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May I say one thing before you bring in Ms Harper, convener?

It is important to put on record our thanks to the staff who work in mental health services, but particularly in CAMHS. I should say to the committee—we will provide more detail as always, because I know that you will ask for it after the session anyway—that the last quarter saw a record number of new patients starting treatment in CAMHS, as our NHS continues to remobilise and as demand has increased. That is a record number of new patients entering CAMHS, and that is down to the efforts of the workforce, who have increased in number, although we know that we have more to do there The staff have been amazing in rising to the challenge. I hope and know that they will continue to do that. We will send you more details because I know that the committee is always interested in the numbers.

Yes. I think that many folks who have thought about this for a long while acknowledge that, if you are in a rural area, particularly in a remote rural area or an island community, not everything will necessarily be on your doorstep. That is right. However, there are other ways of delivering services within those communities. Let us take, for example, rural Aberdeenshire—let us go with your constituency, convener, which contains many remote rural places, although some folk might find that hard to believe. There are different ways of delivering services there that ensure that those communities can still flourish and benefit from those services.

During the course of the pandemic, we have seen a rise in the use of telemedicine, but Grampian was a trailblazer in telemedicine long before the pandemic period. We can deliver a lot of services to remote rural communities online. We have to think about what is required. I have to say that I was sceptical around some of the online provision in relation to mental health services, but it works for people—it works well. Again, in your neck of the woods, convener, over the course of the pandemic period, the Grampian resilience hub did extremely well in bringing services into folks’ own houses at a point where they could not get out or could not get from Newmachar, Insch or wherever to services in Aberdeen.

There are ways of doing what we are talking about, and it is not just about the physical aspect of that 20 minutes; it is about what we can do in terms of the online world to bring those services to communities that are more remote and rural and to island communities? I am sorry if I have gone on too long but I am quite passionate about this.

I agree with the points that Ms Mackay has made. We have a job of work to do to ensure that we have the right mental health workforce for the future. That includes looking at the entry into the profession. It also includes getting the educational elements of this right and allowing folks to follow the career pathways that they may wish. We have some work to do there, but if we are truly serious about getting mental health services right and fit for the future—which I am—we need to recognise that we need more diverse folk in the profession.

Again, we have to be flexible in terms of the workforce. We have talked about school counselling. One of the next big moves, of course, is around folks in the primary care setting, which is extremely important. I have had conversations with a number of colleagues around the table about how we can get that right, because it cannae be the same old. We need folk from diverse backgrounds but, beyond that, we need workers to be multidisciplinary in what they do.

I will be honest with you and say that I am willing to steal good ideas from elsewhere. I met Dr Gulhane a couple of weeks ago about children’s wellbeing practitioners south of the border. I am quite happy to nick good ideas if they fit in. That is grand.

One of the main things that we need to do is to make sure that there is a diverse workforce that caters for the needs of all of society—not just the LGBT+ community but, as Ms Todd mentioned earlier, our minority ethnic communities, which are often not brought into play enough in this regard. In particular, folk will know that I have had an interest in what more we need to do to support our Gypsy Traveller community. We have to get this right for all.

The evidence has been clear since before the pandemic that girls and young women appear to experience poorer mental health and wellbeing than boys. We undertook research on the reported worsening of the mental wellbeing of young women and girls, which was published in 2019. That research highlighted several interrelated drivers that may have contributed to that trend, which included things such as body image concerns. To further explore some of the causes of the trend, we established the Scottish Government national advisory group on healthy body image for children and young people, which published its recommendations in March 2020. We are currently working on meeting those recommendations. That is one area where we need to move further forward.

I know that there has been discussion at the committee and evidence given about the impact that screen time and social media use can have on young folk, so body image is not the only aspect, although it is way up there. We are looking to resource work on that and to work with Young Scot to bring forward a national conversation on body image, screen time and mental wellbeing. We want to hear the voices of young folk about this directly, so that we shape our future work absolutely right.

We have touched on eating disorders today. Young girls are disproportionately impacted by eating disorders, which was again exacerbated during the course of the pandemic. I have already outlined some of the work that we are undertaking there.

We also need to better understand the mental health needs of women and girls who are affected by gender-based violence. Having recently funded and published an Improvement Service report on that important subject, we are now considering how best to take forward its recommendations. We will link all that work to a refresh of the Scottish Government’s equally safe delivery plan.

I would like to touch on another area where we need to do more: autism in young women. I have heard—and I am looking at members’ faces because I think that others have probably heard the same thing—that it is much more difficult for a young girl or a young woman to be diagnosed as autistic, and often they are left in limbo for a long while and diagnosis comes far too late. We have to ensure that we work on that. It will take a fair amount of graft to get it right for the future.

I hope that that gives you a flavour of some of the work that I see as being a priority, but there are many other things that we are doing also.

