15. Mental Health First 🟢

In the quarter to March 2026, 91.2 per cent of children started CAMHS treatment within 18 weeks. Adult psychological therapies sat at 79.4 per cent against the same 90 per cent standard. SPICe compilation of board returns found 42,530 children waiting for a neurodevelopmental assessment at 31 March 2025, with no equivalent national PHS series. Health, schools and most of the NHS workforce are devolved. Scotland has no statutory lever for a counsellor in every micro-business.

Current reality

Legal and institutional position

NHS mental health services, CAMHS, psychological therapies, education, school counselling grants, and most occupational health policy for public bodies are devolved. The 18-week CAMHS and psychological therapies standards are Scottish Government standards, published by Public Health Scotland.

Neurodevelopmental assessment for autism and ADHD is not the same service as CAMHS. PHS states that children waiting for a neurodevelopmental assessment who do not meet CAMHS referral criteria are not counted in CAMHS statistics. There is a national neurodevelopmental specification. CAMHS has no statutory, quarterly national waiting-time publication.

Workplace support for private employers varies. Public-sector EAPs and occupational health sit under Scottish employers. Access to Work Mental Health Support Service is a UK Department for Work and Pensions scheme. Employment law and statutory sick-pay architecture are reserved. Scotland can fund, guide and attach conditions to public contracts. It cannot, by Holyrood statute alone, require every private micro-firm to employ a counsellor.

The latest official numbers

CAMHS (PHS, quarter ending March 2026).
91.2 per cent started treatment within 18 weeks (standard 90 per cent; previous quarter 90.0; year earlier 91.6). First met in the quarter ending December 2024 and has held since. 3,858 started treatment. Median: 50 per cent within six weeks. Referrals: 9,807, up 10.9 per cent from the previous quarter. Waiting list: 4,791, up 18.0 per cent from the previous quarter. SG statement in the same release: waits over 18 weeks at their lowest since 2013; 12 of 14 boards reporting zero waits over 52 weeks.

Workforce (NES Turas).
CAMHS at 31 December 2025: 1,501.7 WTE (1,723 headcount), +53.4 per cent on a decade earlier, −2.7 per cent on the previous year. Vacancy rate 2.9 per cent. SG cited 1,506 WTE and +51.6 per cent over ten years, and said the 320 additional posts by 2026 had been exceeded.

NHS mental health workforce at 31 March 2026: 20,454 people, 18,112.9 WTE; 16,247.6 WTE with a clinical remit; nursing 11,362.9 WTE. Psychology clinical staff at 31 December 2025: 1,733.6 WTE, +61.7 per cent over a decade; vacancy rate 3.2 per cent.

Adult psychological therapies (PHS, quarter ending March 2026).
79.4 per cent within 18 weeks (previous quarter 82.1; year earlier 78.6). Standard still unmet. 19,285 started treatment. Median: three weeks. Referrals 31,179. People aged 65+: 73.8% within 18 weeks.

Neurodevelopmental (SPICe / Health, Social Care and Sport Committee, board returns to 31 March 2025).
42,530 children waiting across boards that could supply a figure (Grampian could not separate the data; Tayside was not accepting new referrals). About one in 25 of the 0–18 population, according to 2023 estimates. Four boards saw more than a 500 per cent rise since 2020. Median waits: 22 weeks (Western Isles) to 141 weeks (Ayrshire and Arran); average median 76 weeks. Longest waits: 69 to 342 weeks; average longest 196 weeks. Adult pathways existed in only some boards. There is still no PHS quarterly national ND series.

Schools and community (SG local-authority returns, April 2024–March 2025).
School counselling: 24,130 children and young people; 496 counsellors (headcount); 7,152 hours a week. Peak use S2–S3; 64 per cent girls. Some authorities extend into P6–P7; coverage is not universal in primary. Community mental-health supports: 79,412 people, including 9,582 family members and carers.

Strategy monitoring (January 2026).
Average adult wellbeing improved; the share of adults at the GHQ-12 threshold fell. The same report described the picture as mixed, with inequalities persistent.

How it is experienced in daily life

A secondary pupil can see a school counsellor. A P3 pupil in many authorities cannot, on the same funded model. A CAMHS referral in 2026 is more likely to start within 18 weeks than five years ago. An ADHD referral may wait years and will not appear on the CAMHS dashboard. An adult offered CBT in three weeks, and an adult still outside the 18-week standard can live in neighbouring boards. A council employee has an EAP; a sole trader has Breathing Space and, if eligible, Access to Work.

How it got here

CAMHS was the public failure of the 2010s. Staffing rose by about half, lists were published, and the standard was met from late 2024. Neurodevelopmental demand grew faster than any equivalent expansion of assessment capacity, and was defined out of the CAMHS count. School counselling was funded from 2018–19 for secondaries. Adult talking therapies never received the same sustained workforce lift. Workplace provision followed employer size, not statute.

