Mental health and wellbeing : workforce action plan 2023-2025

Section A - Introduction

The Mental Health and Wellbeing Strategy (“the Strategy”), sets out Scottish Government and COSLA’s vision of a Scotland, free from stigma and inequality, where every person fulfils their right to achieve the best mental health and wellbeing possible.

The scope of the Strategy is wider than that of its predecessors, with an increased focus on wellbeing and prevention. It considers every part of what supporting mental health and wellbeing means. This includes addressing the underlying reasons behind poor mental health and wellbeing; challenging the stigma around mental health, providing early support, specialist help and support for mental illness and helping to create the conditions for people to recover and thrive.

The Strategy Delivery Plan sets out the actions that we will take over the next 18 months to make progress towards delivering the outcomes and priorities identified in the Strategy.

Delivering the Strategy and its associated actions can only be achieved with the right workforce, supported to have the right skills, in the right place at the right time.

This Mental Health and Wellbeing Action Plan (“this Action Plan”) sets out how Scottish Government and the Convention of Scottish Local Authorities (COSLA) will progress a range of activity to address key workforce issues that have been raised in consultation with delivery partners. It is not intended to replace existing plans, policies or work already underway. Instead, its purpose is to focus on key areas where action is required – doing so in a way that is pragmatic and realistic given the current financial challenges and the available supply of workforce. The Action Plan outlines areas for continued and / or enhanced activity and provides case studies in Annex A that highlight examples of good practice from across mental health and wellbeing services.

This Action Plan will support local partners and partnerships as they continue to make local decisions to plan and deliver the mental health and wellbeing workforce needed to provide excellent services as set out in the Strategy Delivery Plan.

A summary of activity which will be undertaken in the first 18 months can be found here.

Our Approach

Working in Partnership

This Action Plan will be progressed jointly by Scottish Government and COSLA to support a whole systems approach. As with the Strategy Delivery Plan, the Verity House Agreement is relevant across this Action Plan. We will seek to realise its commitments through our actions whilst aligning with wider work on the Agreement.

In progressing the actions across the plan, we recognise the differing roles, responsibilities and capacity of our respective organisations and each action will be led jointly or by the most appropriate partner, whilst maintaining a spirit of collaboration and joint oversight.

We also know wider partnership work will be crucial; achieving our vision will rely largely on the people who work within and across sectors to improve the mental health and wellbeing of our communities and will need a cross-society approach. This includes local and national government; public bodies such as the NHS, Social Care sector and national organisations. This Action Plan will support local partners and partnerships to continue to make local decisions to plan and deliver the mental health and wellbeing workforce needed to provide excellent services as set out in the Strategy Delivery Plan. All actions set out within the Strategy’s Delivery Plan will interact closely with this Action Plan.

This is the first phase of this Action Plan, it will be reviewed and refreshed after 18 months, and regularly thereafter. We recognise this Action Plan will not provide all the solutions to the current and future challenges faced by the workforce and that much more will need to be done over future iterations. Taking a phased and dynamic approach to this work will allow us to regularly review and measure success of ongoing activity, adapting and responding to new and emerging challenges, innovation and evidence, as well as feedback from our stakeholders.

Resource

Achieving the shared vision set out in the Strategy will require a cross-government, whole system and sustained response. We are committed to working with and investing alongside our local and national partners (public, private and third sector).

The Financial Framework in the Strategy recognises that, as the current financial challenges are likely to continue over the next few years, it is even more important to ensure that investment is effectively targeted to deliver sustainable and high- impact services and support. In this context, the Strategy will provide a framework for prioritising resources across the system over the next ten years.

The duty of Best Value applies to Scottish Government, local authorities and all public bodies in Scotland and is relevant both to new programmes of work and to how we use existing funding in the system to improve performance and outcomes. Adequate funding that is fully aligned with the Strategy outcomes will be required to support effective delivery. We will work across Local and National Government and relevant partners to determine adequate costings and we will work together to identify how this will be funded, whether this is through additional funding or by using existing resources more effectively. In implementing the actions in this Action Plan, we will work with partners to ensure we recognise pressures and look to reprioritise actions and drive efficiencies to ensure we can focus on agreed priorities, while recognising wider financial pressures.