I will add to what Ms Todd has said, as there are a number of other things that we need to do. We need to raise awareness of adverse childhood experiences in our communities and across the nation. We have to recognise the impact that trauma can have on people. That is why we are investing in our national trauma training programme and providing some £4 million to support the development of trauma-informed workforces and services.

In some parts of the country, trailblazing work is going on. I had the pleasure of talking to folks from South Ayrshire and Dundee recently. I was very impressed with the huge amount of work that South Ayrshire Council has done with its workforce and with elected members on trauma-informed practice. We have to ensure that such work is exported across the board.

Ms Harper asked about eating disorders. Eating disorder services are extremely important to me because, as folk know, I know people who have been impacted by family members having eating disorders. During the pandemic, the number of eating disorder cases has risen, and we have to continue to monitor and react to that.

As folks know, we conducted a national review of eating disorder services. The review group is jointly chaired by Dennis Robertson, a former MSP, who has campaigned vociferously for improved services, and Dr Charlotte Oakley, who was previously the clinical lead of the connect-ED—eating disorders—service at NHS Greater Glasgow and Clyde. The group’s aim is to ensure that stakeholders are empowered, through collaboration and engagement, to provide their input, experience and expertise and to play a leading role in delivering the recommendations and improving services.

I am sure that the committee is well aware that, in June, we announced an additional £5 million to respond to the review’s recommendations. We have also provided further investment in third sector organisations—for example, we gave £400,000 to Beat, the UK’s eating disorder charity—to provide a wider range of options and support for those affected by eating disorders, including families and carers.

I do not think that we should underplay the issue. There has been an increase in the number of folk presenting with eating disorders, so we have a fair amount of work to do to get it right for folk.

We need to listen to the voices of lived experience with regard to how we shape services for the future. I refer back to the LATNEM women. There were mixed opinions on various parts of service delivery, but all the folks who expressed an opinion said that, during the pandemic, the Grampian resilience hub had been absolutely fantastic in responding to women’s needs. We need to learn from the Grampian resilience hub’s work during the pandemic and see whether we can replicate it across the board. Something went on there that obviously worked for those women, and if it worked for them, it is likely to work for others. Such services can operate in the same way in remote, rural and island areas as they do in urban areas because, in the main, communication is by telephone or video call. We need to look at that in more depth.

I will be honest with you. We would not be picking up such nuggets of information and good practice if we were not going out and hearing the voices of lived experience. I want to continue to do that.

Hugh Masters may want to say a bit more on that.

On perinatal care, feedback from the third sector has highlighted the difficulties in navigating service delivery in a safe way during the very turbulent times of the pandemic. To support the third sector, we funded additional support that was focused specifically on wellbeing issues. We have had learning during the pandemic that we can use in the future, and the Grampian resilience hub is the prime example of that.

I do not have any specific information with me on the impact on perinatal mental health support for ethnic minority women during the pandemic. We can have a look and see what information we hold and get back to the committee on that.

I will hand over to Maree Todd to cover some of the other issues that Dr Gulhane raised.

Given that mother and baby units have been mentioned, I think that it is important to expand on some of our thoughts in that regard. The “Delivering Effective Services” report recommended that the number of MBU beds in Scotland be increased and said that that could be achieved through expansion of the existing units or the creation of a third MBU in the north of Scotland. The report also recommended that an options appraisal be undertaken to determine the most appropriate way to increase the number of beds in Scotland.

That work is under way and a number of options are being considered, including the creation of a third mother and baby unit in the north and the expansion of one or both of the existing units in Glasgow and Livingston. We have to look at a number of issues including equity of access, cost and safety, and the sustainability of the service. All of that needs to be considered as part of the options appraisal. My intention is that we will hold a public consultation in early 2022, which will help to inform the options appraisal and the decision-making process. We will seek to engage with as many stakeholders as possible—in particular, we will engage with as many folk who have lived experience as we possibly can.

We recognise that, as Hugh Masters rightly pointed out, folk from further afield than Livingston and Glasgow, where the existing mother and baby units are located, often have a fair way to travel. We have therefore put in place the mother and baby unit family fund to help with travel expenses for families. We hope that we can move forward on that front in the early part of next year by consulting folk on the future of mother and baby units.

I am continuing to monitor that matter, as is the programme board. There are always calls for additional resources—that is the way of the world. I am keen that all the resource that has already been allocated for the work in boards be used. When it has, we can look at whether other resourcing is required.

What is key for me, at the moment, is that we ensure that recruitment is taking place, that the money is spent and that the services that are delivered are shaped by the voices of lived experience. At that point, once the report cards that I mentioned have been looked at, we can consider what else we need to do and where.

I ask all health boards to ensure first that they utilise the resources that they have already been given to maximum effect.