Adult secondary mental health services: consultation analysis

5 Assessment, care planning, treatment, and support

5.1 Introduction

Part three of the consultation asked seven questions on the assessment, care planning, treatment, and support standards.

5.2 Question 15

Table 5.1 provides the quantitative response to Question 15.

This shows that around two-thirds of all consultation respondents who answered Question 15 either agreed or strongly agreed (67%) that the standards within the assessment, care planning, treatment, and support theme will improve the experiences of people using secondary mental health services.

Base = 81 (individuals = 44 and organisations = 37)

Percentages may not total 100% due to rounding

5.3 Question 16

Table 5.2 provides the quantitative response to Question 16. This shows that just under two-thirds of all consultation respondents who answered Question 16 either agreed or strongly agreed (62%) that the standards within the assessment, care planning, treatment, and support theme will improve the outcomes of people using secondary mental health services. A relatively large proportion of respondents neither agreed nor disagreed (26%) with this statement.

Base = 81 (individuals = 44 and organisations = 37)

Percentages may not total 100% due to rounding

5.4 Question 17

Table 5.3 provides the quantitative response to Question 17.

This shows that over two-thirds of all consultation respondents who answered Question 17 either agreed or strongly agreed (69%) that the standards within this theme clearly set out to individuals, their families, and carers what they can expect from a secondary mental health service.

Base = 81 (individuals = 44 and organisations = 37)

Percentages may not total 100% due to rounding

5.5 Question 18

Three-fifths (60%) of all consultation respondents answered Question 18 which asked respondents whether they think there is anything missing from the assessment, care planning, treatment, and support standards.

Theme 1: A repeat of the key themes

Many respondents (individuals and all organisation sub-groups) repeated points they made earlier and to other consultation questions - see Section 2.5 (Key themes).

Theme 2: Key principles to underpin effective delivery of the assessment, care planning, treatment, and support standards

Some respondents (individuals and all organisation sub-groups) provided feedback that could be described as key principles to help underpin effective delivery of the assessment, care planning, treatment, and support standards. These respondents considered it important that this set of principles were fully reflected within the final standards and wider commentary.

Some points raised relate to people with lived experience of accessing and using adult secondary mental health services, while others relate to services themselves, and are summarised below.

People with lived experience should:

• have access and choice on the right services at the right time and in the most appropriate setting based on their needs
• have access to self-management support to ensure that they do not only receive care when acutely unwell or are in crisis
• 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)
• be genuinely listened to, and treated with compassion, empathy, dignity, and respect at all times

Services should:

• adopt person-centred and holistic approaches to assessment, care planning, treatment, and support
• be equally accessible – both in terms of levels of accessibility in services across Scotland and regardless of personal circumstances or background
• ensure shorter waiting times between referral, assessment, and treatment
• adopt consistent criteria to assess access to services and support
• provide both consistency and continuity of care and treatment
• adopt human rights based approach and practice and trauma-informed care and support
• have appropriate processes and procedures to ensure that people are kept informed and kept up to date with progress
• be inclusive of carers and family members
• ensure improved communication and links between services and professionals
• routinely monitor the experiences of staff (alongside the experiences of those accessing adult secondary mental health services) to further support the improvement of services

Theme 3: The standards could be improved or strengthened

Some respondents (individuals and all organisation sub-groups) felt that the assessment, care planning, treatment, and support standards as set out in the consultation document could be amended, reworded, reframed, enhanced, and/or further strengthened in some way. This feedback in part reflects calls from respondents for more detail, specification and/or greater clarity on these standards, including terms used.

