 The next item of business is a statement by Maureen Watt on the mental health strategy. The minister will take questions at the end of her statement so there should be no interventions or interruptions. I call on Maureen Watt up to 50 minutes, please minister. Thank you very much, Presiding Officer. As the Scottish Government's first dedicated minister for mental health, I have been driven by a simple principle that we must prevent and treat mental health problems with the same commitment, passion and drive as we do physical health problems. I believe that this is a principle shared across this chamber and beyond. That is why it is at the heart of our new strategy. Everyone has mental health. For all of us, our health has both mental and physical aspects, but they are not always thought of in the same way. We want to create a Scotland where stigma related to mental health is eradicated and where prevention and early intervention is central. We want to be a nation where mental health care is person-centred and recognising the life-changing benefits of fast, evidence-based treatment. In the last decade, mental health services have changed dramatically. There has been excellent work from the NHS, local authorities and third sector organisations. Staff in all of these organisations at all levels make life-changing and life-saving interventions every day. However, I believe that we all have a mutual ambition to go further. Today's strategy and its 40 actions set out our starting point. That strategy has been fundamentally shaped by views and feedback from organisations and service users across Scotland. We received almost 600 responses to our engagement paper and we held public events and meetings. The volume and the content of the responses and discussion demonstrated passion and commitment for change. In late 2016, the Health and Sport Committee carried out its inquiry into mental health. Its findings were thoughtful and constructive and gave added impetus to the issues that we were developing. The committee raised the importance of child and adolescent mental health, including rejected referrals, early intervention, treatment and the need for multiple services to work together, including health, education and local authorities. The overarching message to us from the engagement was simple. Be more ambitious and recognise mental health as an essential part of all health and social wellbeing. As this is the first national strategy since the integration of health and social care, we have worked closely with COSLA in developing it and we will continue to work closely with them as we work to implement the strategy nationally and locally. Intrinsic to the strategy and intrinsic to implementing the actions and the vision is a human rights-based approach. A concrete way to do this is the panel approach of participation, accountability, non-discrimination and equality, empowerment and legality. The reality of implementing the actions and the development of future actions must continue to keep human rights at its core. The Scottish mental health partnerships vision is one that I suspect we all share. It is of a Scotland where people can get the right help at the right time, expect recovery and fully enjoy their rights free from discrimination and stigma. I want mental and physical health to have parity of esteem in practice. It is there in law already, but people's lived experience and our data suggest that there is a way to go. Achieving parity will not be easy, but it is vital. We estimate that only one in three people who would benefit from treatment for a mental illness currently receive that treatment. We also know that people with lifelong mental illness can die 15 to 20 years prematurely. That is a major health inequality, and I cannot accept it. To achieve parity of esteem over the 10 years of this strategy, we must see and be able to measure the following. Equal access to the most effective and safest care and treatment. Equal efforts to improve the quality of care. Allocation of time, effort and resources on a basis to commensurate with need. Equal status within healthcare education and practice. Equal high aspirations for service users. Equal status in the measurement of health outcomes. Improving mental health services and care is not solely the preserve of the health portfolio or the NHS. To tackle the causes of poor mental health, action is required across Government, including education, housing, justice, environment and the economy. That is also true of agencies and organisations outwith the Scottish Government. There must be work across all public services to harness the widest range of opportunities to improve the population's mental health. Without doubt, poverty is the single biggest driver of poor mental health. The fairer Scotland action plan sets out how we will help tackle poverty, reduce inequality and build a fairer and more inclusive Scotland. The broader implementation of mental health law must promote a human rights-based approach. We will ensure that this is made clear in statutory guidance. We will also commission a review of current legislation. We will do to see that and, if what, further reforms are necessary, so that the needs of people with learning disabilities and autism are properly taken into account. That is not the only legislation that we propose to consider. We will reform adults with incapacity legislation so that it fully reflects the requirements of the UN Convention on the Rights of Persons with Disabilities. In that reform, we propose a particular emphasis on provision of supported decision making. We will ensure that improving mental health and wellbeing are central in all new public health priorities. We will challenge the NHS to prioritise the physical health of people with mental health problems, removing barriers to people accessing services. I visited Maryhill Health and Care Centre in Glasgow this Tuesday and the mental health information station in Edinburgh this morning and heard first hand about those challenges. We will focus on prevention and early intervention for children, young people and adults to help to prevent the development of mental health problems and to step in promptly where they develop. We have already agreed to fund a managed clinical network for perinatal mental health. That is the first MCN in Scotland for mental health