Published 24 July 2020 SP Paper 776 3rd Report, 2020 (Session 5) Public Petitions Committee Comataidh nan Athchuingean Poblach Inquiry into mental health support for young people in Scotland Published in Scotland by the Scottish Parliamentary Corporate Body. All documents are available on the Scottish For information on the Scottish Parliament contact Parliament website at: Public Information on: http://www.parliament.scot/abouttheparliament/ Telephone: 0131 348 5000 91279.aspx Textphone: 0800 092 7100 Email: [email protected] © Parliamentary copyright. Scottish Parliament Corporate Body The Scottish Parliament's copyright policy can be found on the website — www.parliament.scot Public Petitions Committee Inquiry into mental health support for young people in Scotland, 3rd Report, 2020 (Session 5) Contents Membership changes ____________________________________________________1 Introduction ____________________________________________________________2 Executive Summary _____________________________________________________5 Strategic service delivery _________________________________________________7 A co-ordinated approach _________________________________________________7 No one-size fits all _____________________________________________________10 Clear pathways _______________________________________________________13 Advice and awareness raising ___________________________________________16 Developing emotional literacy ____________________________________________16 Personal and Social Education (PSE) ______________________________________17 Building resilience _____________________________________________________18 Support for parents and carers ___________________________________________19 Professional constraints_________________________________________________21 Recognising what works ________________________________________________21 Supporting the professionals _____________________________________________23 Accessible services ____________________________________________________24 Early Intervention______________________________________________________26 Widespread training____________________________________________________29 Peer support __________________________________________________________31 Training _____________________________________________________________31 Empowered but not overwhelmed _________________________________________32 Conclusions and recommendations _______________________________________34 Annexe A - Evidence gathering ___________________________________________38 Annexe B - Extracts from Minutes and links to oral evidence __________________39 Annexe C - Written evidence submitted to the Committee _____________________42 Public Petitions Committee Inquiry into mental health support for young people in Scotland, 3rd Report, 2020 (Session 5) Public Petitions Committee Remit: To consider public petitions addressed to the Parliament in accordance with these Rules (and any additional matter added under Rule 6.1.5A) and, in particular, to— (a) decide in a case of dispute whether a petition is admissible; (b) decide what action should be taken upon an admissible public petition; and (c) keep under review the operation of the petitions system. http://www.parliament.scot/parliamentarybusiness/CurrentCommittees/ petitions-committee.aspx [email protected] 0131 348 5254 Public Petitions Committee Inquiry into mental health support for young people in Scotland, 3rd Report, 2020 (Session 5) Committee Membership Convener Deputy Convener Johann Lamont Gail Ross Scottish Labour Scottish National Party Maurice Corry Tom Mason Scottish Conservative Scottish Conservative and Unionist Party and Unionist Party David Torrance Scottish National Party Public Petitions Committee Inquiry into mental health support for young people in Scotland, 3rd Report, 2020 (Session 5) Membership changes 1. There have been five occasions where the membership of the Committee has changed during Session 5 (12 May 2016 - to date): • Michelle Ballantyne MSP (Con) - 29 June 2017 to 17 June 2018 • Rachael Hamilton MSP (Con) - 17 May 2018 – 10 September 2019 • Angus MacDonald MSP (SNP) - 8 June 2016 – 26 August 2019 • Rona Mackay MSP (SNP) - 16 June 2016 to 6 September 2018 • Brian Whittle MSP (Con) - 8 June 2016 – 25 February 2020 1 Public Petitions Committee Inquiry into mental health support for young people in Scotland, 3rd Report, 2020 (Session 5) Introduction 2. In December 2016, a public petition was lodged by Annette McKenzie, calling for consultation with, and consent from, a parent or guardian before prescribing medication to treat mental ill health if the patient is under 18 years of age. Ms McKenzie lodged her petition following the tragic death of her daughter, Britney, from an overdose of prescription medication. We are grateful to Ms McKenzie for her courage in highlighting these concerns to the Committee in circumstances no parent should ever have to face. 3. At present, under the Age of Legal Capacity (Scotland) Act 1991, a person under the age of 16 years has the legal capacity to consent to any medical procedure or treatment where, in the opinion of a qualified medical practitioner, they can understand the nature and possible consequences of the procedure or treatment. 4. Doctors have a common law duty to respect the confidence of their patient, including those under the age of 18 who are deemed to have the capacity to consent. Guidance issued by the General Medical Council highlighted confidentiality as central to the trust between doctors and patients; and that information may only be shared— • if required by law or by a court order; • if the patient has given consent for the information to be shared, or • if it is justified in the public interest – for example, if the benefits to a child or young person that will arise from sharing the information outweigh both the public and the individual’s interest in keeping the information confidential.i 5. During its consideration of the petition throughout 2017 and 2018, the Committee took oral evidence from the petitioner; charities including Penumbra, Scottish Association for Mental Health (SAMH) and Children in Scotland, and from the then Minister for Mental Health. 6. In addition, the Committee considered a wide range of written submissions from stakeholders including the Scottish Government, representatives from the medical profession and organisations which have a role in promoting and protecting children and young people. The Committee also heard from individuals sharing their own personal experiences of the support they received for their mental health. 7. From the evidence gathered, the Committee noted strong support amongst key stakeholders including the Scottish Government, the Scottish Youth Parliament, the Children and Young People’s Commissioner Scotland and the Royal College of General Practitioners that young people under the age of 18 should be able to give consent to treatment for themselves and that the principle of patient confidentiality should be protected. 8. The evidence highlighted however serious concerns about the experiences of young people seeking help for their mental health. Some young people explained that they felt cast aside by their GP, despite their obvious signs of distress. In some i SPICe Briefing for Public Petitions Committee regarding PE1627 2 Public Petitions Committee Inquiry into mental health support for young people in Scotland, 3rd Report, 2020 (Session 5) cases, the distress escalated to such a degree that in the absence of any support, they worryingly turned to self-harming and attempting suicide as a way of coping with their mental health. 9. The Committee therefore agreed to establish an inquiry into mental health support for young people in Scotland to understand and suggest improvements on how young people feeling low and/or anxious, particularly for the first time, can get the advice and support they need. This level of support is often referred to as “tier one” of the Child and Adolescent Mental Health Services (CAHMS) model of care and is delivered by practitioners working in universal services including health visitors, GPs, school nurses, teachers, social workers, youth justice workers and workers in third sector organisationsii. 10. The Committee recognises the comprehensive work that has been undertaken to review this critical area of public health including Audit Scotland’s report on Children and young people’s mental health, published in 2018 and the Children and Young People’s Mental Health Taskforce, published in July 2019. There is broad consensus in many of these important pieces of work. Unsurprisingly, there are also significant parallels between these pieces of work and the Committee’s conclusions and recommendations. The Committee is concerned, despite such broad consensus, that many young people who are feeling low or anxious are still unaware or able to access the support that they require. 11. The mental health and wellbeing of children and young people is a vast policy area. The Committee therefore agreed to focus the scope of its work on the areas that received the most evidence through its initial call for views. These were advice and awareness raising, professional constraints and peer support. 12. Mental health and wellbeing is also an ever-evolving area of public health and policy developments are regularly being announced. The Committee notes the Scottish Government’s commitment to mental health and wellbeing as set out in its Mental Health Strategy 2017-27 and the most recent