Maureen Watt: mental health 'is about looking at the whole person'
Holyrood's exclusive interview with the UK's first ever dedicated mental health minister
Maureen Watt - credit David Anderson/Holyrood
Aside from John Swinney’s new job, the appointment of a dedicated minister for mental health was arguably the biggest announcement in Nicola Sturgeon’s post-election reshuffle.
Former public health minister Maureen Watt became the first person to take such a role, not just in Scotland but in the whole of the UK.
The idea of creating a unique government portfolio in mental health had been mooted by pressure groups and children’s charities. The concept of a dedicated role was tried by Jeremy Corbyn in his UK shadow cabinet before a widespread mutiny left the Labour leader with too few allies to fill the post.
In Scotland, all parties had included a commitment to seek equal consideration for mental and physical health in their Holyrood manifestos for May’s election.
By the end of the month, during Mental Health Awareness Week, Aberdeen South MSP Watt was appointed with a commitment to invest an additional £150m to improve services.
Born into an Aberdeenshire farming family in the 1950s, Watt became the first MSP to swear into parliament in Doric in 2006, having taken the regional list place of Richard Lochhead after he contested the Moray by-election.
It was growing up in rural Aberdeenshire that Watt became first aware of the concept of mental health.
“I think it was more probably in relation to dementia. My parents used to say ‘if I get dottled – which is a Doric word – like Auntie so-and-so, take me out to the field and shoot me’, you know. Of course you can’t do that!” she laughs.
Sitting down with Holyrood for her first in-depth interview since taking on the role, Watt reflects on how much has changed in attitudes and awareness of mental health since.
“My family are farming stock and I remember my father helping a couple of families who had been left after the farmer himself had committed suicide. The wife and children were having to either get rid of the stock or keep the farm going, and I remember my father helping out.”
In days when mental health was largely overlooked, suicide would sometimes be the first indication that anything was wrong. And although suicide rates have decreased slightly in Scotland since the 1990s, according to the National Records of Scotland, awareness of mental health and suicide prevention has been more dramatically transformed since Watt was young.
“Sometimes we forget that. We focus on the here and now and forget how far we’ve come,” she says.
For Watt, this became evident when her children, now in their early twenties, were at school.
“When they were at school they would talk openly about mental health problems or autistic spectrum disorders in a way we’d never have dreamed of in my generation. And in a good way, helping out, with those children not isolated but brought into the group. We have to remember we have come an awful long way in terms of being open and talking about mental health issues.”
There has been a huge shift in the way mental health is diagnosed and treated too, with a growing understanding that we all have mental health, and all have periods where we are less well.
“You’re right,” agrees Watt. “We used to think of mental health being people who might have been committed to, in my area, Royal Cornhill hospital or Craig Dunain, remember. You thought about people who had been detained in a mental health setting. Now, it’s much more about low-level mental health problems and dealing with that in the community.”
That very morning new statistics published by the Scottish Government had revealed a 30 per cent rise in children and young people using mental health services over the last two years, as more and more young people grow aware of their own mental health.
Workforce figures also showed the number of psychologists working in child and adolescent mental health services (CAMHS) has more than doubled in the same period.
Watt sees the figures as a success of the ‘ask once, get help fast’ ethos advocated by the Scottish Association for Mental Health (SAMH) which she has clearly adopted, and appears to have fed directly into the design of services. Watt enthusiastically uses the slogan throughout our meeting.
However, the CAMHS stats also show inequalities between health boards, with NHS Borders, NHS Fife, NHS Forth Valley, NHS Grampian, NHS Lanarkshire, NHS Lothian and NHS Shetland failing to meet an 18-week waiting time target dating from December 2014.
Children’s charities said it required an “urgent response”.
A team from Health Improvement Scotland have been assigned to work with the struggling boards to improve access and reduce waiting times.
Despite the fact they are being missed, Watt welcomes the existence of the targets.
“We introduced waiting-time targets. It was quite often the case you’d be waiting over 52 weeks in the past, so introducing the targets has focused minds.
“Yes, the availability of CAMHS and quick intervention is patchy over health boards, but that’s why we’ve invested in Health Improvement Scotland helping those health boards who are not meeting the targets to reconfigure services or do whatever is necessary to help them meet the times.”
