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

2. Evidence from stakeholders/Policy Colleagues (Guidance Section 2.2)

The Strategy and accompanying Delivery Plan and Workforce Action Plan were developed through extensive stakeholder engagement, including a full public consultation and direct discussions with the Diverse Experiences Advisory Panel, the Equality and Human Rights Forum, Mental Health Leads Network, Professional Advisors Group, and Stakeholder Engagement Group.

A series of workshops run in collaboration with Public Health Scotland informed the Outcomes framework featured in the Strategy – these were attended by hundreds of people representing a wide range of organisations. Our public consultation received nearly 500 responses, and an independent analysis of these has been published online. We also held a series of consultation events in Summer 2022 that were attended by nearly 300 people representing 117 organisations. A wide variety of other ad hoc engagement was conducted alongside this, including with people with lived experience.

A first draft of the Strategy was shared with over 150 stakeholders in January 2023. The Strategy was modified based on the feedback received. The Delivery Plan and Workforce Action Plan were taken to several stakeholders for comment, including the Equality and Human Rights Forum and the Diverse Experiences Advisory Panel. We wanted to make sure that all of our policy documents were underpinned by equalities and human rights. In addition, the Workforce Action Plan was developed and informed via a Workforce Advisory Group, evidence available through key areas of work such as the Non-Binary Working Group, Young Person’s Guarantee and the Scottish Mental Health Law Review as well as targeted engagement with Royal College of Nursing, Royal College of Psychiatrists, Scottish Care, and Glasgow Disability Alliance.

Evidence from children and young people (Guidance Section 2.2)

Our objective is to have ongoing engagement with children and young people as we develop policy. Since 2017 we have carried out significant engagement with children and young people. The projects described above have had different interactions and engagement plans with children and young people which continuously help to shape new policy and validate the direction of current policy. We have heard extensively what children and young people want and expect from mental health and wellbeing support and have used this wealth of information to help inform the children and young people’s policy including specific actions within the plans, rather than seek further engagement on drafts of the Strategy. Descriptions of engagement with specific policy areas within children and young people’s mental health can, including current and past Boards described in previous sections, be found below.

Children and Young People’s Mental Health and Wellbeing Joint Delivery Board

Engagement took place via Children and Young People’s Mental Health Taskforce; Youth Commission; Children and Young People’s Mental Health and Wellbeing Programme Board. Engagement Officers were employed to work across all Task and Finish groups to make connections and identify whole system and more targeted engagement needs with children and young people, including those with lived experiences and seldom heard groups. The Board and associated Task and Finish groups had Members of the Scottish Youth Parliament (MSYPs) representatives.

Community Mental Health

Engagement has been ongoing since before the development of the 2017 Mental Health Strategy, including via Children and Young People’s Taskforce; Youth Commission; Children and Young People’s Mental Health and Wellbeing Programme Board; Children and Young People’s Mental Health and Wellbeing Joint Delivery Board. Ministers have also commissioned a youth led independent evaluation of the impact of services.

CAMHS Improvement

Engagement took place via Children and Young People’s Taskforce; Youth Commission; Children and Young People’s Mental Health and Wellbeing Programme Board; Children and Young People’s Mental Health and Wellbeing Joint Delivery Board.

Eating Disorder Policy

Engagement took place via National Review of Eating Disorder Services in Scotland and eating disorder charity, Beat. Children and young people are continuously involved in the development of eating disorder policy. Lately, the charity Beat in collaboration with Young Scot, is facilitating a Lived Experience Panel cohort consisted exclusively of young people to support the National Eating Disorder Network take forward the remaining recommendations from the Review.

Perinatal and Early Years Mental Health

The Perinatal and Infant Mental Health Programme Board had 2 Participation Officers, who were employed by Parent and Infant Mental Health Scotland (PIMHS). The participation officer posts supported the implementation of the Delivering Effective Services report and 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. Their main role was to engage with women and families who have used services, or have felt they would have benefitted from more support with their mental health around pregnancy and as a new parent, to gather evidence to support service development.

Children and Young People’s Mental Health

Children and young people are engaged in the development of all policy on an ongoing basis. This includes through a range of youth commissions and national conversations and by working with a range of organisations working with children and young people.

Student Mental Health and Wellbeing: NUS Scotland are members of the Student Mental Health and Well Being Working Group.

The National Trauma Transformation Programme (NTTP): organisations which support and advocate for care experienced children and young people are represented on the NTTP Steering Group and are consulted widely as part of the ongoing design and delivery of the programme.

Analysis of the evidence

Using evidence detailed above, please answer the following questions on how this relevant proposal will impact children.

