this is what needs to change and I think there's quite a lot there that different organisations may want to respond to perhaps some of the organisations involved around mental health I'm quite interested in looking at this public health mental health division which seems to be not helpful I don't think and perhaps you know I don't know whether there's other organisations that people think that we could usefully contact. Certainly the Scottish Government charities and groups operate in the field perhaps the professional bodies because it would be interesting if there's a view from psychiatrists and so on do they see that is this a feasible thing to have a hub which is almost the equivalent of A&E but is directing people out of what's often the key or something an A&E department. Rachel? I'd like to work out the points that Karen made about the risk assessments and the collaboration of all the relevant people who are making those assessments at the time and actually that probably is a sharing data issue and software data so if we could look at the best way to working out how that can be achieved. Okay, anyone else? Okay, I think we're agreeing that we want to take the petition forward in the terms writing to the Scottish Government and other key people once we get a response from them you will have the opportunity along with Gillian to respond to what comes in before our further consideration then if you want to make a further submission at that point you will be able to do so but that would allow us to look at the extent to which you think people have responded to the asks that you've made within your petition itself and I think with that can I again thank you very much Karen for coming along and thank your fellow petitioner Gillian there's lots for us to think about from that petition and with that can I close this meeting.