Funding decisions and the principles which underpin these will be built into the new governance arrangements for the Strategy. This will also include arrangements for evaluating and monitoring the impact of investment against the Strategy’s outcomes, which will inform ongoing and future resourcing. Decision-making will align with the joint understanding of the separate accountabilities and responsibilities of the key partner organisations and partnerships.

The Mental Health and Wellbeing Workforce

The mental health and wellbeing workforce are positioned across a variety of sectors and play a critical part in how we:

• promote positive mental wellbeing;
• prevent poor mental health or further deterioration in those with existing mental health conditions; and
• provide safe, effective, timely, local, compassionate, trauma-informed and evidence-based support, care and treatment, and that takes into account reasonable adjustments, where these are required.

The Strategy considers that the mental health and wellbeing workforce is made up of the core mental health and wellbeing workforce and the wider mental wellbeing workforce.

The core mental health and wellbeing workforce consists primarily of those who provide frontline mental health services and treatments for all age groups and from various sectors. These are staff who are specifically employed in services within statutory organisations, the independent sector or the third sector to support mental health and wellbeing. This includes, but is not limited to, staff in mental health services (such as mental health nurses, psychiatrists and psychologists), third sector mental health support, social work staff who provide mental health support (including Mental Health Officers), GPs, mental health pharmacists, paid peer support workers, psychotherapists, counsellors, psychological therapists, and Allied Health Professionals who provide mental health support.

The wider mental wellbeing workforce includes roles in the public, third, and independent sectors which, although not directly employed in providing mental health services, support treatment and recovery, have an important role in supporting someone’s mental health and wellbeing or play a significant role in promoting good mental health for all. Examples include but are not limited to, employers; wider health, social work and social care staff, including pharmacists and pharmacy technicians; community link workers; police officers; community group leaders; faith leaders; school staff and youth workers.

While not part of the paid workforce, it is crucial that this Action Plan also recognises and values volunteers, experts by experience, unpaid peer supporters and unpaid carers (including family and friends), who provide care and support and form an integral part of a person’s support system. This support includes, social connections and relationships, delivering frequent reassurance, possibly personal care, prompting medication, and promoting positive lifestyle choices, all of which aids people’s mental health and wellbeing. While this collective group does not form part of the core or wider workforce, this Action Plan makes specific reference to the contribution they make.

Learning disabilities and neurodiversity are not mental health conditions. However the workforce that supports these communities’ learning disability and neurodevelopmental pathways operate mainly within the mental health landscape and will straddle across both the core and wider mental health and wellbeing workforce. Therefore, we reflect upon the needs of these communities and the workforce they call upon in the Strategy and this Action Plan.

Where are we now?

Scottish Government and COSLA recognise the significant and important work that is carried out every day by the mental health and wellbeing workforce and the associated support and services across Scotland. This work is carried out by a wide range of people who are known for their sensitive, flexible and adaptive approach to supporting the mental health and wellbeing of the people in Scotland, whilst balancing their own mental health and wellbeing needs. However, staff are not immune to the indiscriminate impact of psychological trauma, poor mental health and wellbeing or mental illness. Trauma can sometimes lead to a wide range of mental health difficulties that may affect us all in different ways throughout our lives and careers. The workforce’s own wellbeing must be protected. Doing so will also ensure they are enabled to do their jobs well and support one another in the workplace.

Recognising the demand for mental health provision, there has been significant investment in mental health services and staffing alongside an increased focus on Fair Work. Through this, there have been some areas of improvement in mental health workforce recruitment with a record number of staff working in some services.

Whilst this record investment and increase in staff is a positive move in the right direction, we recognise there remains significant workforce challenges as highlighted in the Strategy. These include increased overall demand for mental health support and services and a rise in people presenting with more complex mental health needs. These challenges impact on the wellbeing of staff and the ability of services and employers to attract, train and retain staff. This affects services’ ability to engage with and deliver long-term strategic workforce planning.

The Workforce Policy and Delivery Landscape

The Strategy interacts with wider work being undertaken by national and local government. As set out in Appendix 1 of Strategy, there is a range of work already taking place across all sectors and through a wide range of current and upcoming policies, programmes and initiatives, all of which will contribute to the Strategy’s outcomes. This Action Plan does not seek to duplicate the good work already taking place but rather to connect and align with it, and build on it. The section below sets out some key policy drivers and elements of the delivery landscape that have been considered through the development of this Plan.

