Adult secondary mental health services: consultation analysis

Appendix B: engagement events

Introduction

This Chapter presents a summary of the main points raised at the five stakeholder engagement events which supplemented the public consultation. The narrative below was drawn from a review and synthesis of the event notes provided by the Scottish Government client team.

The engagement events covered the two consultations – Quality standards for adult secondary mental health services, and Delivery of psychological therapies and interventions: national specification.

Some events were facilitated by the Scottish Government while others involved key stakeholders. The events were structured in different ways – some aligned more closely to the various sections or themes contained in the consultation documents, others encouraged a more general conversation about mental health services. Some but not all event notes clearly separate out discussion points of relevance to each consultation.

Key themes

Overarching points

Overall there was positive feedback from stakeholders who attended the events on the standards – they were “welcomed” and considered very much “needed”. Not least in response to the negative and detrimental impact of the COVID-19 pandemic and the current cost of living crisis. Here, stakeholders pointed to increasing demand for, and pressure on, mental health services in Scotland and its workforce.

Access

Equality of access to mental health services in Scotland was considered essential by stakeholders who attended these events. Improving equity of access was viewed as key to supporting a preventative and early intervention approach and to address barriers when individuals move between and out of services.

A related point raised by stakeholders was the importance of ensuring that groups who are more likely to experience poor mental health have improved access to the support and services that meets their diverse and complex needs (for example, engagement and support should be tailored to a person’s particular needs where possible). Groups mentioned in the event notes included disabled people and people from an ethnic minority community.

Stakeholders also considered it important that people should be able to access the same range and quality of mental health services regardless of where they live or their personal circumstances. For example, people who live in rural areas and people with lived experience of substance use were specifically mentioned at the events.

Wider points raised by stakeholders relating to the access standard, included that:

• there was felt to be a lack of a “one-stop-shop” for people to access information on mental health and wellbeing support services
• people should have access to ongoing care and support if it is needed again (that is access to support and services that is not time-limited and without a predetermined end date)

Assessment, care planning, treatment, and support

Within the Fife Voluntary Action engagement event note it was highlighted that most adults who access secondary mental health services may only see mental health professionals a small number of times each year. As such, it was considered important that mental health services provide tools and tips for self-care – for example, helping people to remain well by supporting effective self-management.

A point raised by stakeholders was that a standardised approach to care planning would encourage information and record sharing and cross team working – and that such an approach could help people as they move between and out of services and reduce the risk of individuals “falling through the gaps”.

Moving between and out of services

Stakeholders felt that there was scope to improve communication, collaboration and coordination between mental health and other services (for example, addition services, primary care services) to help ensure a smooth transition for people as they move between and out of services.

Stakeholders who attended the Thrive on Thursday engagement event highlighted the Edinburgh model of support which includes Thrive Welcome Teams, Thrive Collective, and Thrive Network as an example of good practice. Stakeholders who attended this event said that these services were joined-up and connected, and that services could also be accessed digitally through the iThrive app.

Workforce

Stakeholders considered that mental health services in Scotland and its workforce were under significant pressure and under-resourced – and that this may make meeting the standards more challenging.

Stakeholders also felt that there could be a stronger approach to tackling stigma in mental health and wellbeing, including reducing stigma among healthcare providers, as well as increased provision of more trauma-informed support. Training and workforce development across the sector was viewed as crucial to meeting the standards.

Stakeholders noted that mental health support services should cater for the different needs of groups of people at a higher risk of poor mental health. For example, stakeholders at the Learning Disability Assembly engagement event, suggested that additional training was required to ensure the mental health workforce were better able to engage and support people with a range of disabilities and complex needs.

Governance and accountability

In relation to the governance and accountability standard points raised at the events included that some stakeholders:

• felt that the standard could include enhanced monitoring of equalities information and data – while at the same time recognising data protection issues
• noted that access to advocacy services was covered within the standard, but that the standard did not sufficiently cover how people could be supported to advocate for themselves

Wider points

Wider points raised by stakeholders are outlined below.

Stakeholders considered it important that people with lived experience of accessing and using secondary mental health services were meaningfully engaged and consulted to help inform the design, delivery, and improvement of mental health services and support - and this would ensure that services better meet the needs of service users.

Some stakeholders provided more positive feedback on the standards – for example, stakeholders who attended the Thrive on Thursday event felt that the proposals contained within the consultation document displayed empathy and helped to promote individual choice and control in mental health care and support.

Other stakeholders highlighted concerns with the language and terms used with the consultation document. For example, those who attended the Learning Disability Assembly event felt that the term “secondary mental health services” could be interpreted by some people as less important than other services.

Some stakeholders felt that the standards could be improved or enhanced in some way, for example: by more fully recognising the links between addiction and poor mental health; and by reviewing the standards to remove any duplication and to ensure that they are clear and easily understood.