It is clear she sees the figures as a positive. “The result of the younger generations being more open and talking about it is more children and young people are accessing the service. As well as having waiting-time targets, we have also got more people wanting to access the service.”
A new ten-year strategy for mental health has been unveiled by the Scottish Government, which is holding a number of consultation events to discuss the draft document.
The response has been mixed. In an article for Holyrood’s website, Andrew Strong of the Health and Social Care Alliance Scotland said the third sector had “serious concerns” about the scope of the new vision.
Like the previous strategy, he said, the new one appears to focus on reporting rather than outcomes. “We can’t accept a situation where Scottish mental health policy, once a world leader, is not effectively influenced by the voice of lived experience,” he wrote.
Holyrood puts this to Watt. How involved will people who actually suffer mental ill-health be in shaping and evaluating the strategy?
“It’s absolutely key to have service users involved as well as their carers and families, and professionals,” she says, pointing to the fact the most recent consultations were not the first held by government.
“As soon as we said we were developing a new strategy consultation, it has been taking place. Then we had the draft we published which has led to the kind of ‘second round’ of consultation, if you like.”
The government events, run in conjunction with NHS Health Scotland, have also been supplemented by events run by other organisations, she points out.
“Today I was at the AGM of Vox in Glasgow, this morning I was at Children in Scotland who had a huge range of organisations relating to children and young people there. Young Scot, who have given us their strategy, the Scottish Youth Parliament have fed in. One Sunday I was at the Church of Scotland youth assembly.
“So there’s been a huge range of events, and not all by any means I’ve managed to attend, but I have had a fair cross-section of access to discussions.”
The government’s commitment to mental health is demonstrated by the existence of her new role, she says, a position she feels “privileged” to hold.
“I see my role as trying to get everyone to see the whole person, both physical and mental health, and not just in the health professional field but in society as a whole. It’s also that parity of esteem between mental and physical health.”
But while the notion of parity of esteem has certainly risen to prominence in the political lexicon in recent years, what does it actually mean? Given the extraordinary costs of tertiary medicine, parity of budget seems unlikely.
“I think it is about looking at the whole person. Often physical ailments cause depression, therefore a mental health illness. Similarly, we know that if you have mental illness, you are more likely to die earlier. Up to ten years earlier. They are so very much linked, so we must see people as a whole and treat them as a whole.”
This hints at Chief Medical Officer Catherine Calderwood’s vision of ‘realistic medicine’ which seeks to move away from a ‘doctor knows best’ culture to empower patients to make more decisions about their care. Given the history of treatments and strained relationships with services, could this could be more of a challenge in mental health?
“I think there’s maybe a misperception that people are given medication and thrown out the door. I don’t think that’s the case,” offers Watt.
“If I had asthma, for example, which I have, I would expect a medication but I would also expect to be given ideas about breathing and perhaps signposted to Asthma UK’s website and stuff like that. You wouldn’t expect not to get a treatment for depression, and medication does help very much in the treatment of depression. I wouldn’t expect people not to get that, but also, we would want them to be signposted either to a website or other support.”
But realistic medicine also strives to reduce over-treatment. Some voices in the medical profession have said antidepressants are being over-prescribed which results in patients becoming medicalised. Others have defended their use.
Watt refuses to get drawn into what is “very much a clinical decision” arrived at between doctor and patient, but she is clear there should be a focus on early intervention and prevention.
“I don’t think I need to get involved in that but I think what we want to see going forward is much more signposting of individuals to other avenues of help.”
The third sector can play an important role in doing this, she adds, but it requires doctors to be aware of what support is available.
One person with bipolar disorder who spoke to Holyrood expressed frustration that, after being registered with her local authority, she felt medicalised and encouraged to volunteer. What she needed to feel better, she said, was a job.
“I feel I’m much more valued and less defined by bipolar when I am earning and have a life and work balance,” she said.
Watt says she hopes the new strategy can encourage an all-of-government approach to such challenges. “That’s very much part of what I want to see the new strategy encourage. So it’s not just saying here is a mental health strategy, but here is a mental health strategy in relation to all aspects of government.”
