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Thanks for the question, and thanks to the individual who asked the question. First, the reduction in the working week is one of the issues that trade unions have brought forward. That fundamental issue was raised by those who represent the workforce at the regular meaningful engagement that we have with trade unions as part of the pay negotiations. It was not something that was necessarily brought forward proactively by the Government or, indeed, by employers. We thought that it was important to listen to the trade unions and that is why we have made a commitment to the reduction of the working week.

Clearly, the reason why we have not said that we will do that by tomorrow, next month or within a short or narrow timescale is for precisely the reasons that the individual who has contacted you highlighted: we would have to look at the implications for staffing.

We are committed to continuing to invest in our workforce. Inevitably, that will mean growing it. If we are going to reduce the working week, there is no doubt we will have to look at filling some of the significant numbers of vacancies. I would be the first to admit that there is a significant number of vacancies in nursing and midwifery.

I hope that the individual who asked that question will be reassured that we will work through the detail before we implement a shorter working week. We must understand what the demand pressure on the workforce and the impact on services would be, and then ensure that we have adequate staff to respond to that.

That is a really good question. There are a few areas to mention. As you will see from the most recent strategy, which was, as I said, co-designed with COSLA, there is a significant focus on tackling the social determinants of suicide.

Literature upon literature and academic research after academic research makes the link between social determinants such as the inequality that exists and the unfortunate completion of suicide. We are working exceptionally hard on the issue, but we can do more in that workstream.

You will also see in the strategy that a lot of work is being done on pre-crisis intervention—getting to people before their situations escalate to becoming specialist mental health challenges.

Regarding my assessment, it might be better to take that off the table and to get an answer to you in writing with more detail on each workstream and the assessments that have been made. The most recent published strategy, “Creating Hope Together”, gives a good indication of what we think has worked and of where we need to go further collaboratively with local partners. I hope that you get the chance to look through the strategy in detail.

Does Hugh McAloon or anyone else want to come in to add to what I have said? I know how involved you were in the strategy with COSLA.

Obviously, we have publicly said that we are attempting to reach that target by March 2023, which will be challenging—it is an ambitious target, to go back to my previous point. We will set ourselves those ambitious targets in order to push the entire system to help us to meet them.

It is a common theme, I know, but, although I am confident that some health boards will meet that target, there are other health boards—including one of the health boards that the member has cited regularly to me—that are very unlikely to achieve that target, so we are giving them more intense support and getting improvement plans from them. We are not accepting the fact that they will not meet the target by March 2023, but we are saying, “How can we help you to get there or as close to there as possible?” There are a myriad of challenges. As the member knows, although we have done well on workforce recruitment, that will be different in rural areas, urban areas, island communities and so on. That target for spring next year will be challenging, but I am committed to doing everything that we can to get us there.

Alexander Stewart understands that urban areas and large population centres have their own challenges. Urban areas often have areas of higher deprivation in large concentration. We have talked about those social determinants that can have negative outcomes for people’s physical and mental health. Urban areas have their own challenges—as do remote, rural and island communities—which are usually centred around access to services, as he rightly says, but also the workforce, which is not unrelated to that point, and the recruitment and retention of the workforce.

I should say that NHS 24 has a mental health hub—as, I am sure, the committee is aware. There were some challenges when it first started, but we saw improvements across all the metrics in 2021. The demand for the NHS 24 mental health hub has remained consistently high—I spoke to the chief executive a couple of weeks ago—and the service has not seen much of a dip since July 2020. There have been peaks and troughs, as you would imagine, but demand has been consistently high at more than 2,500 calls per week, and thus far it has responded to more than 200,000 calls.

We will continue to invest in local services. In remote and rural areas and island communities, in addition to ensuring that people have access to the important statutory services, I am particularly keen that we work closely with the third sector, which has an important role to play. It plays that role across the country, but, in remote and rural areas of Scotland, we can utilise the third sector to help us with some of the challenges around access. That is not to say that statutory services should not do what we need them to do, but there is an ability to use and invest in the third sector more than we currently do.

Obviously, we want to prevent as many suicides as we possibly can. That is a core part of the strategy. A lot of work is going on with the third sector in relation to the support that we can offer to families that have suffered—and not just families, as we understand that suicides have an impact on entire communities. In my Glasgow Pollok constituency, throughout the course of the pandemic, there were a number of tragic cases of young men and women completing suicide, and entire communities were rocked by that.

We will be working on the bereavement support, but a lot of the work is on the preventative side and, because the statistics tell us that a disproportionate number of young males are completing suicide, a lot of focus is going into that space. Hugh McAloon can say a bit more on the pilots.

