"Subject: 'Almost 800k Scots are on antidepressants - Herald article'
I am writing to you, as acting head of Scottish Government's mental health division, about this Herald article yesterday:
I am very concerned by a number of the statistics highlighted in this piece, including the rise in drug prescribing linked to diagnosis for depression, dementia and ADHD (I'm assuming adults), and the reference to stigma declining.
The Scottish Government response is not reassuring in any way, unfortunately. Stigma is still with us and I see no evidence of it declining, especially for people with mental disorder labels/diagnoses. There is a blurring of boundaries between "mental illness" and "mental health problems" in the response by government when your mental health strategy makes a clear division between the two. Them and us. Common mental health problems versus severe and enduring mental illness.
Michael Matheson called mental health the "cinderella" service, at an event I attended in October 2013:
At the same event I heard Alex Neil say that general acute inpatient services cost about £4500/patient/week whereas I know that an acute inpatient bed in psychiatric settings, in Fife costs about £2000-£2500/patient/week and in Dundee costs £3000/patient/week. Because I did an FOI request.
Regarding the continual rise in antidepressant prescribing, I believe that Scottish Government should be doing more about this, one of which would be to ensure that doctors are declaring any links with drug companies on Registers of Interest. NHS Lothian did not even have such a Register when I made an FOI request to them in May this year. Yet the Scottish Executive NHS Circular HDL (2003) 62 makes it clear that all health boards should establish a register of interests for all NHS employees and primary care contractors.
I am not sure why Scottish Government is focusing on early diagnosis, in mental health conditions and dementia, rather than appropriate treatment? Is this to take the heat off yourselves, in terms of the inappropriate targeting of health boards which has resulted in patients and carers having to suffer for it? It seems that the continual targeting of health boards, to reduce this and that, increase the other, has put a great strain on services. Especially in a rural area like Fife. I know this personally because my family have had to suffer for it.
For example if you are telling health boards to reduce readmissions to psychiatric wards, to put more care or services "in the community" then they will be constrained to make inpatient care less attractive and resource-full so as to move patients out more quickly. Therefore in Stratheden there was no therapeutic input in the wards. Patients were walking up and down the ward or round in circles, for something to do. That, I believe, is unacceptable. I raised awareness of this in 2010, to Geoff Huggins, then head of mental health division. I also told him about the other issues in Lomond Ward regarding female patients being at risk. On one occasion early 2011 I met in his office at St Andrew's House with Basil Haddad, then head of mental health improvement.
I contend there has to be a rethink by Scottish Government mental health division as to how they are advising and directing mental health service planning and performance. The current mental health strategy is not up to the mark. There is a lack of clear direction and to be frank it looks like it was cobbled together without any heed to previous strategies and achievements. The meaningful involvement of the real experts by experience should have been a priority. Nothing about us without us. Independent advocacy should also have had its place.
I think that you and the mental health division team at Scottish Government should be consulting with a range of service users, carers, psychiatric survivors and stakeholders, and not just a small band of favourites or a focus group of your own choosing. You should be listening to all the voices, not just the crowd pleasers and the people who have a position and can't speak out for fear of losing it. That is very unfair, for them and for the rest of us who are actively working for mental health service improvements.
Scottish Government mental health division should be welcoming the critical voices as indicators of what isn't working, not excluding them/us from key events where we can positively influence change. It doesn't look good to spectators outside of our goldfish bowl to see the hierarchical shenanigans of Healthcare Improvement Scotland and their cohort who seem to be getting away with unsophisticated soundbites and banning people who have something valid to say. It looks daft to anyone who has a measure of insight and know-how. But more importantly it is doing nothing to bring about real change for the benefit of patients, service users and carers.
I will put this Email in a blog post for others to view and I would appreciate a response from you to the points and questions I have made/asked. I am copying in other members of the SG mental health team and their superiors, HIS leaders and government ministers.
PS I am away to Glasgow early today for an Induction Day with the DClinPsy students at Gartnavel Royal as a member of CUSP, the service user and carer involvement group. An example of "meaningful involvement"."
Here are the names and job titles of the people I copied in to this letter Email, many of whom I have engaged with face-to-face, some I have worked with on mental health groups, others I've engaged with by Email or phone:
Niall Kearney, Head of Mental Health Improvement, Scottish Government
Hugh Masters, Associate Chief Nursing Officer, Scottish Government
Joan Blackwood, Professional Nurse Adviser Scottish Government
Moira Connolly, Principal Medical Officer Scottish Government (until recently)
Geoff Huggins, Acting Director for Health & Social Care Integration, Scottish Government
Paul Gray, Director General Health & Social Care, Chief Executive NHS Scotland
Michael Matheson MSP, Minister for Public Health and Sport
Alex Neil MSP, Cabinet Secretary for Health and Well-being
Angiolina Foster, Chief Executive, Healthcare Improvement Scotland (HIS)
Brian Robson, Executive Clinical Director, Healthcare Improvement Scotland
Denise Coia, Consultant Psychiatrist and Chair of Healthcare Improvement Scotland
Ruth Glassborow, Director of Safety and Improvement, Healthcare Improvement Scotland
Johnathan Maclennan, Improvement Adviser, Healthcare Improvement Scotland
Roderick Campbell MSP North East Fife (where I live)
[Here are screenshots of the letter Email, in 3 parts:]