and is a significant step forward in achieving parity. We have made considerable progress in improving access to specialist child and adolescent mental health services, but demand continues to increase. We have listened to concerns about rejected referrals to CAMHS and we will commission an audit of them. Sometimes CAMHS is the right route for young people and at other times an alternative would be better. We will look at the whole system recognising the importance of specialist services but also of early interventions at tier 1 and 2. That could be of particular importance to looked after children. We will complete the roll-out of targeted parenting programmes to ensure availability across Scotland. We will be commissioning the development of a matrix of evidence-based interventions that can improve the mental health and wellbeing of children and young people. We will also develop a new separate 10-year child and adolescent health and wellbeing strategy covering both physical and mental wellbeing. Schools are one of the key places to ensure that the children of Scotland have the care and support that they need. That is why we will soon commission a review of personal and social education, the role of pastoral guidance and counselling services in Scotland. Our aim in this review is simple to ensure that every child has appropriate access to emotional and mental wellbeing support in school. We will facilitate work with Police Scotland to ensure that people who have mental health problems, who are in contact with the police or who are in distress, get the help and support that they need. That will include work through our refreshed justice strategy and through our distress brief intervention programme. We will also be working with the Scottish Prison Service and partners to improve the mental health of prisoners, including young offenders. We aim to create a social security system in Scotland that is based on dignity fairness and respect and supports those with mental health problems. Not securing employment is the biggest inequality that people with mental health problems can face. Utilising our new employability powers, we will work across services to support people to stay in and return to work. That includes being committed to working with employers to support the mental wellbeing of their employees. As I mentioned earlier, the physical wellbeing of people with mental illness is of major concern to me. I am committed to ensuring that services such as screening and smoking cessation are supported to help to improve participation rates for those with mental health problems. That will be the start of tackling 15 to 20 years premature mortality. Other work will be needed, and I believe that I can count on the support of many in taking the right steps and in addressing that significant health inequality. Through our twin programme of investment and reform, we are working to shift the balance of care across health and social care. In the coming year, we project that NHS spending on mental health will exceed £1 billion for the first time. In each year of this Parliament, we are committed to that investment increasing and with mental health receiving an increasing share of front-line NHS investment. None of those improvements to mental health services will be realised without having the right staff in the right place. We will work to give access to dedicated mental health professionals in all A&Es, all GP practices, every police station custody suite and all our prisons. Over the next five years, that will mean an increasing investment to £35 million for 800 additional mental health workers in those key settings. That increased investment through the NHS for this workforce will be in addition to the £150 million already set out for improvement and innovation. That means that I can confirm today that over the next five years, the total Scottish Government direct investment in mental health will be over £300 million, which will support implementation of this strategy. In primary care, we are developing new multidisciplinary models of supporting mental health. That will help to achieve, ask once, get help fast and to better equip people to manage their own health and encourage recovery. Presiding officer, as I hope I have made clear, that strategy is not the end of a process, it is just the beginning. The voices of stakeholders and service users have been key to its development, and I am determined that they will also be key to its implementation. That is why, to help me steer the strategy being taken forward, I will be convening a biannual forum of stakeholders. In that forum, I want to hear their views and get their help for now and in the future. To ensure that we learn from what actions laid out so far have achieved, we will carry out a full review at the halfway point of this strategy. I hope that members across the chamber will be able to see reflected in this strategy the ambitions that they and others have promoted. I believe that this strategy can build on and can be built on and developed in the years to come. I believe that together we can deliver the mental health support, care and services that the people of Scotland deserve. The minister will now take questions on the issues raised in her statement. I can allow around 30 minutes for questions and then we have to move on. Can I remind everyone that there is a lot of business to get through this afternoon, so brevity would be very much appreciated? I would ask those who wish to ask a question to press their buttons now and I call on Miles Priggs. To begin by expressing my concern, I know that it is shared across the chamber that the Scottish Government has only allocated 45 minutes for Parliament to question the Government today on the new mental health strategy. That said, there are a number of areas within the new 10-year strategy that I welcome and which Scottish Conservatives called for within our mental wellbeing policy statement, which we published at the beginning of December. The key message from all stakeholders who will be tasked with the delivery of the strategy over the next decade in communities across our country is that all the words in the world in a Government strategy will not make the difference if they are not backed up with real reforms and resources. The last mental health strategy contained 36 actions, given that