Response 998417500

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About You

1. What is your name?

Name
Peter J Gordon

3. Are you responding as an individual or an organisation?

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Questions

1. Our framework sets out 8 priorities for a new Mental Health Strategy that we think will transform mental health in Scotland over 10 years. Are these the most important priorities?

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Yes
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If no, what priorities do you think will deliver this transformation?
Thank you for inviting comments via this consultation. I have been an NHS psychiatrist, trained and working in Scotland over the last two decades. If I may, can I make a few general comments first. (1) This consultation, like almost all Scottish Government consultations is at best only half-way up what academics and researchers term 'The ladder of participation'. In terms of "engagement" the views of others is sought only after the Scottish Government have pre-determined the "framework" for discussion. (2) In terms of transparency the public should be told who were involved in developing this framework to this stage, along with designations, dates and minutes of meetings. The Scottish Government do not do this and this lacks openness. (3) Have those with experience of mental difficulties been involved up to this stage of the "framework"? (4) Have survivors and activists been involved up to this stage of the "framework"? (5) Have the Medical Humanities been involved up to this stage of the "framework"? (6) Have sociologists been involved up to this stage of the "framework"? (7) Philosophy and ethics matter too for any public health policy. Have such areas been considered? (8) This all matters as Scotland has a prevailing approach that is biomedical. Even the independent mental Welfare Commission follow this as the central determinism. There is no alternative or complementary approaches and activists have generally been mischaracterised by the Scottish Government for raising such considerations. This is very far from "engagement" or indeed a fair consideration of "human rights" (9) Has Scotland looked at other countries approaches to mental wellbeing? Is there a role for "critical psychiatry" or as I prefer to think a pluralistic science that questions approaches that may be all prevailing, and may have as a result, not considered in a reasonable way the potential harms as well as the potential benefits

2. The table in Annex A sets out a number of early actions that we think will support improvements for mental health.

Are there any other actions that you think we need to take to improve mental health in Scotland?
See answer (to Question1). But I would add: (a) We need true Freedom to Speak Up in Scotland and less rhetoric from Scottish Government and less bullying. The Scottish Government's commitment here has been very poor. I understand that the Director General, Paul Gray, has asked for NHS Boards to appoint non-independent Board Executives as "Whistleblowing Champions". Sir Robert Francis made it clear in his report that such champions must be independent. Who then is holding the Department of Health to account for this? (b) Patient Opinion is a great development but it should not be triaged by NHS Boards and Scottish Government so as to present only the favourable comments. This is unethical. The Director General, Paul Gray, is one of the best examples of this approach as is NHS Forth Valley. The Director General has declined to comment on this though he says, like our First Minister, that he supports openness. (c) Over-medicalization (Realistic Medicine). It is not in the "framework" as far as I can see. What has happened to the Chief Medical Officer's welcome thoughts?? 1 in 7 Scots on antidepressants. Antipsychotic prescribing rising year-on-year in all age groups across Scotland. This is not "conservative prescribing? (d) Psychology has been second fiddle in Scotland for as long as and indeed before the SNP Government. Why? One reason may be because Pharmaceutical industry has had a fast grip on psychiatry and "education" in Scotland. Why then has the Dept of Health not nailed their colour to the mast and properly supported a Sunshine Act? The Scottish public want it! And we ss Chairs of National SIGN Guidelines have in many cases, significant vested interests, yet meaningful transparency is not there. Who is holding Healthcare Improvement Scotland to account? (SIGN is under this quango Board) meantime more and more HIS staff are getting accolades band awards from Queen and Country. (e) Healthcare Improvement Scotland (HIS) have done some good work but the "improvement science" that they have imported from Boston, IHI, is experimental and adopts a USA cultural approach. An approach that is most different to an "independent" Scotland. It is a business model often based on reductionisms and the language of mechanics. HIS are intimately aligned with the Scottish Government and the Department of Health run by Paul Gray. This risks a pre-determined rhetoric, a distortion of reality, and a culture where only those who are "improvers" are fully accepted. This is hardly the culture vthat Robert Francis so recommended after his inquiry into Mid-Staffs.

3. The table in Annex A sets out some of the results we expect to see.

What do you want mental health services in Scotland to look like in 10 years' time?
(1) Safe havens (2) healing environments (3) psychology! (4) "parity of esteem" between the medical humanities and biomedical science (5) Mental Health Act compatible with Human Rights (6) Openness and transparency in the Scottish Government (Code of Conduct of Civil Servants followed). Accountability. True ethical leadership (7) the end of "education" of medical professionals by commercial interests. Both NHS Forth Valley and NHS Lothian have "education" which relies completely on the sponsorship of the Pharmaceutical Industry (8) Less resource put into HIS and more into front-line staff where professionalism is supported (9) Les national top-down improvement agendas that often break-up continuity in local services and disempower staff (unless you are an "improver") to feedback real professional experience.