Adult secondary mental health services: consultation analysis

4 Access

4.1 Introduction

Part two of consultation asked seven questions on the access standards.

4.2 Question 8

Table 4.1 provides the quantitative response to Question 8.

This shows that a majority of all consultation respondents who answered Question 8 either agreed or strongly agreed (70%) that the standards within the access theme will improve the experiences of people using secondary mental health services.

Base = 85 (individuals = 48 and organisations = 37)

Percentages may not total 100% due to rounding

4.3 Question 9

Table 4.2 provides the quantitative response to Question 9.

This shows that over half of all consultation respondents who answered Question 9 either agreed or strongly agreed (57%) that the standards within the access theme will improve the outcomes of people using secondary mental health services. A relatively large proportion of respondents neither agreed nor disagreed (32%) with this statement.

Base = 85 (individuals = 48 and organisations = 37)

Percentages may not total 100% due to rounding

4.4 Question 10

Table 4.3 provides the quantitative response to Question 10.

This shows that more than two-thirds of all consultation respondents who answered Question 10 either agreed or strongly agreed (68%) that the standards within the access theme clearly set out to individuals, their families, and carers what they can expect from a secondary mental health service.

Base = 84 (individuals = 47 and organisations = 37)

Percentages may not total 100% due to rounding

4.5 Question 11

Around two-thirds (65%) of all consultation respondents answered Question 11 which asked respondents whether they think there is anything missing from the access standards.

Theme 1: The role of external factors and constraints

Many respondents (individuals and all organisation sub-groups) noted support in principle for the access standards in their consultation response. This support is reflected in selected extracts from consultation responses including: “Generally we are pleased with the standards” (See Me); “The standards are well set out” (individual); “The standards are good in an ideal world” (individual); “It sounds good, all the important things are covered” (individual); and “Commendable and places the needs of the individual at the centre of the support” (Police Scotland).

Most respondents who noted support in principle for the access standards, identified issues or caveated their positive response in some way.

Resource constraints

First, some respondents (individuals and all organisation sub-groups) felt that achievement of the access standards may be difficult given current resource constraints experienced by adult secondary mental health services. The main points raised by these respondents included that:

• adult secondary mental health services have historically been under-funded, and current staff shortages and staff burnout means that services continue to be under significant pressure and strain
• constrained resources and capacity within services present additional challenges both in terms of how realistic and achievable the access standards are, and for services to manage the expectations of people accessing support
• digital infrastructure improvements and/or developments would be required to support effective delivery of the access standards (for example, standardised IT system, fully integrated electronic health records)

“Whilst the standards are welcomed, there is much dependent on how they are implemented in practice and how willing agencies are to deliver upon the standards. They could be considered idealistic and may not reflect current challenges in terms of resources, workforce”.

South Lanarkshire Health and Social Care Partnership

Wider factors

Some respondents (individuals, health improvement, mental health and other organisations) suggested that many factors potentially impact access, such as:

• access to public transport for people living in remote/rural communities
• digital and geographical connectivity for digital options
• limited services/professionals
• long waiting lists
• stigma

A related point raised was that the access standards alone may not lead to an improvement in the outcomes of people accessing and using adult secondary mental health services.

Points raised by these respondents included that: “it is likely resource and staffing will be required” (COSLA); an improvement in outcomes could be “deeply subjective” (Social Work Scotland): and “The needs of some people might be better met in other parts of the system…The standards assume that people’s circumstances and symptoms will not change, we need to consider how people’s journeys evolve over time” (South Lanarkshire Health and Social Care Partnership).

Theme 2: Accountability and transparency in delivery of the standards

Some respondents (individuals, health improvement, mental health, and organisations who support specific target groups) raised points relating to the links between transparency and accountability of the access standards and their impact on service delivery and managing expectations.

Typical points raised by these respondents included calls for:

• the access standards to have a clear and transparent process of accountability and monitoring
• more specific detail on how the access standards would be implemented, alongside examples of what positive change around access might look like
• more detail on how the access standards would be measured, monitored and audited – including clarity on roles and responsibilities, indictors and metrics, and how the Scottish Government would ensure compliance

While broadly supportive of the access standards, some of these respondents reported that the access standards (and all of the standards) outlined in the consultation document may benefit from being reviewed by the Scottish Government to:

• ensure that they are clearly and sufficiently defined
• consider how they relate to one another
• ensure they are not open or subject to interpretation in any way
• ensure that they do not have the potential to cause confusion, be considered contradictory, or run the risk of “raising false expectations”

“There may be contrasting perceptions of need and priorities between patient and the service. Consideration needs to be given as to how these standards would be balanced, supporting a service to meet individuals needs and providing realistic expectations of service provision. The way in which service user views and professional experience and expertise are balanced will also be key in any data collection exercise”.

COSLA

Theme 3: Accessible information and communication is vital

In relation to people’s ability to access adult secondary mental health services, respondents (individuals and all organisation sub-groups) raised several points regarding the provision of clear information and communication on the range of services that are available, and how people can access them.