no report card on how they were delivered or achieved has ever been compiled, can the minister tell Parliament today how many of those actions from the last mental health strategy were actually achieved? Given that the new mental health strategy aims to transform services and treatments for those with mental health problems over the next decade, can the minister outline to Parliament how that progress will be monitored? Will the minister chair an advisory group to drive the strategy's implementation forward? Will the minister commit today to providing an annual progress report to this Parliament? When I was elected to this chamber, Deputy Presiding Officer, in my maiden speech, I said that mental health was the most pressing thing facing our country. I am sorry to say that today feels like a missed opportunity. I welcome the fact that, in the last part of her speech, the minister said that the strategy is not an end process, that it is just the beginning. I think that that will have to be the case, and I hope that the minister will look at listening to organisations in the coming weeks and months as we hear the concerns around the strategy. Maureen Watt Thank you, Presiding Officer. Miles Biggs will know that the bureau determines the work and programme of the chamber, not the Government. The health and support committee will be able to scrutinise the strategy, which I am sure that it will want to do. I am pleased that Miles Biggs recognises that the many asks in his party's manifesto in last year's election have been met in this strategy. Of course, as I said in my statement, we will be putting in place governance structure in order to see how this strategy is taken forward. In fact, in terms of the last strategy, there were updates on specific actions in the last strategy, published online at various times throughout it. I am happy to give an annual report to Parliament. If that is what Parliament wishes, but as I say, I am sure that the health and support committee will want to scrutinise the strategy as set out further. Monica Lennon I thank the minister for early sight of her statement this afternoon. There are actions in the strategy that are to be welcomed, such as the managed clinical network for perinatal mental health and additional mental health professionals for our A&Es, GP practices, police stations and prisons, and a commitment to young carers that we welcome. The publication of the 10-year mental health strategy was an opportunity for us to be bold and ambitious. That is why I was hopeful that, when the Scottish Government delayed the strategy last year, it would listen to concerns raised by stakeholders and the health and support committee and that the final strategy would contain the transformative action that is required. I am disappointed that the Government is ignoring Scottish Labour's plan for investment in school-based counselling and wrapping around early intervention support in schools, a plan back by Bernardal Scotland just last week. I am disappointed because we know that half of all mental health problems begin before the age of 15. So, although it is welcome that the minister has committed to look at rejected referrals, the scope of that audit remains unclear. We are talking about 17,000 children over the last three years who have been referred to CAMHS have waited for help only to be turned away. Children and young people should have been at the very heart of this 10-year mental health strategy, but I see that we have to await a follow-up strategy on CAMHS. Without a solid commitment to immediate investment in action to support early intervention, how can the minister give assurances that the strategy will adequately improve the wellbeing of our children and young people? I think that, with 40 actions in the strategy, that is indeed transformative. I think that the member will find that most of the asks in her parties manifesto have been met in full or partially. In terms of the audit for rejected CAMHS, that is precisely what Monica Lennon has been calling for. In terms of rejections to CAMHS, referrals to a range of physical services are rejected too as not being the appropriate action. That is why, in the strategy, we are beefing up the services that are available to young people and others at tiers 1 and 2. Precisely, that is why I mentioned the real importance of education and a review of personal and social education and what education and schools can do. We all know that, in terms of curriculum for excellence, all those involved in education are responsible for literacy, numeracy, health and wellbeing, and that includes mental wellbeing. That is why we are undertaking the review to make sure that that is happening. I remind the chamber that the main opposition spokespeople are given some leeway in the answer questioning. I ask for brevity in future questions, please. I have Claire Hawke to be followed by Annie Wells. I refer members to my register of interest as a registered mental health nurse. First, I welcome the strategy and the opportunities for improved care that it offers in the area of mental health. I ask the minister what measures the strategy will put in place to improve equity of access to perinatal mental health services across the country. Maureen Watt I thank Claire Hawke for her question and I recognise her experience in this area. As she said, I have already announced the new managed clinical network for perinatal mental health, and that will bring together health professionals who work in the area of perinatal and mental health. The expert leadership in that area will identify current gaps in perinatal care and pathways and it will develop and implement guidelines and best practice in ensuring improved standards and make sure that everyone gets the same high level of care regardless of where they live. In terms of recruitment, that is under way for a lead clinician. They will be assisted by additional dedicated maternity nursing and infant mental health experts and managed support and should become operational later this year. However, the enthusiasm with which the announcement of the managed clinical network received is giving me great hope in this area. Annie Wells The Scottish Government set its own target that 90 per cent of adults and children, referred by a GP for treatment for mental health issues, should begin treatment within 