This Action Plan builds on our National Workforce Strategy for Health and Social Care, published in March 2022 for the mental health and wellbeing workforce, recognising the importance of the five pillars it outlines (Plan, Attract, Train, Employ, Nurture). However, this Action Plan is not intended to cover all five pillars for the entire mental health and wellbeing workforce. We know that roles and responsibilities for workforce planning, training and regulation vary between different sectors of the mental health and wellbeing workforce. For example:

Within the core mental health and wellbeing workforce:

• There are parts of the workforce for which Scottish Government has a direct responsibility in planning and supply through appropriate roles and educational pipelines. For example, Scottish Ministers set the number of fully funded places for mental health nursing degree courses, and training places for NHS trainee clinical and MSc psychologists are funded by Scottish Government through NHS Education for Scotland (NES).
• COSLA and local government work with partners in Health to undertake workforce planning that ensures a sustainable, and viable level of service appropriate to local need.
• The Social Care sector has many different employers. Workforce planning activity is primarily undertaken at individual employer level linked to local demand and their service delivery plans. Scottish Government has no direct role, as other specific workforce planning structures are in place, but it influences input to ensure that appropriate consideration is taken of the mental health and wellbeing workforce.
• The Health and Care (Staffing) (Scotland) Act 2019 is due to be fully in force on 1st April 2024. The Act aims to provide assurance and will provide information to assess that there are appropriate staffing levels in place to support high quality, safe and person-centred care and identify opportunities for improvement and innovation. It will ensure the right people are in the right place at the right time, will support the wellbeing of health and care staff and has an important part to play in reset, recover and reform.
• Scottish Government or other statutory bodies are often the funder through grants, contracts, commissioning processes and will provide principles on which funding will be provided in order to facilitate the provision of a stable, well trained and adequately resourced workforce.
• Scottish Government also has a role in working alongside partners, including the third sector, local and UK Governments to provide employability and skills training support to ensure staff have the right skills.
• Scottish Government continue to work with training and education partners who provide training and support for the health and social care workforce.
• NHS Education for Scotland (NES) provides education, training, workforce development, data and technology for health and social care. The work NES does affects everyone who works in and with health and social care services, as well as every person in every community in Scotland.
• The regulation of the majority of healthcare professional groups is reserved. However, the regulation of new groups of healthcare professionals and those regulated since the Scotland Act 1998 is devolved to the Scottish Parliament. Further information on professional healthcare regulatory bodies can be found here.
• The Scottish Social Services Council (SSSC) is the regulator for the social work, social care and children and young people workforce in Scotland. SSSC registers this workforce, setting standards for their practice, conduct, training and education and support their professional development.
• The Care Inspectorate is the national regulator for care in Scotland. Regulated care services are currently required to keep records and annually submit these to the Care Inspectorate. This includes staff personal and training information. National reports are published from this information.
• Healthcare Improvement Scotland (HIS) is the national improvement agency for health and social care in Scotland and is responsible for the development of Staffing Level Tools and the Common Staffing Method to be utilised for workload and workforce planning. In addition, HIS will play a role in monitoring Health Boards compliance with the staffing duties outlined within the Health and Care (Staffing) (Scotland) Act 2019.
• The Scottish Prison Service (SPS) is developing its Mental Health & Wellbeing Strategy in partnership with key stakeholders, including experts in mental health and those with lived experience. Their Strategy will link directly to our Mental Health and Wellbeing Strategy and ‘Creating Hope Together’, Scotland’s Suicide Prevention Strategy. Scottish Government will continue to explore ways to support the development and implementation of the SPS Mental Health and Wellbeing Strategy.

Within the wider mental health workforce:

• Through the Health and Safety at Work etc. Act 1974 and the Equality Act 2010, employers have legal duties to take action to protect mental health at work and support people with mental health conditions. We know that supporting and promoting good mental health and wellbeing at work benefits both the individuals and employers.
• Scottish Government has an influencing role in supporting employers to promote and support the conditions that enable good mental health at work.
• It is for colleges and universities to ensure that they have appropriate mental health support in place for all their students and staff including those on placements.

