Good morning. I'm very pleased to be here to be able to respond,
although I think "respond" is quite an interesting way of describing it,
because in the Mental Health division, we've been fully behind this process
throughout the process, and indeed also for the Adult Mental Health Indicators.
I've now recently entered my eighth year in this job,
which is quite a long time to be with an area of work within the Scottish Government.
Throughout that period, one of the key things that we've been seeking to do
is to develop our understanding of ideas like:
What is the state of the mental health of Scotland?
How are our young people growing up?
What do we actually know in terms of the data that's available
in respect of housing or education or justice data around violence
that might give us a good understanding of the context in which people are living their lives?
What are people telling us about their experience of life?
The development of items such as the Warwick-Edinburgh Mental Well-being Scale,
which is now part of the Scottish Government's overall National Performance Framework,
are very valuable in giving us that insight and that knowledge of what's actually going on.
I'm going to try and cover five or six things this morning,
each of them probably quite briefly,
and to put what Jane described very eloquently
into something of the context, as to how we within the Scottish Government understand that,
and how it fits within some of the work that we're doing.
But I think part of the value of the Indicators is that
while we've supported them and while we've collaborated with them,
directly and through Health Scotland,
ultimately they're also yours to do whatever you want to do with them.
We don't own or control or determine the Indicators.
But these are things which you can use locally
to highlight where you think things are getting better
or to highlight where you think things aren't improving in the way you'd expect.
They are nicely powerful in that way,
they're not controlled or owned by any part of the system.
And that is always nice to see within a broader democratic context.
I'm going to cover these items.
I'll try and do each quite quickly.
In terms of the context,
we in government have various methods by which we seek to produce change in the world.
Sometimes we produce legislation,
and that was described in terms of the Children's Rights legislation.
We spend money, we develop guidance,
we produce strategies,
we employ people,
we create new organisations and we collaborate with existing organisations.
Through those, we seek to engage in things such as education or social work,
or awareness raising or information sharing.
But all of those have got the objective of trying to produce improvement and change.
I think all of us today would like to live in a world in the future
which is a better world than the one that we do today.
We seek to produce benefit for our young people and the young people of the future.
While we can say that we do that through spending more money,
or by making commitments or by having visions,
ultimately the way in which we should be tested is by the degree to which we deliver change.
Work such as the work that comes out of the Indicators gives us that sort of benchmark.
It gives us the contextual understanding of the degree to which the world in the future
is a better world than the world we're in now.
That's probably the key purpose and intention in creating frameworks like this.
It's to enable us to assess the degree to which the things that we do
do produce the changes that we say that they will do.
We can look down the track and see whether we have done things
to address items such as domestic violence,
such as exclusion,
such as poor educational attainment.
Or indeed, things like under-diagnosis of ADHD.
Or whether some of the interventions like Triple P or Incredible Years, which I'll mention later,
are having the impact that we've been told that they would have,
so that they are actually resulting in longer-term benefits for children and young people.
So there are a few bullet points there,
but it's broadly to establish that context, that understanding, that broader scorecard,
which enables us to see the degree to which the things which we're doing are producing change.
We understand in that that we are one agent, and governments are one agent,
and local government and voluntary sector are all acting in a complex and difficult context.
We're sitting very differently in 2011 than we might have anticipated to be sitting.
We have banks in turmoil, we have unemployment rising in parts of the UK.
We have different challenges.
But we continue to be key agents in producing the future.
The particular area which I have direct day-to-day responsibilities around
is Child and Adolescent Mental Health Services.
The work in this, around the Indicators,
at least in part comes from that work.
It comes from the SNAP report produced in 2003,
and it comes from the Mental Health of Children Young People Framework for Promotion,
Prevention and Care,
published in October 2005.
And each of those identified a broader context for work around children's mental health,
that it wasn't simply about specialist staff and it wasn't simply about in-patient.
It was about the broader social understanding of mental health
and the context within which people live.
An approach followed through in Getting It Right For Every Child -
Boyd McAdam is going to be talking about that shortly,
and in the Early Years Framework, which Derek Bruce will be addressing as well.
We embedded some of this work,
and the particular commitment to produce this Indicator set, within TAMFS -
Towards A Mentally Flourishing Scotland - the document that we published in 2009,
in Commitment 4, that we would develop and publish the Indicators.