General comments on the standards

A few examples include that:

• consideration of the wider determinants of health do not normally sit within secondary mental health provision – feedback included that: it would be important to allow the standards to focus on what services can deliver and avoid being held to a standards on matters out with the control or influence of adult secondary mental health services; delivering on the standards requires a “whole system approach” beyond adult secondary mental health services; others questioned what this standard refers to in practice, and how it could be made clearer to achieve its intended aim
• it was felt that emphasis was currently placed on some elements of the assessment, care planning, treatment, and support standards than others – for example, it was suggested that the ‘treatment’ element could be further elaborated on to: help inform people of what treatment they can expect and how it would be delivered; provide clarity on the wide range of psychological therapies and interventions available (including reference to the Matrix of Evidence Based Psychological Therapies); clearly delineate adult secondary mental health services from the mental health and wellbeing support provided by public health, the third sector and wider society; explain that it would be reasonable for people to expect to be treated as close to home as possible; explain informed consent; and acknowledge that the range of treatments and evidence base continually evolves and that this should aid service planning and commissioning
• access to social and other forms of support out with adult secondary mental health services was felt to have a valuable role to play in supporting people to keep well – for example, family relationships networks, peer support networks, kinship networks, access to leisure and physical activity, and other community resources were all mentioned in consultation responses
• terms used could be clearly defined and further clarified – a few examples include: ‘a range of professionals who can meet my assessed needs’, ‘adequate staffing skill mix’, ‘crisis’, ‘trauma-informed’, ‘If I need support from multiple professionals and agencies, I will have a designated named person who will offer support in coordinating these’
• the standards could acknowledge that it may be appropriate to draw upon a range of models of care planning, tailored to the identified needs of individuals accessing services – “This would help to avoid a formulaic approach which assumes one model of formulating an individual’s needs and describing the interventions which will be offered will suit all. Such approaches tend to inevitably become a ‘tick box’ exercise, rather than an individualised description of how the person’s needs have emerged or changed over time and the strengths they possess/can draw upon in their recovery, with appropriate treatment intervention alongside. Similarly, it may be helpful to include an explanation that all therapies, treatments or supports will not only be tailored to the needs identified in collaboration with the client; but will also be based on a scientific evidence base, of proven efficacy” (NHS Greater Glasgow and Clyde Older People's Psychology Service).
• services must be able to deliver these standards for all people – “including those from minority groups and those who experience healthcare inequality” (LGBT Health and Wellbeing, Equality Network)

Wider general comments made by respondents are provided in Appendix F.

Some examples of points raised in relation to specific assessment, care planning, treatment, and support standards are outlined in Appendix E.

Additional standards proposed

A few respondents proposed that additional standards could be considered, including:

• “I will have a choice in what service I am referred to” (See Me) – in order to align with a recent Health and Social Care Alliance Scotland and VOX Scotland’s report which prioritises empowering patients to choose and access the right services at the right time based on their needs
• “I will be contacted with support if there is an internal issue impacting my appointment” (See Me) – to ensure a person has check-in call or support with a trained professional if another clinician is, for example, on sick leave staff
• it is suggested that there be a standard, within each section, relating to the interface with general practice (Royal College of General Practitioners Scotland) - as specialist services become increasingly pushed due to rising demand and workforce shortages, patients turn to their GPs, and sharing care plans could help GPs signpost and support
• a standard around prescribing (Royal College of General Practitioners Scotland)
• a standard relating to tackling stigma (Scottish Women's Convention)

5.6 Question 19

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 5.4 provides the quantitative response to Question 19.

This shows that just under two-thirds of all consultation respondents who answered Question 19 either agreed or strongly agreed (64%) that the assessment, care planning, treatment, and support standards will help do this.

Base = 78 (individuals = 43 and organisations = 35)

Percentages may not total 100% due to rounding

5.7 Question 20

Three-fifths (60%) of all consultation respondents answered Question 20 which asked respondents whether they had any suggestions for how the assessment, care planning, treatment, and support standards could go further to help ensure that services meet everyone’s needs. The main themes are presented below.

Theme 1: A repeat of the key themes

Many respondents (individuals and all organisation sub-groups) repeated points made earlier at Question 18 and to other consultation questions (Section 2.5).

5.8 Question 21

Around half (51%) of all consultation respondents answered Question 21 which asked respondents to share any of their thinking on the answers provided to Questions 15 to 20, and to provide views on the assessment, care planning, treatment, and support standards.

From a review of the qualitative responses to Question 21, no new themes emerged that are not already captured above at Question 18 and Question 20.