Mental health and wellbeing strategy, delivery plan and workforce action plan: child rights and wellbeing impact assessment (CRWIA)

1. What evidence have you used to inform your assessment? What does it tell you about the impact on children’s rights? (Guidance Section 2.2)

This CRWIA relates to the Mental Health and Wellbeing Strategy and accompanying Delivery Plan and Workforce Action Plan.

Our objective is to have ongoing engagement with children and young people as we develop policy. There have been several boards looking at children and young people’s mental health since 2018 including; Children and Young People’s Mental Health and Wellbeing Joint Delivery Board: The Joint Delivery Board’s focus was to deliver the recommendations of the Children and Young People’s Mental Health and Wellbeing Programme Board, the Children & Young People’s Mental Health Taskforce, the Youth Commission on Mental Health, the Audit of Rejected Referrals and Child and Adolescent Mental Health Services (CAMHS) Audit Scotland Report. CAMHS Improvement: Recommendations made in the Audit Scotland: Audit of Rejected Referrals; Children and Young People’s Mental Health Task Force; Youth Commission; CAMHS waiting times data along with the Perinatal and Infant Mental Health Programme Board. Engagement has taken place around all of these projects and has shaped the direction of the policy and informed the actions within the delivery plan and workforce action plan.

Specific engagement with children and young people in relation to the Strategy was undertaken with the Scottish Youth Parliament in December 2021 and along with consultation responses from organisations working with children and young people, the findings were considered as part of the development of the strategy.

It should be noted that some of the following engagement was focussed on the work of the Children and Young People’s Mental Health and Wellbeing Joint Delivery Board (JDB) which was building on the work of the Programme Board and continuing to oversee reforms to ensure children, young people and their families receive the support they need, when they need it, underpinned by the values, principles and components of Getting it right for every child, and responsive to local needs and systems.

The engagement activity undertaken was in many forms and gathered the views of children and young people on accessing information and support for mental health and wellbeing. Findings from the research and wider events helped inform decision-making, service design, and delivery for the JDB and its successor, the Joint Strategic Board (due to meet early 2024). This engagement did not specifically engage on discussions on the proposed content and structure of the Mental Health and Wellbeing Strategy. However, the voices of children and young people and these with lived experience obtained from the work of the JDB contributed towards the development of the strategy.

As part of the work of the Children and Young People’s Mental Health and Wellbeing Joint Delivery Board, significant engagement with children and young people was undertaken. A set of principles for participation and engagement were developed to support consideration of this at the Board itself, where children and young people were represented through Scottish Youth Parliament (SYP), and within the Board’s Task and Finish Groups. In addition, engagement was also undertaken with infants, parents, carers and the Early Learning and Childcare (ELC) workforce across 7 local authorities.

Eating Disorder Policy

National Review of Eating Disorder Services in Scotland The National Review of Eating Disorder Services was commissioned by Scottish Government in 2020. Engagement events were arranged with members of the public including those with lived experience of all types and severity of eating disorders, and their families, concerning their views about the current services and suggestions for improving treatment for people with eating disorders. The Review published its final report and recommendations in March 2021.

Community Mental Health

The Framework on which services are based was developed through two years of engagement with stakeholders and a response to recommendations from the Children & Young People’s Mental Health Taskforce, Youth Commission, Audit Scotland report on Children and Young People’s Mental Health and the Audit of Rejected Referrals. As part of the work of the Joint Delivery Board, the Scottish Youth Parliament (SYP) was commissioned to undertake an evaluation of community mental health services. The full report is available on the SYP webpage.

Perinatal and Early Years Mental Health

The World Association of Infant Mental Health has produced a position paper on the rights of the infant which, alongside UNCRC, has informed our approach to both Infant Mental Health service provision/awareness and how the rights of the infant are respected within other services. In 2019, the Scottish Government established the Perinatal and Infant Mental Health Programme Board to oversee, provide strategic leadership and have overall management of the delivery of improved perinatal and infant mental health services. The Women and Families Maternal Mental Health Pledge and the Infant Pledge which sets out expectations for services supporting a rights based approach. The engagement undertaken provided a critical mechanism for the inclusion of lived experience in the development and delivery of services plans; in the thoughtful implementation of plans; and in evaluating how new perinatal and infant mental health capacity is being experienced by parents, babies and families. The meaningful inclusion of lived experience enabled policy makers and services planners to think afresh about how we better expand and integrate P/IMH services to support effective prevention and recovery in the perinatal and infant mental health space.

Children and Young People’s Mental Health

We monitor a range of sources of continuous evidence gathering to build a picture of the needs and health and wellbeing trends of children and young people in Scotland. Among others this includes: the Growing Up in Scotland Survey, Young People in Scotland Survey, School Health and Wellbeing Census, Thriving Learners Study. This data provides us with a range of insights in to the mental health and wellbeing of children and young people and of new and emerging trends. We also engage directly with children and young people regularly through children and young people’s organisations to listen to their voices and gather feedback directly.

The National Trauma Transformation Programme

Over recent years there has been increasing awareness and evidence about the impacts of trauma and adversity, including the adverse childhood experiences (ACEs) studies. There is also increasing understanding about the importance of relationships, positive childhood experiences, and trauma-informed approaches for supporting resilience and recovery. The Transforming Psychological Trauma Knowledge and Skills Framework, on which the National Trauma Training Programme resources are based, has been informed by this research evidence, as well as the views of experts with lived experience of trauma. An overview of the latest evidence on the impact of psychological trauma as well as the barriers and enablers of trauma-informed approaches is available here.

While much of the routinely collected data and published research studies on mental health and wellbeing are available, there remain gaps in the knowledge. There is also a need for more data and evidence that captures specific experiences, perspectives and outcomes of equality groups. This is explained in more detail in the Equality Evidence Report accompanying this Strategy.

There are different systems for providing data used within and across health care, social care and the third sector. Although this results in variations in the availability and accessibility of data, robust methods to gather, analyse and share it should be encouraged. This is being explored in the context of Scotland's Data Strategy for Health and Social Care.

The lived experience of individuals and practitioners brings a rich and diverse type of evidence, and we want to ensure it is sought and appropriately gathered. This can contribute to significant improvements to policies and services, actively support collaboration with clinicians and researchers, and support shared learning of what works. We will continue to engage with people with lived experience as we begin to deliver actions and this will form part of our governance structure to ensure accountability.