I'm really glad to be here today on the publication of those.
It's always quite nice to get to the end of a process where you've done what you said.
We made 22 commitments in TAMFS,
and we can now say that we have delivered the 22 commitments that we made.
That always makes me just feel a little bit pleased.
It now means we need to think of the next set of commitments to make for the next 2-3 years.
I'll come onto that shortly.
But I would also hope that you might help us in framing those commitments.
The other commitment that we made within TAMFS which is probably most pertinent to this
is the commitment to develop the web portal
Hands On Scotland,
which was developed at the centre in Fife.
This sits within the context of focus for mental health services and mental health improvement.
We've worked with Health Scotland, we've worked with Jane and Alison
in determining what we'll do next with the Indicator set.
Our intention is to continue to work to develop the set.
We're looking forward to seeing the reports from Health Scotland
and the Scottish Public Health Observatory.
We'll see what that tells us.
Quite often when we look abroad,
we see other countries which have developed information and data sets
which run over many years.
Certainly, in North America we see such sets
which enable them to track the change in social outcomes
resulting from different initiatives and circumstances.
In some ways, while it creates a snapshot of where we are today,
it's also a slow-burner in terms of the data and information that it gives us over time.
But the work is directly relevant to policy and action.
It has both a descriptive element in describing what is going on,
but it also has, to some degree, a normative element,
in that it tells us what we think is significant
within the area of children's mental health and children's wellbeing.
There is a degree of consensus which has been developed by the Indicator group around that.
In those terms, as we begin to see the data coming out,
and some data will come out more regularly than others,
it enables us to begin to track the degree to which things are changing
and the degree to which we are agents in that change.
We are fully engaged with the discussion,
both of ensuring that the data sources which are, for example,
within surveys or data collection systems,
we can maintain those where possible.
But also that we're able to begin to fill some of the data list Indicators.
I guess within that, some key elements which I'll be keen to see developed,
are around items such as violence in the home...
domestic violence.
But also other areas around the presence of drugs and substance misuse -
areas where there's some data at the moment but there are contextual factors
which we think are likely to be very powerful and indicative of future life challenges.
We've asked Health Scotland to continue the updating revision of the Indicators over time.
We've agreed with them that they will develop a broader Indicator group to work with that.
It won't be the same group that they used to develop the Indicators themselves,
which was very broad-based,
but it will be something they can bring together semi-regularly
to take a look at what we've got and how things are going.
Also, Health Scotland will be delivering support for local use of the Indicators.
As Jane said, while they provide a national picture of what's going on in Scotland,
the magic of many of them is that there is local data for many of them
which goes down to health board or local authority, or in some cases, down to ward level.
Those become items which it becomes relevant to track.
Certainly, one of the items which we are keen to see more use of over time,
in this set but also for the adult set,
is the use of the Warwick-Edinburgh Mental Well-being Scale
to track what's going on within your community
and the degree to which that might be the same or different to what's going on in others.
There is a real value in doing that.
And we think it will also help you to communicate locally
what mental well-being means for children and young people in your area,
and to point to a wider piece of research and consensus work which establishes that.
In terms of what we're currently doing within Child and Adolescent Mental Health Services,
we've had quite a busy three or four years.
We have a current HEAT target -
the HEAT targets are the national NHS targets that we work to,
as the NHS in Scotland - to deliver improvement.
A relatively small set of targets overall.
But we're about to head into the final year of the access target
in respect of Child and Adolescent Mental Health Services.
At the moment, that target is a referral-to-treatment target
for specialist services of 26 weeks,
which is to be delivered by 31st March 2013.
So we're about to hit the final year for delivery of that target.
We're likely to be publishing data on all health boards' performance in March of this year
as part of the HEAT Dashboard,
which will enable you to see the relative performance across health boards in Scotland.
We're already considering aligning the target with the broader access target
for Psychological Therapies by 2014,
with a reduction in the period from 26 weeks to 18 weeks.
And we're out to an internal consultation within the NHS on that at the moment.
That's a key delivery target.
Because this is an area where historically services in Scotland have been challenged
and have not performed to the standard that we would all expect.
To support the target, this year we're investing an additional £5.5 million
over and above what we were investing three to four years ago.
What we've seen with that is a significant growth in the specialist CAMHS workforce.