This Action Plan intends to build upon other national labour market, employability, education and skills strategies and employers’ own workforce strategies. This includes encouraging trauma-informed and person-centred workplace practices within the mental health and wellbeing system, supporting an employability approach that has dignity and respect at its core, consistent with both No One Left Behind, and the dimensions of Fair Work. The Fair Work Convention’s Framework defines Fair Work as ‘work that offers effective voice, opportunity, security, fulfilment and respect’. These five dimensions interact with each of the National Workforce Strategy for Health and Social Care’s (“the HSC Workforce Strategy“) five pillars.

Our vision and strategic aim within the Action Plan will support the ambition for Scotland to be a leading Fair Work Nation by 2025, where Fair Work drives success, wellbeing and prosperity for individuals, businesses, organisations and society. The Fair Work Action Plan 2022 sets out actions to promote fair and inclusive workplaces across Scotland.

This work also supports our national mission to tackle Child Poverty as through providing good, well-paid jobs, we can measurably improve income for low-income households, helping them to move out of poverty.

The Mental Health Policy and Delivery Landscape

The mental health policy landscape is complex; and key recent developments have been taken into account in the development of this Action Plan. These include:

On 13 September 2023, Audit Scotland published its report on Adult Mental Health Services. The report contains a number of recommendations for Scottish Government, local authorities and our partners, many of which reflect the themes set out in our Strategy. Through this Action Plan and the accompanying Strategy Delivery Plan, we have looked to ensure that the actions set out, reflect and respond to those Audit Scotland recommendations.

Scottish Government recently published core standards for mental health services. These standards will initially apply to adult secondary mental health services and are part of a wider ambition to develop a suite of standards for mental health services, building on the work of the Child and Adolescent Mental Health Services (CAMHS) service specification. A national service specification for Psychological Therapies and Interventions has also been published and a specification for Eating Disorder services is currently in development.

The standards intend to set out to individuals, their families and carers what they should expect from a mental health service to reduce the scope of unwanted variation in the quality of care, and therefore reduce inequalities in experiences and outcomes. The phased approach towards implementing the specifications and standards is intended to align with the approach to this Action Plan, and ensure the workforce is appropriately resourced to support their delivery. There are many actions relevant across the five pillars of workforce planning.

As set out in the Strategy Delivery Plan, a key action is to establish a new Mental Health and Capacity Reform Programme to enhance protection of people’s rights. This Action Plan also considers some further recommendations from the Scottish Mental Health Law Review (SMHLR) report. In particular, the recommendation to consider steps to improve the recruitment and retention of ethnic minority staff, across different professions within mental health services as well as recommendations around the training of workforces in relation to unpaid carers.

This Action Plan supports the delivery of our Creating Hope Together, Scotland’s Suicide Prevention Strategy 2022-2032, and its associated first action plan 2022-2025; as well as the forthcoming Self-Harm Strategy and Action Plan.

Scottish Government is also working to provide improved access to high-quality and integrated care for people with co-occurring mental health and substance use issues. As part of the forthcoming Scottish Government Alcohol and Drugs Workforce Action Plan, Scottish Government is developing new operational protocols which will detail how mental health and substance use services should work together to provide high quality care. The Alcohol and Drugs Workforce Action Plan aligns closely to this Action Plan and it sets out further actions Scottish Government and partners will take including to progress training opportunities, ensuring that services are well informed and fully empowered to support the mental health needs of people who use drugs and alcohol.

Scottish Government and COSLA are fully committed to working collaboratively to improve the experience of the social care and social work workforce. To help deliver meaningful change for the workforce, Scottish Government and COSLA, and in conjunction with partners across the sector have established a collaborative initiative – The Joint Social Care and Social Work/Services Workforce Taskforce (JSST). This taskforce will work together to identify, support, and accelerate progress on priority issues affecting the Social Care and Social Work workforce over the short and medium term.

Stakeholder Feedback

In line with the development of the Strategy, this Action Plan reflects what we have heard from our partners and stakeholders during our consultation process. This includes significant and welcome input from the workforce, and people with lived experience of poor mental health and wellbeing and mental illness.

Scottish Government and COSLA recognise that the workforce has the knowledge and experience to guide service design and delivery. We are extremely grateful to those who shared their views and lived experience, directly informing and influencing the development of this Action Plan. We are committed to ensuring that the views of our stakeholders continue to drive the work we do to realise the ambitions of the Strategy and this Action Plan.

