Adult secondary mental health services and psychological therapies and interventions specification: consultation analysis, key themes report

Quality standards for adult secondary mental health services and national specification for delivery of psychological therapies and interventions: consultation analysis Key themes report September 2023

Report prepared by: EKOS Ltd, St. George's Studios, 93-97 St. George's Road, Glasgow, G3 6JA.

Report commissioned by: Scottish Government, Mental Health Directorate. Applications for reproduction of any part of this publication should be addressed to: Scottish Government, Mental Health Directorate, St Andrews House, Regent Road, Edinburgh, EH1 3DG.

Introduction

1. This summary document considers the key themes that emerged from two Scottish Government consultations:

• Quality standards for adult secondary mental health services (102 responses)
• Delivery of psychological therapies and interventions: national specification (95 responses)

2. The consultations ran for 13 weeks from 14 December 2022 to 17 March 2023, and were supplemented by several in-person and remote stakeholder events.

3. This summary document sits alongside the consultation analysis main reports and executive summaries which have been published separately.

Findings and key themes

4. Both consultations contained similar closed and open-ended questions.

5. Overall, there was a high level of support for the standards and specification. Responses to closed questions shows that a majority of consultation respondents agreed or strongly agreed that the standards and specifications will:

• improve the experience of people using services
• improve outcomes for people using services
• clearly set out to individuals, their families and carers what they can expect from a secondary mental health service
• help to meet everyone's needs regardless of their background

6. While a majority of respondents 'agreed' with all closed questions (albeit to varying degrees) – and therefore expressed support in principle with the standards and specification - there were some questions which attracted mixed feedback. For example, in some cases upwards of almost one-third of respondents 'neither agreed nor disagreed' with particular statements in the adult secondary mental health consultation, and over 40% in the case of the psychological therapies and interventions consultation.

7. Several cross-cutting themes emerged from analysis of the responses to the open-ended questions, leading to considerable repetition of points and views. The themes can be grouped into four main categories:

• the standards and specification
• resources
• services and service providers
• people with lived experience and their family and carers

8. Each of these themes is now considered in more detail below.

The standards and specification

9. Consultation respondents welcomed and understood the rationale for the development of quality standards for adult secondary mental health services and a national specification for the delivery of psychological therapies and interventions.

10. Common themes that emerged from the qualitative feedback includes that:

• further clarity, detail, guidance and consultation was requested on how the standards and specification would be implemented, monitored, and audited
• there was a request for the standards and specification to be clear, concise, appropriately described and defined, specific, measurable, and easily understood
• any terms used within the standards and specification should be defined, consistent and not interchangeable

Resources

11. There was universal feedback from consultation respondents that implementation of the standards and specifications would require the provision of additional resources and other support.

12. Much of the qualitative feedback highlighted that it may be difficult for services to meet the standards and specification due to factors such as:

• budgetary pressures – constrained and reducing financial resources
• workforce challenges – staff shortages, recruitment, retention, diversity, supervision, wellbeing, morale, burnout

13. Consultation respondents felt that adequate and sustained financial resources would be required alongside other support (for example, training and digital infrastructure and support) to build workforce capacity and capability.

14. A concern raised was that aspects of the standards and specification may also raise expectations of delivery of care, which cannot currently be met given the afore-mentioned pressures and challenges.

15. While it was considered important that the standards and specification are aspirational – respondents felt that they must also be achievable. A consensus view was that consideration should be given by the Scottish Government to where additional resource is required in order for the standards and specification to be achieved.

Services and service providers

16. Consultation respondents also raised some cross-cutting themes relating to services and service providers, namely that:

• person-centred, collaborative care and holistic approaches are viewed as a key component of the delivery of adult secondary mental health services and psychological therapies and interventions
• inclusive information and communication are considered essential – in plain English, in different languages, and in other accessible and user-friendly formats
• there is a need for 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 and specification (for example, general practice and community pharmacy) as this is usually a person's first point of contact - for example, how the standards and specification would interface with primary care, how roles in primary care would complement care delivered by secondary services and psychological therapies and interventions, and clear referral processes
• it was considered imperative that the standards and specification seek to understand the wider social determinants of health in seeking to reduce inequalities in mental health (for example, housing, income levels, 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 and psychological therapies and interventions

People with lived experience

17. A recurring theme raised by consultation respondents was around the role and input of people with lived experience of using adult secondary mental health services, and psychological therapies and interventions. This includes that:

• the standards and specification 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 and psychological therapies and interventions, their families and carers, and the workforce should remain connected to service development and policy