We assess that over a two-year period, just over two years now,
we've seen a 33% increase of the specialist workforce.
And that broadly takes us from somewhere a wee bit short of 600
to somewhere which is north of 800.
And that's a key component of the promotion and prevention component
of the CAMHS framework,
in that a key focus for specialist staff
is in providing general staff support and understanding about child mental health
and being available for consultation where that will help.
It works with the commitment towards Link Workers with every school and items like that.
If we're going to offer a good public health
and good mental health improvement service in respect of children's mental health,
a key component of that is having a specialist workforce
which is effective and adequately resourced.
Some areas have seen a bigger increase.
Yesterday I was in Lanarkshire,
and they've seen a 50% increase in their workforce,
albeit from a lower base, in the last two years.
That scale of change is something that we expect to see and retain over the coming period,
even as other items become squeezed.
We're looking at work around Integrated delivery,
not just looking at delivery through specialist services.
We're working within NHS NES, our education organisation,
along with colleagues in Children and Young People across the Scottish Government,
in the context of the Children and Young People's Change Fund,
to look at items such as Triple P and Incredible Years -
indicated interventions for children and young people with conduct disorders,
delivered through parenting approaches that create support
for parents to work with their children.
We would expect to see that as being a key component of delivery over the next 3-4 years.
In addition, we're also working with a balanced scorecard in respect of CAMHS,
and that sits alongside the Indicators,
focusing more on the service understanding and the service interventions in respect of CAMHS.
That gives us another data source.
Across this,
I'd really want to emphasise the degree to which data is becoming increasingly important
to the way in which we deliver mental health services and mental health improvement
within Scotland.
When I sort of think back to how things were in 2004 when I started,
generally what I was told was, data didn't apply to mental health
in the same way it applied to other areas of health business.
Mental health was just different.
It was over-determined, it was about families, it was about poverty, housing.
It was about all of those things. And the Indicator set says that's true.
At the same time, you should still know what you're delivering in terms of the service,
and you should still know what the outcome you're achieving is.
So we build data into all of the work we do.
And over time, the Indicator set that we're working with will provide part of that context.
It won't tell us how many people have seen a specialist service in the last six months,
but it'll give us indications of broad need and change in need over time,
based on some of the measures within there.
I'm just going to finish with a couple of minutes on the current consultation we're engaged in,
which is on the Mental Health Strategy for 2012-2015.
We're engaged in the consultation process which runs until the end of January,
after which we'll be doing development work
and engaging with ministers on the priorities and objectives that they want to set
for the three years to the end of March 2015.
We think three years is a reasonable period to set objectives in.
Most of the people who set the objectives will still be around and required to deliver on them.
It's also a reasonable period of time in which we might expect to see change.
We know a lot of this work is long-term in terms of housing and poverty.
At the same time, three years is roughly half the time
that a young person spends in primary school.
It's about half the time that a young person spends in secondary school.
And when we set objectives which are five years or ten years or 20 years,
we need to be careful not to forget the people we're working with at the moment.
So I quite like three years as a time period.
There'll be continuity with what we're already doing.
Our objective will be to deliver on the existing commitments as part of any new targets.
We're not forgetting the targets we've got.
We'll look to integrate the work on prevention and treatment,
not seeing these as separate, alternative or competing systems.
So thinking about how we can put in place support for what goes on in education
as part of a broader mental health strategy.
Also working from the evidence base -
identifying where we want to spend public money,
and where we want to interfere in people's lives.
We need to have the understanding that what we're doing will have benefit -
not just that it's good that there's a need there or it's good to commit money -
but that we can demonstrate in the things that we do that they will produce better outcomes
for the young people we're working with.
We also want to develop our knowledge of cause and effect,
the degree to which the things we say will produce outcomes do produce outcomes.
The degree to which we do produce that better future that is our common objective.
So if you have thoughts from today, or more generally,
and haven't been involved in any of the consultation events we've had to date,
or if on the back of today's event you might like a consultation event,
we would be very happy to come and play with you.
We get a lot of value out of talking to people.
Quite often, they come up with better ideas than we had. We quite enjoy that.
We then steal them and say they were our ideas.
We know you'll be OK with that as long as we do it.
So if you would find that helpful or if you would find that valuable,
I would ask you to engage with us.
I'm going to put up my slide which says who I am and where I am.
Thank you.