You will know, convener, that I was Cabinet Secretary for Justice before I was in this role. It is a real failure—I do not use that word lightly—in our approach to have police officers attending somebody who is in distress and be with them for five hours. That is not good for the individual who is suffering that distress, because the police officer—who will do an excellent job, given the circumstances—would be the first to say that they are not the best person to help with mental health needs. It is not the best use of the police officer’s time, and it is not the best approach for the individual involved. It is not good for the system as a whole in relation to the response that we are giving to people. In itself, it is a failure of approach and lays bare some of the failings that the petitioner spoke about when she gave evidence on Luke’s case. I know—I do not suspect—that Luke’s case is not an isolated one.

We often talk about mental health being on a par with physical health and, from the Government’s perspective, that is true in terms of priority, but I do not think that we see the evidence of that cascading through the entire system. The example that you give is good, which is why we have in recent years set up the NHS 24 mental health hub, so that people have access nationally to clinical specialists for the mental health distress that they face.

I go back to the common theme of pilots. A number of pilots that we have run across the country—some of which have now been evaluated—have shown us a much better model. I think back to the one in Govan in the south of Glasgow, where, if a call came into the police because somebody was worried about the possibility of another person seriously harming themselves, the police officer would go with a specialist community psychiatric nurse to attend the incident. I will not quote exact figures, but if I remember correctly, the amount of officer time that was then spent on such a situation reduced by more than half.

Perhaps I would be better passing to Dr Cook, who will be able to answer your question from a clinical perspective.

I will make a brief statement, if I may, convener.

I will not take up too much time in my opening remarks. I am keen to hear from members and to allow as much time as possible to take questions.

However, first and foremost, I want to reiterate what you said, convener. I read Karen McKeown’s testimony. It was very moving and I offer my sincerest condolences to her for the sad passing of her partner. The passion that she has brought to the issue is a fitting tribute to her late partner, Luke. I am grateful to her for coming to the committee.

I hope that it is clear that the petitioner and the Scottish Government want the same outcomes, although we might not necessarily agree absolutely on how we get to them. I suspect that that is the same for everybody at the table.

We want a mental health system in which, first of all, we can intervene as early as possible before a situation needs crisis intervention, and in which the person does not have to repeatedly tell their story. We heard that clearly from Ms McKeown over and over again. Luke asked for help eight times, I think, before he got the support that he required. We want a responsive system, in which all partners work together at every level of need. That should apply to signposting to help and advice, access to support in our communities, provision of the right support to people who are in distress and, importantly, delivery of specialist mental health support and services where that are necessary and critical.

Our forthcoming mental health and wellbeing strategy will be key in setting out not only those aspirations but how we will achieve them. We will publish that strategy in spring 2023. It will set out what every member of the public is rightly entitled to expect when they ask for help in relation to their mental health. I want our strategy to act as a blueprint for a high-functioning mental health system in respect of how we respond to all levels of need. We expect the system to act responsibly. Nobody—I emphasise that—should have to struggle in the way that Luke had to struggle, or to fight for the help that they need. The earlier that we can get people the right support, the better will be our chances of having better outcomes and stopping issues from escalating.

At the heart of the work, especially on our new strategy, must be a focus on reducing stigma, on prevention—including suicide prevention—and on involving the voices of lived experience at every level. That came over strongly from the petitioner and it resonates with many people.

I will get into the finer detail of that, convener, but I am happy to leave it there for now and to end where I started, which is to acknowledge Karen McKeown’s passion, drive and bravery, and to commend her for a petition that is of fundamental importance.

One of the other theories—Alastair Cook is right to describe them as theories at this stage—was that in the early days of the pandemic and throughout the really difficult periods, we saw a real groundswell of local activity in terms of third sector support and help. I think that we could all testify to that, and it still exists to an extent. I certainly remember that, at the beginning of the pandemic, it just sprung up organically. Therefore, people might have had access to services in ways that now, as people get on with the jobs that they would normally have done, do not exist as much. Again, that is one of the discussions that we have had.

Absolutely. Angela Constance and I meet and talk regularly about this.

I should have said from the outset that I am grateful to Paul Sweeney for speaking about his own mental health issues. I know that other members have also done so in the past, and I think that it is important for us to do that. It is not incumbent on us—we do not have to do it and we do not necessarily owe it to people—but, given the platforms that we have, the more that we can talk about such things, the more that we can, I hope, reduce the stigma around mental health issues. I am grateful to all members who have done that.

Medication-assisted treatment standard 9 is key. MAT standard 9 is the expectation that all people with co-occurring drug use and mental health difficulties will receive mental health care at the point of the MAT delivery. As always, some local authorities are doing better than others, but we have asked all local authorities to submit their implementation plan to the Scottish Government, setting out how they will embed all 10 standards across the piece in their area.

As you can imagine, we are monitoring that very regularly. I am doing it monthly, where necessary, or quarterly. Local authorities that are doing well in that regard will have less monitoring and supervision. As you can imagine, where we see issues with regard to that MAT standard—all MAT standards, but MAT standard 9, in particular, is relevant to your question—we are monitoring those local authorities very regularly and having conversations about that. Obviously, that is also backed by a commitment to multiyear funding.