Malcolm Chisholm: The Health and Sport Committee's report: "Inquiry into child and adolescent mental health and well-being"

Health: The importance of support during children's early years Malcolm Chisholm (Edinburgh North and Leith) (Lab):
As the committee's excellent report and the accompanying evidence make clear, there is a great deal of continuity in mental health policy from the previous Administration and from the Scottish Needs Assessment Programme report of 2003 in particular. Now, however, there is even stronger evidence about the supreme importance of the very early years for mental health, which is backed up by exciting new research about the effect of early family relationships on brain development.

As we head towards more difficult times for public expenditure, it is more important than ever that we identify the areas that are most important for the future of society and ensure that they are prioritised. I believe that the early years, and the first three years of life in particular, are such an area.

Evidence to the Health and Sport Committee certainly supported that point of view, especially the evidence given by Dr Philip Wilson on 25 March. He referred most strikingly to some work in the United States, which Mary Scanlon also mentioned, that suggested that it is possible to predict at the age of three as many as 70 per cent of children who will end up as in-patients in psychiatric hospitals or in prison. He also described the intensive home-visiting programme that was developed by David Olds in the United States, which I am pleased to say is now being taken up on a pilot basis by NHS Lothian, as the minister said.

Follow-up studies in the US indicated that children in vulnerable families who had received intensive home visiting from health visitors up to the age of two were, by the age of 15, half as likely to have psychological problems and half as likely to have been involved in the criminal justice system as similar children who were not in the programme. There is no more graphic illustration of the potential importance of health visiting, which was a major feature of the committee's report.

We should remember, however, that the example that I gave was targeted on vulnerable families, and I remind members that that was the thinking behind Hall 4, which was issued while I was a minister, as was the SNAP report. A good impulse was behind that, because we must have intensive rather than occasional home visiting if we are to support vulnerable families. That said, a clear danger is that children will be missed if not enough health visiting is undertaken, and it is generally agreed that the approach has swung too far the other way. It is important to find the middle ground - the minister recognised that in her speech, although people might feel that the balance needs to be redressed even further.

The committee's report and all members today have certainly acknowledged that health visitors are crucial in early identification. Equally, the report recognises that the task is not just for health visitors; we need a multi-agency strategy to address obstacles to early intervention. The committee made important recommendations about nursery schools and about training for the early years workforce across the board.

However, none of that can be at the expense of specialist CAMHS staff, not least because those staff train the wider early years workforce. I will focus on the staffing recommendation because it is clear that for many other issues, such as waiting times, staffing is the most crucial - but not the only - relevant element. The spotlight in the report is on the NHS and the figure of 20 specialist staff per 100,000 population, but we should remember the role of local authorities. In Edinburgh, several jointly funded posts were the result of changing children's services fund money. There are great concerns about the continuance of the local authority's contribution to those posts, and the fact that many of those staff in Lothian have temporary contracts is a particular concern.

A wider issue is council funding for mental health services in the voluntary sector. If we do not support the voluntary sector and other support services for mental health, the burden on CAMHS staff becomes all the greater. A superb project in my constituency that was funded by the fairer Scotland fund, called women supporting women, lost half its funding last year and is existing on a lesser service this year. That project has helped hundreds of women with young children in my constituency. Without that support, they and their children might well have had to access psychiatric services. We need to remember the wider funding situation, as well as the specific NHS money.

Of course, I welcome what the minister said about increased NHS funding for specialist CAMHS staff and the announcement a few weeks ago about clinical psychologists, but psychiatrists have told me that expanding the psychiatric workforce is an issue. The Government says that lots more psychiatrists are in training, but what guarantee do we have that they will obtain permanent posts? NHS boards must create the posts, which is a concern for some psychiatrists. The committee also raised the issue of research.

I should not really be mentioning the next subject just in my last 20 seconds, but it is clear that a key issue is the mental health improvement agenda. I note that SNAP's former chair, Graham Bryce, highlighted the failure to step up that programme, which must be central in the work against stigma, to which I know that the Government is strongly committed. January 7th 2010, (Column 22437-9)