These respondents felt that more accessible and inclusive information and communication was needed - in plain English, in different languages, and in other accessible and user-friendly formats. Support was expressed for approaches which adopt the principles of inclusive information and communication. The role of, and access, to interpreters was also considered important.

“Access to translation, easy-read materials is currently a challenge and would require considerable resources to meet this standard”.

South Lanarkshire Health and Social Care Partnership

These respondents suggested that the needs and preferences of different groups of people should be taken into consideration where possible. The feedback highlighted that the access standards should seek to:

• empower and enable people to choose and access the right services at the right time based on their needs – a person-centred approach
• provide more opportunities for people with lived experience to choose appointment styles that suit them and their preferred way of engaging with services – choice was emphasised as important
• ensure that services have flexible opening times – to ensure that people could access support out with traditional office hours
• have in-built flexibility from the outset – to ensure that adult secondary mental health services were responsive to the changing needs, preferences and demands of people who access these support services

Albeit there was some acknowledgement among health improvement organisations that there may be practical challenges around supporting people’s preferred ways of engaging with services and that the standards should be “realistic about these challenges so expectations are managed appropriately” (Royal Pharmaceutical Society).

Theme 4: Something missing from the access standards

A few respondents (all organisation sub-groups) considered there something missing from the access standards and/or felt that these standards could be enhanced or strengthened in some way.

Much of the feedback provided was not framed or explicitly connected to the specific access standards as outlined within the consultation document – that is ‘What I can expect’ (access standard 1.1 to 1.6) or ‘How services will support me’ (access standard 1.7 to 1.12).

Rather, a range of individual points were in the main identified, and a few examples included that the access standards:

• did not sufficiently consider or were not drafted from the perspective of certain groups of people – for example, families and carers, and people who may not traditionally look to access mental health services (for example, individuals subject to orders within the Mental Health Act) are mentioned in a couple of consultation responses
• could further highlight the role and value of peer support networks, outreach support, and to the range of formal and informal community resources and assets that help people to remain well
• could include explicit reference to the reasonable adjustments duty in order for those seeking treatment via secondary mental health services to be aware of their statutory right to reasonable adjustments, as well as any expectations created by the standards

Wider examples are contained in Appendix F.

Where comments were provided on specific access standards, some examples are provided in Appendix E.

4.6 Question 12

The Scottish Government recognise that currently not everyone has the same experiences or outcomes when they engage with mental health services. They want these standards to help make sure that services meet everyone’s needs whoever you are and whatever your background.

Table 4.4 provides the quantitative response to Question 12.

This shows that over half of all consultation respondents who answered Question 12 either agreed or strongly agreed (58%) that the access standards will help do this. A relatively large proportion neither agree nor disagree (30%).

Base = 82 (individuals = 46 and organisations = 36)

Percentages may not total 100% due to rounding

4.7 Question 13

Almost two-thirds (64%) of all consultation respondents answered Question 13 which asked respondents whether they had any suggestions for how the access standards could go further to help ensure that services meet everyone’s needs.

Theme 1: A repeat of the key themes

Most respondents (individuals and all organisation sub-groups) repeated points made earlier at Question 11 and to other consultation questions - see Section 2.5 (Key themes) for more detail.

Theme 2: Continued engagement with a range of stakeholders

A few respondents (individuals and mental health and other organisations) called for the Scottish Government to make sure that appropriate processes and mechanisms were in place to ensure continued engagement with a range of key stakeholders, including:

• the mental health workforce in the public, third and private sectors
• with people with lived experience of accessing adult secondary mental health services (and their families and carers and organisations that support them)
• with groups of people who may be ‘hidden’ or ‘harder to reach’ and who, for example, do not wish to engage with these services, do not seek support for their mental health, or who find it difficult to take the first step and ask for help (and their families and carers and organisations that support them)

Such an approach was considered key to: ensuring that access to adult secondary mental health services reflected the needs of those who access these services; ensuring stakeholders, including people with lived experience, were at the centre of policy design and service development, and improving access to services.

Co-production is important

These respondents considered “co-production” important in order to:

• improve the commissioning, planning, design, and redesign of services – and to ensure that the access standards remain responsive to the needs of people with lived experience
• increase awareness and understanding of the mental health system, the services that are available, and make it clearer and easier for people trying to access help
• improve access to services - ensuring that there is “no wrong door” at the point of first contact, and that the first point of contact always engages in support or signposts, and does not dismiss concerns
• identify and address the barriers and underlying issues experienced by different groups of people (for example, people who share protected characteristics) when they look to access adult secondary mental health services, and tackle stigma and discrimination
• ensure information and communication is understandable, available in a range of formats, targets the needs of service users, and made available to advocates, families and carers of people
• ensure people with lived experience are engaged as “active partners” in the process - that is, supporting people to be equal partners in their own care and involving them in shared decision-making

4.8 Question 14

Over half (57%) of all consultation respondents answered Question 14 which asked respondents to share any of their thinking on the answers provided to Questions 8 to 13, and to provide views on the access standards overall.

From a review of the qualitative responses to Question 14, no new themes emerged that are not already captured above at Question 11 and Question 13.