Professor Malcolm MacLachlan:

If I may follow up on that, this issue, the interaction of disability and mental health services, is the one I am personally most worried about within our services. Currently, if someone develops a severe mental health condition or, often, a moderate one, he or she needs to be referred out of services if he or she wants to receive medication. We are trying to promote a model whereby there would be in-reach, for instance, by psychiatrists into a children's disability network team or an adult disability team. The reason that is particularly important for people with autism is that sometimes they will have taken longer to build up familiarity and trust with the support team. Members can imagine that if someone develops mental health problems, perhaps because of the frustrations of living with autism, and is then referred out of a team, it can often make his or her mental health condition much worse. Furthermore, the teams to which people are referred are often not well resourced. This also puts psychiatrists in very difficult circumstances in that they may often feel that the best intervention for someone with a severe mental health problem is not necessarily medication, but within their own teams they do not have other health and social care professionals. I know for a fact that many psychiatrists are very concerned that they are having to prescribe medications in lieu of alternatives. To me, this highlights the importance of having a model whereby we would have in-reach from psychiatry where medication is potentially beneficial. That is probably, in my view, in the minority of cases, but it would be great if the committee could highlight that because we have a lot of service user participation in the service improvement programme for people with autism. Within the protocol - and I have already described the independent evaluation for that - the consistent issue that is raised is the mental health of people with autism.