Adult secondary mental health services: consultation analysis

1 Introduction

1.1 Introduction

In December 2022 the Scottish Government launched the consultation ‘Quality standards for adult secondary mental health services’. The consultation ran for 13 weeks and EKOS Ltd, an independent research consultancy, was commissioned to analyse the responses received. This report presents the findings from that analysis.

1.2 Background

Context

Secondary mental health care services are there to meet the needs of individuals who have longer-term or complex psychological or mental health conditions (for example, complex trauma, or severe depression) that cannot be met by their GP or other primary care services.

Secondary mental health care services are usually services which need a referral from a GP or another healthcare service. These services are usually made up of Community Mental Health Teams (CMHT) and adult in-patient mental health wards.

Secondary care services may be delivered in the community or in hospital by a team of mental health professionals who have the skills and training to meet people's needs. Examples include: Psychiatrists; Mental Health Nurses; Psychologists; Occupational Therapists; other Allied Health Professions; and Social Workers and Mental Health Officers.

Currently, there are no national standards for adult secondary mental health services in Scotland. Both people with lived experience of using secondary mental health services and people who work and volunteer in services have identified this as a barrier in the delivery and provision of quality care and support. The development of these standards aims to address this gap.

Existing strategic documents and other interlinking work

Demand for mental health services in Scotland had been growing gradually before the coronavirus (COVID-19) pandemic in 2020. The pandemic has made the situation worse, and the Mental Health Transition and Recovery Plan (October 2020) outlines the Scottish Government’s response. It addresses the challenges that the pandemic has had, and will continue to have, on the population’s mental health and wellbeing. It has a key aim of ensuring safe, effective treatment and care of people living with mental illness. The Plan committed the Scottish Government to the development, implementation, and assessment of quality standards for adult mental health services.

The standards for adult secondary mental health services were published for consultation in the context of the development of the new Mental Health and Wellbeing Strategy for Scotland which is due to be published in June 2023. The Strategy sets out aims for a high-functioning mental health and wellbeing system and the standards government expect services within that system to deliver. Measurement of the standards will provide indicators that can form part of Scottish Government’s activity related to the monitoring and evaluation of the Strategy and Delivery Plan.

The standards for adult secondary mental health services complement other ongoing and interlinking work, such as the:

• creation of the National Care Service (NCS)
• the findings from the recently published Mental Health Law Review
• the consultation relating to the Delivery of psychological therapies and interventions: national specification, which closed on 17 March 2023

Involvement of people with lived experience

Throughout the development of the standards, the Scottish Government engaged extensively with people who use mental health services, the mental health workforce and organisations who deliver mental health services. The engagement reports were published alongside the consultation document as supporting documents.

The Scottish Government set up and worked with the Mental Health and Wellbeing Standards Working Group which was made up of people from each of these groups. The Working Group was chaired by someone who had used adult mental health secondary services.

The Scottish Government also reported regularly to the Mental Health Quality and Safety Board which is chaired by the Minister for Mental Health and Wellbeing.

1.3 The consultation

The standards are structured around the themes that emerged from engagement with people lived experience of using adult secondary mental health services and the workforce. The five themes are:

• access
• assessment, care planning, treatment, and support
• moving between and out of services
• workforce
• governance and accountability

A key priority in developing these standards has been addressing the inequalities in outcomes and experiences for people accessing mental health services. The evidence base shows that access to and experience of mental health support and services is not experienced equally across the population. The standards have been developed to support equitable access to mental health care and support as well as equity in the experiences and outcomes of people using services.

The consultation sought views on a number of questions about the standards. The feedback from the consultation will be used by the Scottish Government to write the final standards and develop how it measures if these standards are being met.

A standalone executive summary has been prepared that highlights cross-cutting themes arising from this consultation and the Delivery of psychological therapies and interventions: national specification consultation.