18 weeks. In December last year, NHS stats have yielded 22.5 per cent, one in five, were not seen within this time frame. In fact, the target has never been met since it was set by the Scottish Government in December 2014, and between October and December last year, only two health boards were able to meet the 90 per cent figure. In her statement, the minister talks about getting the right help at the right time and that ask ones get help fast approach. We welcome this, but ask what specific action the Scottish Government will take to make sure that those in need of mental health treatment are not subject to excessive waiting times. I thank Annie Wells for her question. Scotland was the first country to introduce waiting times for mental health services. I agree with her, and I have said in this chamber many times that I am not content with too many health boards not meeting their targets. Although we are seeing some areas excellent progress in this, 82.5 per cent of people receive help within the 18 weeks. The median average waiting time across Scotland was nine weeks. As the member knows, improvement teams have engaged with 4th valley, Lothian Ayrshire and Arran Borders, and in terms of 4th valley, for example, we have seen a 40 per cent increase in that health board meeting their waiting times. Of course, there is so much more to do, and that is why we are putting an emphasis on putting more workers into tiers 1 and 2, so that people can have help where they might not necessarily need to be referred to CAMHS or adult psychological therapies and reduce the number of rejected referrals. I think that, in the strategy, she will see from our summary of actions that we intend to take steps in that area. I would like to ask the minister what provision will be made to ensure that young people who have exhibited suicidal tendencies or have a history of suicide attempts are referred immediately for specialist treatment with no delay in the future. Presiding Officer, every suicide is a tragedy. Where a young person needs to be seen by a clinician urgently, that should happen. It does happen on a daily basis. We are investing in access to CAMHS, and we will be engaging with stakeholders later this year to publish a new suicide prevention action plan by early 2018, which will dovetail very much with the mental health strategy. However, it is unacceptable that people are not being seen as they require. I know that the minister thanked COSLA in her statement. The reality is that this was meant to be a joint strategy between COSLA and the Scottish Government. For obvious reasons, because the implementation of the strategy will require work from the Scottish Government, from councils and from the IJBs. That is why I am sure that she is disappointed by Councillor Peter Johnson's note that was circulated to all councils last night, saying that they were unable to endorse the mental health strategy outlined by the Government today. I should iterate that Councillor Johnson is the health and wellbeing spokesperson for COSLA, and he is also the SNP group leader in West Lothian. That is a disappointing start for the statement. Shona Robison says that we missed the welcome. She says quite clearly that this was meant to be a joint endorsement. Can the minister tell us what action she will do to alleviate the crisis that we have with COSLA and how we can stop cuts to mental health budgets from IJBs? Maureen Watt, we can sure rely on Anna Sarwar's negativity. We have worked, as I said in my statement, very closely with COSLA in the development of the strategy. That joint working has been going on for work for months. Peter Johnson welcomed the strategy. We have put further ambitions in the strategy and, of course, we will be working with COSLA and the integrated joint boards post their elections in making sure that all this works. Jenny Gilruth, followed by Alison Johnstone. To ask the Scottish Government how the new mental health strategy will support the development of positive mental health and wellbeing in schools and in so doing resilience in young people. I thank Jenny Gilruth for her question and recognise her experience in schools in this field. As I have said, we will undertake a review of PSE in schools and make sure that all those involved with school children have the necessary qualifications and support structures to help children in schools. Clearly, identification of upcoming problems with young children is best identified in schools along with parents. It is important that we give parents the tools to recognise their children who might be experiencing distress and know precisely where to go to, which might well be through their GP. However, there is a great opportunity in schools to build resilience among our young people to be able to deal with whatever life throws at them. What provisions are in the strategy to tackle rising levels of self-harm among children and young people in Scotland? How will we make sure that young people presenting with self-harm are never met with stigmatising response? Morrin Wood Self-harm is clearly an area that is a demonstration of mental distress. I visited services in Perth, where in schools at lunchtime there is group work with children who have been presenting with self-harm. Again, that is an area where schools can help and where, in fact, peer support can be of real benefit to help children who are demonstrating self-harm. Fulton MacGregor To be followed by Mike Rumbles One of the concerns that we have discussed previously in this chamber is that children or young people with mental health problems are admitted to known specialist wards, not least the issues that were raised by the mental welfare commission last year. Could the minister outline how she intends to address that through the strategy? Can I also advise the chamber again that I am the PLO for the health secretary? With a sore throat, I can tell. Morrin Wood I can tell Fulton MacGregor that we have seen improvements as reported by the mental welfare commission in 2016, with fewer incidents of young people being admitted to non-specialist wards, 135 admissions involving 118 young people in 2015-16. In the previous year, it was 207 admissions involving 175 young people. In the mental welfare commission's report, there were six recommendations, and many of them were for NHS boards. Of course, NHS