In addition to a formal consultation process (an independent analysis report can be found here), a series of stakeholder events for the mental health and wellbeing workforce were conducted. These events were supplemented by engagement undertaken by the Mental Health and Wellbeing Workforce Advisory Group with stakeholders they represent. This generated additional detailed responses focusing on potential solutions to challenges from a range of partners, including:

• territorial and national health boards
• COSLA^[1]
• Scottish Social Services Council (SSSC)
• Social Work Scotland
• Association of Directors of Education in Scotland
• Royal College of Nursing
• Royal College of Psychiatrists
• Royal College of General Practitioners
• Senior Medical Managers Group in Psychiatry
• Mental Health Nurse Leads
• Royal Pharmaceutical Society
• Community Pharmacy Scotland
• Scottish Directors of Allied Health Professionals (AHP) (including AHP mental health leads and AHP Federation Scotland)
• Distress Brief Intervention Programme Board (including Lanarkshire Association for Mental Health, LifeLink, Penumbra, Police Scotland, Scottish Association for Mental Health and Support in Mind Scotland)
• Scotland’s Mental Health Partnership (including British Psychological Society, Samaritans Scotland, See Me, Support in Mind Scotland, Penumbra)
• Mental Health Foundation
• Scottish Care
• Aberdeenshire Voluntary Action
• Engage Renfrewshire
• Fife Voluntary Action
• CVS Falkirk
• Scottish Recovery Network
• Heads of Psychology Services Scotland (HOPs)

Challenges and Opportunities

The Mental Health and Wellbeing Strategy Evidence Narrative and Equality Evidence Report undertaken for the Strategy sets out what the research tells us about mental health and wellbeing in Scotland, including the mental health and wellbeing workforce.

This section contains a short summary of the challenges and potential solutions raised related to the mental health and wellbeing workforce.

As highlighted, mental health and wellbeing support and services are facing significant pressure, including that related to high demand, staff capacity and limited resource. Stakeholders expressed this has been further exacerbated by the impacts of Coronavirus (COVID-19), EU exit and the cost of living crisis, both on the person seeking support and on the workforce themselves. These pressures are subsequently having an impact on the wellbeing of staff and the ability of services to attract, train and retain the workforce. This is likely to affect services’ ability to engage with and deliver long term strategic planning for the workforce.

As with general challenges in Scotland’s labour market^[2], there is an ongoing need to build upon existing work to address issues such as widening access to mental health career pathways, make careers more attractive to recruit and retain a diverse range of students, trainees and existing staff; understand and overcome barriers in traditional recruitment routes; enable the workforce to access and participate in training and upskilling; improve and support career progression and further embed Fair Work practices to ensure that we can attract and retain the workforce.

Our consultation with stakeholders also identified themes around current barriers and challenges experienced throughout the mental health and wellbeing workforce. For example, a need to:

• Attract new recruits to particular job roles or sectors;
• Retain the current workforce and address issues around remuneration;
• Continue wellbeing support for the workforce;
• Address large workloads;
• Address difficulties with staff being able to participate in training;
• Tackle inequalities including those related to socio-economic determinants and protected characteristics;
• Improve data collection, including equalities data, for workforce planning purposes;
• Create alternative pathways and entry points/training opportunities into mental health and wellbeing careers;
• Understand and address the impact of negative image of services or sectors as portrayed in the media;
• Challenge stigma associated with working in mental health roles, as reported by some consultation respondents;
• Ensure there is adequate focus on early intervention and preventative support and services where appropriate;
• Increase collaboration across the sectors, with more multidisciplinary/agency and partnership working; and
• Further harness the expertise and capacity of the third sector and address issues around commissioning processes.

Some of these challenges are specific to those working in particular roles, sectors, and settings. Some are compounded by factors such as population demographic or geography. For example, the consultation highlighted that some of the issues above are exacerbated in rural and island communities. These recurring themes straddle across all the pillars of the workforce journey.

In addition to highlighting key challenges, consultation respondents also spoke of the pride the workforce take in their roles and the positives of working in mental health and wellbeing, especially when helping to tackle health inequalities of an often-stigmatised group of people.

Reflecting these challenges and in line with Scottish Government duties, a range of Impact Assessments, including an Equality Impact Assessment and Island Impact Assessment have been undertaken as part of the process to develop this Action Plan. These seek to maximise the impact of this Action Plan and mitigate unintended consequences.