“Tired”

The Scottish Parliament returned from summer recess this week and the First Minister outlined her Programme for Government during a speech to the Scottish Parliament.

The first Minister offered “a clear vision of the kind of country we want to be” and outlined a “£250 million health investment package that will deliver dedicated mental health counsellors in schools, extra training for teachers, and an additional 250 school nurses to offer emotional and mental health support and provide more advice for young people and their families dealing with mental health issues.”

Dame Denise Coia has been appointed to lead a £5m taskforce to reshape and improve child and adolescent mental health services

I welcome this announcement.

However, the Political Editor of BBC Scotland stated that the word he had most commonly heard around the Scottish parliament to describe the new Government Programme was “tired”.

Two summers ago I recall being invited to submit thoughts to this:

When the Strategy was finally published I was not alone in feeling rather underwhelmed by the “vision” that it offered. It seemed to me somewhat “tired”.


This was the basis of my submission of the 6th August 2016 below:

No. Thank you for inviting comments via this consultation. I have been an NHS psychiatrist, trained and working in Scotland over the last two decades. If I may, can I make a few general comments first.

  • This consultation, like almost all Scottish Government consultations is at best only half-way up what academics and researchers term ‘The ladder of participation’. In terms of “engagement” the views of others is sought only after the Scottish Government has determined the “framework” for discussion.
  • Have those with experience of mental difficulties been involved up to this stage of the framework?
  • Have survivors and activists been involved up to this stage of the framework?
  • Have the Medical Humanities been involved up to this stage of the framework?
  • Have sociologists been involved up to this stage of the framework?
  • Philosophy and ethics matter in the consideration of any public health policy. Have such areas been considered?
  • In terms of transparency the public should be told who were involved in developing this framework to this stage, along with designations, dates and minutes of meetings. The Scottish Government routinely do not seem to do this and this lacks openness.
  • This all matters as Scotland has a prevailing approach that is biomedical. The independent Mental Welfare Commission follow this as the principle determinism. There is no alternative or complementary approaches and ‘activists’ have frequently been mischaracterised by the Scottish Government for raising such considerations. This is very far from “engagement” or indeed a fair approach to “human rights”
  • Has Scotland looked at other countries approaches to mental well-being? I would like to see a more pluralistic approach to the science of mental well-being. We need to consider the potential harms as well as the potential benefits of any approach.

 

  • We need true ‘Freedom to Speak Up’ in Scotland.
  • “Patient Opinion” is a great development but it should not be triaged by NHS Boards and Scottish Government so as to present only the favourable comments. This is unethical.
  • Over-medicalization (‘Realistic Medicine’). This does not appear in the framework. What has happened to the Chief Medical Officer’s considerations? 1 in 7 Scots are on antidepressants, mostly long-term. Antipsychotic prescribing is rising year-on-year in all age groups across Scotland. This is not “conservative prescribing” as Government advisers still suggest.
  • Psychology has been second fiddle in Scotland for long and weary and indeed before the SNP Government. Why? One reason may be because Pharmaceutical industry has had a fast grip on psychiatry and “education” of professionals in Scotland. Why then has the Department of Health not properly offered its support for a Sunshine Act? Why has the Scottish Government allowed Health Boards to ignore its Guidance on this for thirteen years? And we now know that Chairs of National SIGN Guidelines have in many cases, significant vested interests, yet meaningful transparency is not there.
  • “Our Voice” is a very important development. However to be truly a democratic voice, of the people (and whatever they may say) the Scottish Health Council (SHC) surely needs to be independent. Currently this is not the case. The risk is that we have here significant, and arguably overarching control by the Scottish Government. This also risks that any “national conversation” begins and ends with those in genuine positions of power.
  • Healthcare Improvement Scotland (HIS) has done some good work but the “improvement science” that they have imported from Boston, IHI, is experimental and adopts a business model based on reductionist mechanical principles. Culturally it has not evolved in the NHS. HIS are intimately aligned with the Scottish Government. This has encouraged a culture where “improvers” are considered more credible than others .

 

  • Safe havens
  • Healing environments
  • Support counselling/psychology
  • “Parity of esteem” between the medical humanities and biomedical science!
  • A Mental Health Act compatible with Human Rights
  • Openness and transparency in the Scottish Government (Code of Conduct of Civil Servants need to be followed and accountability maintained). Only then may we have true “ethical leadership”
  • Less resource put into Healthcare Improvement Scotland and the Institute for Healthcare Improvement (Boston) and more into front-line staffing where professionalism is supported and encouraged.
  • To see the end of “education” of medical professionals by commercial interests. Both NHS Forth Valley and NHS Lothian have “education” which relies solely on the sponsorship support of the Pharmaceutical Industry. This, in my view, is a dreadful approach to education that seeks scientific objectivity.

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