When it comes to listening to the wishes and needs of people who are ill, it becomes a human rights issue. The Scottish Government’s previous mental health strategy and last year’s Mental Health Act included references to a human rights-based approach to mental health.
Watt says she feels it has been a success “in part, but we can always do better”, but the Mental Health Commission, the Scottish Human Rights Commission and members of the Scottish Mental Health Partnership have joined the Health and Social Care Alliance in calling for the new strategy to be explicitly built around human rights.
“Things move on and perceptions and interpretations move on, and you have to embed that in the new strategy,” says Watt. “We’re building on solid foundations. Everything is not bad in Scotland in terms of investment in mental health and we’ve ramped up the focus by having a dedicated minister.”
But with fears, it would seem, that the new strategy bears too close a resemblance to the previous one, what does that ramping up actually look like?
Watt says she welcomes the input from the Alliance and others, pointing to the fact human rights is listed as one of the eight “key strands” in the new strategy. “We’re still listening and the strategy is still in development so watch this space. We’ll take all these contributions on board.”
Another key strand is prevention, which hasn’t featured as prominently in government approaches to mental health before at a Scottish or UK level.
Watt says prevention and early intervention has been a “hallmark” of the SNP’s terms in office of this government since 2007, at which point she was Minister for Schools and Skills.
The focus on prevention has run “throughout all the portfolios,” she says.
“If you were to take that portfolio, the Curriculum for Excellence talks about developing resilience and confident individuals, and we see from the Growing up in Scotland figures that children are more confident, happy and contented with their lives.”
And the focus remains embedded in the new programme for government, Watt argues, with a focus on child poverty and the early years, as well as closing the attainment gap. All of which can play a part in the mental health agenda, she says.
“The Curriculum for Excellence, health and wellbeing in schools, they can play a major part in this. In other areas too, like providing affordable housing.”
Policy discussions between government ministers will now have a voice uniquely concentrated on mental health. Watt cites discussions with Keith Brown in his role as veterans minister on post-traumatic stress suffered by those with experience of war.
“That’s a concrete example of where we can work across portfolios to help that specific group of people, and see the money we give to organisations such as Combat Stress is used to help.”
With the influence and profile of a new role exploring uncharted territory also comes a big responsibility. Opposition parties and the media have, more than ever before, someone to hold accountable on mental health issues, and the success of policy.
“Yes, there’s a lot of focus on the position,” admits Watt.
“A lot will rest on the mental health strategy, but as well as having ambition and vision for the strategy, it’s also about being realistic and deliverable. That, to me, is as important. We have to be realistic about what we can deliver.”
What does success look like, then? For Watt, it is all about SAMH’s ‘ask once, get help fast’.
“It will be much more focus on early intervention, and it doesn’t necessarily mean people having to wait for CAMHS services. It means seeing third sector organisations, and working in schools, giving that counselling some folk need.”
Watt is hoping for great things from five sites piloting the Distress Brief Intervention (DBI) scheme, which sees specially trained staff provide very early interventions to help people manage difficult emotions and problem situations and come up with a ‘distress plan’ to prevent future crisis.
Led by health and social care partnerships in North and South Lanarkshire, local pilots are being hosted by Penumbra in Aberdeen, Support in Mind in Inverness, NHS Greater Glasgow & Clyde and its constituent Health and Social Care Partnerships, and NHS Borders Joint Mental Health Service.
The model emerged from work on the mental health strategy and the suicide prevention strategy, and it is hoped it will better engage and equip people in managing their own health.
“If, for example, someone is showing early signs of self-harming, they get that quick six-week intensive support hopefully that will relieve the situation, but if not, if they get signposted for help, they get that.
“I’m going to see over the next couple of years how that works. That is the sort of early intervention that will perhaps hopefully relieve pressure on traditional CAMHS services so that those who are most in need of that will get that higher-level intervention. That lower-level intervention will help.”
In terms of long-term ambitions in the role, realistic and deliverable is a far cry from ‘a happier Scotland’, Holyrood suggests.
“Of course I would like all of Scotland to be happier,” says Watt. “To be comfortable and confident in their own skin. But I realise large sections of our population face problems that make that less likely to happen. It’s about making sure every aspect of government is improving people’s lives. That’s what we’re in politics for.”
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