Mental health

Mental health unscheduled care

We are working to ensure anyone seeking urgent or unplanned mental health support receives the right care, in the right place, at the right time – regardless of where or what time of day they present. We are creating national and local routes to urgent mental health care to ensure people in mental health distress or crisis are supported closer to home. This will also avoid the need to attend Accident and Emergency (A&E) unless that is where the person can be best cared for.

Mental Health Unscheduled Care Network

We are working with partners through the Mental Health Unscheduled Care Network to improve support for people experiencing distress or crisis, who require unplanned care. We want to ensure support is provided consistently within all health boards. Developing these pathways will ensure support is easy to access, quick, and responsive at the earliest possible point for each person.

Representatives of the Network include mental health unscheduled/urgent care leads from:

• each of the 14 health board areas in Scotland
• NHS 24 Mental Health Hub service
• the Scottish Ambulance Service (SAS)
• Police Scotland
• Distress Brief Intervention providers

Network members contribute to the development of the mental health unscheduled care programme in a number of ways, including identifying future improvement opportunities for services.  

Mental Health Unscheduled Care Pathway improvements

Through the work with the Mental Health Unscheduled Care Network, significant progress has been made to improve mental health unscheduled care support. Some of the key developments include:

• the expansion of the NHS 24 Mental Health Hub (the Hub). The Hub is  accessible through the 111 service and provides a compassionate 24/7 response. It is for anyone who needs mental health support when their GP Practice or usual mental health service is closed. The Hub is staffed by specially trained psychological wellbeing practitioners and mental health nurses. The staff offer a number of care options, including connecting people with other services. Read more information about the NHS 24 111 service
• the development of the award-winning Enhanced Mental Health Pathway allows Police Scotland and SAS’s call centres, to direct mental-health related calls to the Hub

• the introduction of a mental health clinician in each health board. The mental health clinicians are available 24 hours a day, 7 days a week to frontline services, including NHS 24, Police Scotland, SAS and A&E. They provide clinical expertise and advice, telephone triage, and urgent mental health assessments or referral to local mental health services as needed

• the development of a reference guide for police officers and ambulance crews who are supporting individuals in need of mental health support. The guide sets out the 24/7 access arrangements to the mental health clinicians. This allows Police Scotland and SAS to have consistent access to clinical advice on the best care outcomes for the individual and improve, where appropriate, the transfer of care to clinicians
• publishing a mental health unscheduled care resource (December 2024). The resource provides a directory of national services and tools to help unscheduled care services to support and improve people’s mental health and wellbeing
• we are working with the Network and Public Health Scotland to understand how people are accessing and receiving unplanned mental health care. This data will provide an evidence base for mental health unscheduled care pathways and help to identify opportunities for further improvements

Safe spaces: scoping report

We published the Safe Spaces: scoping report in October 2024. The report explores the feasibility of implementing additional safe spaces for people experiencing crisis and acute emotional distress as an alternative to attending A&E.

A safe space should not replace clinical mental health interventions, but help people navigate the mental health system. It could be defined in many ways, including:

• a calm therapeutic environment for individuals to receive specialist support, assessment and treatment
• a non-specialist safety monitoring over a limited period of time, to support the person over the acute crisis phase of their episode of distress
• a comfortable space to be monitored and/or remain safe while intoxicated
• a community safe space which may or may not be staffed by the wider mental wellbeing workforce

The report outlines where it may be necessary to create different and tiered provision to meet the needs of different population groups to ensure they remain safe. It also highlights the substantial number of protocols and service features that must be considered to successfully deliver the services. These range from scrutiny and standards, care planning, risk and impact assessments, access to medication, escalation procedures and safe staffing. 

Psychiatric Emergency Plans (PEPs): national review

Although not mandated by the Mental Health (Care and Treatment) (Scotland) Act 2003, it is best practice for all relevant local agencies and service providers who might potentially be involved in psychiatric emergencies to work together to develop and agree a ‘Psychiatric Emergency Plan’ (PEPs). The PEPs provide a way of comprehensively outlining the roles, responsibilities, and processes in relation to a psychiatric emergency which best reflects local circumstances. The aim of a PEP is to agree on procedures which manage the transfer and detention process in a manner which minimises distress, disturbance, and risk for the individual and others while ensuring a person-centred and human rights approach.

Following the publication of HM Inspectorate of Constabulary in Scotland’s thematic review of policing and mental health  (October 2023), the Mental Health Unscheduled Care Network is taking forward recommendations 11 and 12 through a national review of the PEPs.

We set up a short-life working Group in June 2024 to undertake the PEPs review  to improve consistency and remove barriers to multi agency working when responding to a psychiatric emergency. The review is expected to be completed by December 2024. It will be followed by the publication of a national PEP template and guidance by summer 2025.