Scotland Tonight: Meet the people running SAMH, Scotland's mental health service

Scotland is grappling with a mental health crisis as services and funding fail to meet the needs of those most vulnerable.

For individuals with serious mental illnesses such as schizophrenia, bipolar disorder, and severe depression, the challenges extend beyond the conditions themselves.

Issues with access to care, delayed hospital discharges, a shortage of community-based care and persistent stigma are creating significant barriers to recovery and support.

In the past year alone, more than 50,000 people were admitted to hospital for mental health-related conditions, reflecting the scale of the issue.

However, the system’s capacity to manage these patients effectively in the community is under strain, leading to issues including bed-blocking within the NHS.

Last year, 120,000 bed days were lost due to the delayed discharge of mental health patients and more than 10% of mental health in-patients experience a delay to their discharge from hospital, with the average wait stretching to three months.

SAMH runs several supported accommodation services across Scotland, which help people living with mental illness to live more independently, but this type of support is not available consistently across the country.

Service manager Rachael Leghorn told Scotland Tonight: “We want to try and stop bed blocking within hospitals, I’ve seen it all too well. We had a person that we supported who ended up being in hospital for 27 years.

“It was a lot, lot longer than their initial admission was ever supposed to be, and three years of that was actually held up through the Covid-19 pandemic so it’s really crucial that we have these supported accommodations.

“It’s a scary thing, as people become unnecessarily institutionalised. Within a hospital it becomes so rigid – it’s such a kind of rigid way of life – because it has to be – but they’re also taking away independent factors such as making their own meals.”

Charities say promises made by the Scottish Government to increase mental health spending have fallen short.

A commitment was made to dedicate 10% of frontline NHS spending to mental health by the end of this parliamentary term, however the most recent figures show a decrease from 8.6% to 8.5%.

Access to specialist mental health services remains inconsistent. Only 65% of patients are seen within the 18-week target, with staffing shortages and geographic disparities further limiting availability, particularly in rural areas.

This lack of support disproportionately affects individuals with severe mental illnesses, many of whom rely on consistent, community-based care to live independently.

Stigma also continues to compound the challenges faced by those with serious mental illnesses. A recent study highlights the far-reaching impact:

92% of respondents reported experiencing stigma in relationships with family and friends.
53% admitted to respecting themselves less due to the belief they would never recover.
82% of those who faced stigma in relationships believed others would not want to be their friend.
77% said they had been treated unfairly at work.
58% avoided calling an ambulance or attending A&E for emergency mental health care after experiencing stigma in healthcare settings.

With limited and inconsistent community and preventative support available, there are concerns that our mental health system is not equipped to prevent milder mental health problems becoming more significant or to support people experiencing severe mental illness to live in the community.

Initiatives like the 2023-2033 Mental Health and Wellbeing Strategy and local crisis care pilots aim to address some of these issues, but gaps in SMI-specific commitments persist and campaigners argue comprehensive reform is needed to ensure equitable, effective support for Scotland’s most vulnerable mental health patients.

James, a recovery coach at SAMH, said: “You’re talking about people who’ve been in environments where they’ve been controlled.

James - recovery coach. — James – recovery coach. STV News

“They are told when to eat in the morning, they’re told when to eat in the afternoon. Some of them will have done hobbies, but they’ll have been put on by other people, whereas they come and work with us, and it’s now in their control, which is a challenge, because you’re saying to someone who’s now an adult, who hasn’t had the opportunity before to go out and just do this and make choices for themselves.”

As well as bed blocking within the NHS, the housing crisis is also a playing a part in making access to support more difficult for those with serious mental health issues.

Rachel added: “It can be really, really challenging when you’re getting met with roadblocks.

“I support an individual who we’ve worked with for eight years now to thrive and they absolutely have done that and we’re now ready to get them moved on into their own place, and we’ve been told it’s a two to three-year waiting list for them to have their own tenancy.

“That’s where it can be difficult, because you think you’re doing great work, and we are, but there’s only so many limits to that. That’s where we kind of need a multidisciplinary approach, and everyone thinks on the same boat.

“We all want to do the best, but resources are tight, and we’re all just trying our best to navigate it, but it is challenging, and the worry then is that this individual will start going back the way while they wait for a house, because it’s natural to become disheartened after putting in all that work.”

Maree Todd MSP said: “We are still absolutely committed to that ambition of 10% of total NHS spend going to mental health, with 1% going to child and adolescent mental health.

“The reason that we set those targets is because of the historic underfunding of mental health and children’s mental health compared to physical health, and we are still aiming to achieve that parity of esteem

“You’re talking to somebody here today who worked for 20 years in mental health in a psychiatric hospital, working directly with people with severe and enduring mental health needs.

“I am not going to forget about their needs when we are deciding how to direct our funding in Scotland, but it’s really important that we get some of the funding and attention upstream too.

“We want people to be able to access care in the right place at the right time. We don’t want people to be in hospital any longer than they absolutely need to be.

“We want you to be in the right place receiving care. And it’s I am so sorry that that person stayed in hospital for so long.

“I’m so delighted to see the service that SAMH are providing to support that person to live independently in the community, which is absolutely the best place for them and that enables them to fulfill their potential. It upholds their human rights, and it’s absolutely wonderful to see that type of work happening.”

Catch the full report – Scotland Tonight: Spotlight On…Living with Mental Illness at 10.40pm on STV and the STV Player.