What has already been tried, and what that showed

Published standards plus extra WTE can move CAMHS. The same quarter that met 91.2 per cent also added 732 people to the list, because referrals rose 11 per cent. Extra CAMHS capacity does not empty ND lists. Secondary counselling exists at scale; primary does not. Community supports reach tens of thousands and remain hard to navigate. Strategy monitoring can show population scores moving while specialist adult waits do not.

What needs to happen

The improvement in measurable terms

• CAMHS standard held while the waiting list stops rising faster than it starts.
• Psychological therapies at or near 90 per cent, including for people over 65.
• A national ND waiting-time series, then shorter medians.
• School counselling available in primary on a published coverage measure.
• Pre-diagnostic support that does not require a multi-year assessment first.

Sequence

Keep CAMHS above the line. Publish ND waits on the same cycle as CAMHS. Expand assessment and, separately, non-diagnostic support. Extend the secondary counselling model into primary before inventing a new brand. Grow training places and supervisors together. Workplace coverage starts with public contracts and shared digital access, not a private-sector headcount duty.

Workforce, capital and standards

Doctoral psychology, CAMHS nursing, applied-psychology masters, and school-counsellor supply all have multi-year lead times. Supervision capacity is the binding constraint on quality. The 18-week standards already exist; ND lacks an equivalent public clock.

What would count as success in twelve months?

• Four consecutive CAMHS quarters at or above 90 per cent, with the list not 18 per cent higher
• PT closer to 90 per cent than 79
• A first official national ND waiting-time publication
• A primary-school counselling coverage figure, even if incomplete
• No claim that CAMHS improvement is the same as ND improvement

What can be done under current powers

Who holds the lever

Scottish Ministers and NHS boards: services, standards, training commissions. Local authorities: school counselling and community funds. NES: workforce statistics and training. UK DWP: Access to Work.

The statute, budget or direction

NHS and education statutes; Mental Health and Wellbeing Strategy; CAMHS national specification; neurodevelopmental specification; school-counselling grant conditions; public-contract wellbeing clauses.

What is already possible and unused

Mandatory ND data returns to PHS. Stepped, pre-diagnostic support as the default. Primary counselling on the secondary grant model. Public-sector EAP minimum standards. Signposting small firms into existing free services. More training places with funded supervision.

What would still be true if management improved tomorrow

Referrals can still outrun starts. A psychologist still takes years to train. A six-year ND wait is not cured by a CAMHS press release. Access to Work remains reserved. Poverty, housing and isolation still generate need.

Where the limits are

Law and reserved powers

NHS and schools are Scottish. A statutory duty on every private workplace is not a clean devolved instrument. Access to Work is UK.

Money

Secondary counselling is already about £16 million a year. Primary, ND assessment and PT capacity are recurring Budget lines against the same health envelope.

Workforce and capital

1,502 CAMHS WTE and 1,734 psychology WTE are large, but still small, against 42,530 children on ND lists. Vacancies are down; lead times are not.

Time, geography, UK-wide systems

Board variation is the daily experience. Western Isles months versus Ayrshire years is the same country.

Political difficulty, kept separate from legal impossibility

Choosing ND publication and primary counselling over other NHS lines is a priority fight. It is not a reserved-power problem.

What is not yet known

A consistent 2026 national ND total. March 2026 CAMHS WTE in the June NES release, as distinct from December’s 1,501.7. How many of the 4,791 CAMHS waiters are also on an ND path? PT waiting-list size in the same format as CAMHS. Primary-school counselling hours as a national series.

Honest summary

Achievable now. Hold the CAMHS standard. Publish ND waits. Extend school counselling downward. Grow PT capacity. Use public-sector workplaces as the first workplace test.

Only partly achievable. Every child off an ND list within a year. Every micro-employer with a staff counsellor. Population wellbeing rising solely because clinics are faster.

Would require reserved change. A UK-wide Access to Work redesign, or a private-employment duty that rewrites reserved employment law.

Colour mark: green. The services that decide whether a child or an adult is seen are already Scottish. CAMHS shows those services can meet a standard when staff and scrutiny align. Green does not mean the ND list is acceptable, or that 79 per cent on adult therapies is success.

What this item does not settle. It does not treat CAMHS and ND as one queue. It does not endorse a particular diagnostic threshold. It does not convert modelled economic returns into a Budget fact.

The test is whether the next PHS year still has CAMHS above 90 per cent, whether ND waits are finally aligned, and whether a P6 pupil has the same funded door a secondary pupil already has.

Connection

Item 6 is the school system that hosts counselling. Item 7 is the training pipeline. Item 13 is the early-years and family pressure that presents as later distress. Public finances pay the posts. The Independence Debate is not required for these waiting-time instruments.

People’s Future Scotland