Adult secondary mental health services: consultation analysis

2 Consultation methodology

2.1 Introduction

The consultation ran for 13 weeks from 14 December 2022 to 17 March 2023 on the Scottish Government Citizen Space website. Several remote and in-person events aimed at a variety of audiences supplemented the online consultation.

2.2 Public consultation

Total responses

The consultation received 104 responses. Two organisation respondents each submitted two responses – one response from each organisation was removed during the data review and cleaning process. We removed the response that answered fewer or no questions (for example, one non-Citizen Space response only contained a Respondent Information Form).

This resulted in 102 validated responses, Table 2.1. Key points to note include that:

• the majority of consultation responses were submitted through Citizen Space (88%), with the remainder submitted to the Scottish Government directly by email (12%)
• there was a relatively equal split of responses from organisations and individuals

Organisations

Organisations were then grouped under four broad categories, Table 2.2.

It should be noted that organisations were placed under one category, although it is recognised that there may be some crossover. For example, a third sector membership organisation.

Base = 52

Key points to note include:

• public sector organisations make up the largest organisation category at less than half of all organisation respondents (44%)
• the third sector is second largest and makes up 29% of all organisation respondents
• membership and/or professional bodies represent one-quarter (25%) of all organisation respondents
• the private sector make up the remainder of organisation respondents (2%)

Organisations were then coded thematically, Table 2.3.

Base = 52

Percentages may not total 100% due to rounding

Organisations were placed under one category, although there may be some crossover. The qualitative analysis in the report uses these categories as the basis for drawing out key themes, where appropriate. Where relevant we also highlight specific points raised by the mental health workforce and scrutiny bodies.

A total of 32 organisations or 62% of all organisation respondents support marginalised, socially excluded, or disadvantaged groups or people who share protected characteristics, Table 2.4. This includes a mix of organisations who provide support and services (or their members do):

• to all people in Scotland or those living within a specific geographic area. This includes population level interventions (for example, an NHS Board, HSCP or local authority), or services that are available or open to large parts of the population. By their very nature, these organisations will support people who share protected characteristics as defined in the Equality Act (2010). Equalities is, however, not the primary remit or purpose of these organisations, rather it may be one of a number of strategic priorities or things that they do
• some organisations provide services to marginalised, socially excluded or disadvantaged groups. This may also include engagement with people who share protected characteristics. These organisations have a specific focus on one or more groups of people with, for example, a shared experience or issue or background. Some examples include organisations who support people with mental health issues, carers, people with substance use issues, and people with experience of homelessness
• some organisation respondents have a sole or primary focus on a people with protected characteristics. Protected characteristics include: age, disability, gender reassignment, marriage and civil partnership, race, religion or belief, sex, and sexual orientation

Note: EKOS coding

Individuals

Individual respondents were asked to provide details from an equality, diversity, and inclusion perspective. Key points to note from the tables presented in Appendix A include that:

• females are over-represented in the profile of individual respondents (72%) compared to the population as a whole
• individuals aged 25 to 49 years or 50 to 64 years make up the vast majority of individual respondents (80%)
• over three-quarters of individuals (78%) describe themselves as heterosexual or straight
• 8% of individual respondents consider themselves to be trans or have a trans history
• 84% of individual respondents are from a Scottish or other British ethnic group – predominantly Scottish
• three-fifths of individuals (60%) do not belong to any religion, religious denomination, or body

2.3 Engagement events

The Scottish Government and key partners organised five engagement events between 21 February and 16 March 2023, Table 2.5. The events were advertised in a variety of ways, including the Scottish Government and partners promoted and circulated information through existing channels and networks. The events were also used to signpost attendees to prepare and submit a consultation response through Citizen Space.

A summary of the main points raised during these events is presented in Appendix B. The points raised at the events largely chime with themes that emerged from the public consultation.

Source: The Scottish Government

2.4 Analysis

All responses to the public consultation were moderated by Scottish Government officials in the Mental Health Directorate to ensure that they were valid and appropriate.

The analysis has sought to identify the most common themes and issues. It does not report on every single or specific point raised in the consultation responses. The analysis has been structured in line with the themed sections of the consultation document.

Summary tables for all closed questions are presented in the main report, with further detail provided in Appendix C. This analysis excludes consultation respondents that did not provide a response (meaning blank responses).

For open ended questions, we have undertaken an approach to help readers get a sense of the strength and frequency of themes and issues raised by respondents. This means that:

• most chapters in the report contain numbered themes (for example, Theme 1, Theme 2, Theme 3) - these have been set out in order of relative importance with Theme 1 being noted by the greatest number of respondents
• points raised have been quantified in some way - for example, we use the terms ‘all’ (100% of respondents), ‘most’ (between 75% and 99% of respondents), ‘many’ (between 50% and 74% respondents), ‘some’ (between 10% and 49% respondents), and ‘few’ (less than 10% of respondents) to articulate the strength of opinion

More information on the analysis is presented in Appendix D.

2.5 Key themes

Overall, respondents expressed a high level of support for the development of the standards.

Several key themes were, however, raised to many consultation questions leading to considerable repetition of points and views. Rather than repeat these themes in detail in each chapter of the report, the themes have been summarised below.

The standards:

• further clarity, detail, guidance and consultation was requested on how the standards would be implemented, monitored, and audited – that is, what services they are intending to apply to, what needs to be in place to implement and measure the standards, and how the Scottish Government would ensure compliance and independent assessment
• there was a request for the standards to be clear, concise, appropriately described and defined, specific, measurable, and easily understood
• any terms used within the standards should be defined, consistent and not interchangeable (for example, “adult”, “care”, “support” and “treatment”)

Resources

• budgetary pressures and workforce challenges (for example, staff shortages, recruitment and retention, workforce diversity, supervision and training, and staff wellbeing, morale, and burnout) mean that constrained resources may make it difficult for services to meet and maintain the standards
• adequate and sustained financial resources for increased staffing and other support (for example, workforce planning, training and continuing professional development and digital infrastructure/support) are needed to build workforce capacity and capability
• some standards may also raise expectations of delivery of care which cannot currently be met. While the standards are aspirational - they must also be achievable, and consideration should be given to where additional resource is required in order for the standards to be achieved

Services and service providers

• person-centred, collaborative care and holistic approaches are viewed as a key component of the delivery of adult secondary mental health services
• inclusive information and communication are considered essential - in plain English, in different languages, in other accessible and user-friendly formats, as well as the important role of interpreters
• there could be more effective interfaces and improved information sharing, communication and collaborative working between services and professionals in the public, third and private sectors
• there could be more explicit reference to the role of primary care across the standards (for example, general practice and community pharmacy) as this is usually a person's first point of contact – this could include how the standards would interface with primary care, and how roles in primary care would complement secondary mental health services
• it was considered imperative that the standards seek to understand the wider social determinants of health in seeking to reduce inequalities in mental health (for example, housing, income levels, education, access to transport) – but also recognise that these factors are complex and largely out with the control or influence of adult secondary mental health services

People with lived experience

• the standards need to continue to foster a change in attitudes - people should be supported and empowered to be equal partners in their own care
• the views, experiences, and priorities of people who use adult secondary mental health services, their families and carers, and the workforce should remain connected to service development and policy