boards should address the issues that were raised. One of the recommendations was for the Royal College of Psychiatrists, and we in the Scottish Government are working with their representative and CAMHS-lead clinicians on that. That was to review standards to help adult mental health wards demonstrate their ability to provide safe and appropriate care for under-18s who require admission, and that is action 19 in our strategy. We are also taking actions on scoping highly specialist mental health in patient services for young people to look at forensic calms. Mike Rumbles, followed by Mary Todd. I thank the minister for advance sight of her statement. Despite what the minister has said, there is still no commitment to the scale of resources that are required to deliver the desperately needed step change in services. The Government's statement is carefully worded. The minister said that we will work to give access to dedicated mental health professionals in all AEs, GP practices, every police custody suite and to our prisons. That is not the same as providing dedicated trained professionals in every one of those locations. The Liberal Democrats proposed this in our budget negotiations. The Government is pretending to do it. Minister, is it not more honest to make this difference clear? Maureen Watt. I say to Mike Rumbles that 800 extra mental health workers are 800 real people who will be available to be accessed through those people. We are not in a position as the Liberal Democrats seemed to infer when they did start budget negotiations that there is a pot of money and that we can have people sitting around doing nothing. In fact, what we are doing is making sure that all those areas—AEs, police custody suites—have access to a mental health support worker as quickly as possible. I welcome today's statement. The strategy sets out the opportunities to pilot improved arrangements for dual diagnosis for people with problems, substance use and mental health issues. Can the minister outline how those pilots will be identified and if lessons from them will be implemented nationally? Maureen Watt. I think that we all know that mental health problems and substance misuse are commonly co-occurring and that there are opportunities to optimise how specialist services can work together. Those will be explored by discussion with integrated authorities and NHS boards, identifying examples and opportunities that can be used to inform national guidance and good practice. I would point out that our pilot work on distress brief interventions and transforming primary care also provide opportunities to improve the service response to people with mental health and substance misuse. The evaluation of those will also provide lessons about outcomes that will inform future national models. We also know that services having co-borbidity policies is a recognised protective factor reducing suicide. Healthcare Improvement Scotland is working with NHS boards to implement a suicide prevention framework that allows teams to consider if they have co-borbidity policies and if not to take action to create them. Brian Whittle is followed by Christina McKelvie. There is a mountain of expert evidence highlighting the importance of inclusivity and physical activity as major tools in the treatment and prevention of poor mental health. If you visit the combat stress stand in the member's lobby, they will tell you how they are using activity to tackle mental health issues. The minister's statement suggests that she will challenge the NHS to prioritise the physical health of people with mental health problems. However, we know that this Government has withdrawn funding from 1 April for Jog Scotland, and Sam H is helping to pick up the Government tab. It is so important that it believes that being active is to the mental health agenda. Given that evidence, how can the Government possibly claim that the strategy tackles preventable poor mental health when its actions do exactly the opposite of expert opinion? Maureen Watt. In terms of Jog Scotland, the Minister for Public Health and Sports Scotland is working together to see the way forward for Jog Scotland. The member makes a very valid point, and I said that in my statement, that it is really important that people with mental health problems have good physical health. That is precisely what I said in terms of the actions in relation to that. Those with mental health problems often have poor physical health, and it is important that they get the screening and the tools to improve their physical health. That is precisely what many of the organisations working in that space will signpost people to, so that they have a clear pathway going forward to manage their mental health by improving their physical health, too. I, too, have visited the combat stress stall today, and, of course, the Government gives 200,000 per year to Combat Stress Scotland community outreach service, which aims to provide a better response to the mental health needs of veterans, their families and carers. I think that most people in Scotland recognise this Government's commitment to veterans. The last of the questions in the statement is from Christina McKelvie. Thank you very much, Presiding Officer. Given that the UK Government has been heavily criticised for grave and systematic breaches of the UN Committee on the Rights of Persons with Disabilities, can the minister tell us if steps will be taken to ensure that the review of adults within capacity legislation complies fully with the UN convention on the rights of persons with disabilities? Maureen Watt. As I said in my statement, we intend to take forward our review of legislation in that field to make sure that it is compatible with the UN convention on the rights of people with disabilities. That is to address the compatibility. The work follows on from the conclusion of the consultation on the Scottish Law Commission's report on adults within capacity. We will look at new models of graded guardianship, for example, with a strong focus on supported decision making, and amending, if necessary, powers of attorney to help individuals to make decisions for themselves so that there is clarity in advance on perhaps the deprivation of liberty and what exactly they would prefer to happen if they were detained. That ends the questioning on the mental health strategy