Ms Jacqueline Campbell:

There is a huge amount in there. I will try to answer the Deputy's key points.

There were some significant issues around mental health support in Scotland. Work was being done pre-Covid around what were referred to as rejected referrals. Many children and young people were not getting access to mainstream mental health services. A number of changes came out of that work. In the broader mental health context, there was a recognition that it was not appropriate for some of those children to be referred into what we call child and adolescent mental health services, CAMHS, in Scotland because they did not meet the criteria for that. However, lots of other lower level things were going on - they might be called lower level but were obviously serious for individuals' anxiety - even if they did not merit CAMHS support. As a result of that, a significant amount of money has been invested in community mental health supports in Scotland. That is now being replicated for adults. It is very important to set that alongside the more formal mental health support routes because, for example, anxieties can affect autistic people. Those supports are project-based and in the community. There are lots of local projects and people are able to access that support. It is self-referred so there is no requirement to go through a process.

Also as a result of that original work - Dr. Denise Coia produced the original report - we worked in Scotland on support for children and young people. In September 2021, we published a national neurodevelopmental specification for children and young people. There is a link to that in the briefing the committee got. That is critical because it set out the aspirational standards for service providers. It focused on neurodevelopmental support in that broader sense. The idea is, as we are now piloting for adults, that we do not try to send people down a narrow path, whereby if they have a learning disability this is the pathway they go forward on to get support. It is about a broader approach recognising that people who are in need of neurodevelopmental support are likely to have a number of different things going on. They could have a learning disability and be autistic, they could have attention deficit hyperactivity disorder, ADHD, or a number of things could be going on. That specification, published in autumn 2021, has already set out those standards for children for local service providers. That went hand in hand with the injection of funding. More than £3 million was provided to our local National Health Service, NHS, boards to build capacity to allow people to implement these standards and to support professional development. We could provide the committee with more information about that. It is critical in terms of the new approach and how we intend to bolster that support for children and young people.

There are issues around workforce shortages. I will talk a little about that in the context of adults. To answer the Deputy's points on education, we can provide the committee with more information on that. In Scotland, there is a fairly long history to the educational side of things. Families and parents are probably experiencing similar issues to the ones that people may be experiencing in Ireland, particularly around autistic young people in mainstream schools who are struggling to attend and access support in such schools. A big, critical report came out a few years ago, Not Included, Not Engaged, Not Involved, which reset the relationship around schools. A huge amount of work came out of that, which looked at the use of restrictions on behaviour in schools, restraint in general and the inclusion of autistic young people in the school community. A whole load of work was done around education. An approach in Scotland, getting it right for every child, GIRFEC, applies in schools. If there are children with additional needs in a school setting, they should receive that additional support through mainstream schools. There can be issues around how that is rolled out in practice but that is certainly the backdrop.

On the situation for adults, which I touched on, we will be in a not dissimilar position to the one the Deputy started to describe for Ireland. On autism in particular, we are now seeing a whole cohort of adults who are realising they may have struggled for a very long time with some issues around how they engage socially, or different things that are going on for them, and are coming to their own conclusions that they might be autistic. As we know more about autism, this seems to have come to the fore in Scotland as well. We are seeing a huge pressure on services due to adults coming forward and looking for assessment, support and-or formal diagnosis. We do not currently have the services in most places to support those adults because services were built up around children and young people. What has tended to happen is that in some areas of the country - we obviously have local authorities, health and social care partnerships, and NHS boards in Scotland - support may be available for adults. In other areas, it is not. Sometimes, supports are available for ADHD and autism, but very rarely for both together on one pathway. Where supports are being provided, they tend to be from staff who are being borrowed from the children and young people service to provide that support. This is a fairly well-known and certainly public issue in Scotland through some of the work we have done.

There is also a link in the documents supplied to the committee to a key report that came out in February on adult neurodevelopmental pathways that I encourage members to look at. That report summarises the pilot work we did in Scotland for adults in recognition of the position where adults were not able to easily access support. It has a range of approximately ten recommendations, which will characterise the next stages of this work, which Ministers have signed off on and that we are now setting ourselves up to carry forward. That is critical in the sense that there is recognition of the gap in service and support. There is recognition that we find it is a slightly different position for adults than for children and young people, particularly around diagnosis. While we always build our systems around access to support and assessment, with formal diagnosis not necessarily being part of that, we also recognise that many adults tell us that diagnosis can be quite critical for them. Sometimes, the support adults require may be quite low but what they want is to have that formal diagnosis, for a number of reasons. There is recognition of that. A few steps are set out in that report that will guide us on our way forward. Essentially, at present, we have looked at joining autism and ADHD pathways together on a single pathway.

Certainly, the longer term aim is that this would be a single neurodevelopmental pathway for children and young people so that there would be one door and one route of access that is centred around an individual.