Central to determining the content of the strategy is what people have told us during 18 months of preparation and consultation. We received a vast range of feedback from the public, people with lived experience, representative groups, and other organisations. Some particular issues raised include:

• A need for a stronger focus on prevention and early intervention.
• The importance of tackling poverty and inequality.
• Supporting person-centred and whole family approaches.
• Placing mental health and wellbeing on an equal footing with physical health.
• A need for increased community-based support and services.
• More support outwith CAMHS – community, education etc.

This feedback has helped to inform actions in the Delivery Plan and Workforce Action Plan.

We heard about early intervention, prevention and a whole family approach. We have taken this forward in the Delivery Plan and Workforce Plan by using a life stage model.

Establishing the conditions for good mental health is essential even before birth and throughout infancy, and we know that mental health within the perinatal period (before, during and after birth) has lifelong implications in relation to later mental and physical health. Positive relationships are an important protective factor for good mental health. As babies grow into children and young people, they must develop resilience and coping strategies to support life’s ups and downs. Families, parents and carers play a central role in this. Our commitment to keep The Promise drives an ambition to keep families together where it is safe to do so. The provision of joined up, whole family mental health support at the right time and in the right way can be a key contributor to this. In relationships with families, carers and adults, it is important that children and young people feel listened to and that their mental health and wellbeing needs are recognised and not dismissed.

Children, young people and families should be able to easily access support in their local community when needed, and this support should be focused on prevention and early intervention. More serious issues can develop for some children and young people, so early intervention is vital, wherever possible. It is important that where poor mental health occurs, mental health support services recognise that this impact may occur at different age and stage of life. Improving the connections between children and adult services to better support smooth and informed transition from one service to another can help improve outcomes for young people who are leaving the care system; and over the longer term aid a reduction in the generational impact of being care experienced. Our work on this will also align with our ambitions to improve outcomes for babies, children, young people and families through Getting it right for every child (GIRFEC), and Children’s Services Planning duties, with our approach to change being driven through a preventative approach to whole family wellbeing.

By listening to what people had to say, the Delivery Plan and Workforce Action Plan put together a suite of actions that will support children, young people and their families and uphold their rights. The actions within the plans are built on equality and human rights. We will continue to use the PANEL principles (Participation, Accountability, Non-Discrimination and Equality, Empowerment, and Legality) in taking actions forward and will be publishing a human rights impact assessment which covers the wider context of the Strategy and accompanying documents.

The evidence we gathered informed all aspects of this work however some specific examples of actions, from both plans, which support children and young people can be found below.

Delivery Plan

Strategic Action

2.4: Beyond clinical mental health services, a range of services have a role in promoting good mental health and in supporting those with poor mental health. We will work collectively across government and with delivery partners across a range of sectors to ensure the right support is in place at all levels, linking to actions in the Workforce Plan to ensure that frontline workers have a good understanding of mental health and trauma to help reduce mental health inequalities and barriers to accessing support.

2.6: We will work with partners to enhance mental health and wellbeing support in educational settings.

3.1: We will continue to provide and improve Community Mental Health and Wellbeing Supports and Services for children, young people and their families, which focus on prevention and early intervention and provide support for emotional distress in a community setting.

5.1: We will take a cross-government, cross-sectoral approach to understanding and addressing the social determinants of mental health and the bi-directional relationship between mental health and factors such as poverty, employment, discrimination and trauma, housing and education, building this into decision-making, governance and planning processes at national and local level.

5.2: Scottish Government will continue to prioritise actions on mental health and wellbeing as part of the Best Start, Bright Futures Tackling Child Poverty Delivery Plan, the Promise, Whole Family Wellbeing Funding and national approaches to Fair Work, as well as ensuring there is a focus on these in our wider mental health and wellbeing policies.

6.3: We will continue to work with delivery partners to develop integrated care pathways in line with GIRFEC and GIRFE national practice models ensuring a holistic approach to wellbeing for people with complex care needs.

7.2: Scottish Government will work with NHS Boards to ensure the mental health built estate enables the delivery of high quality, person centred and safe care. In doing so, we will take into account the findings from Equalities Impact Assessments and other relevant assessments.

9.1: We will work with education, NHS boards, the third sector and other delivery partners to strengthen support, care and treatment pathways across the lifespan for neurodiverse children, young people and adults.

9.2: We will take action to improve the mental health and wellbeing of people with learning/intellectual disabilities and that they are empowered to live their lives, just like anyone else.

10.1: Through the GIRFEC approach, we will help parents and families to develop positive relationships with their children before birth and at every stage of their development, supporting their mental health and wellbeing through the ups and downs of life.

10.2: We will continue to invest in and embed perinatal and infant mental health services at all levels of need so that women and families across all areas of Scotland have access to these services.

Workforce Action Plan

With regard to advancing equality of opportunities for attracting and employing young people into the Mental Health and Wellbeing (MH&W) Workforce there are actions that seek to:

• support people’s ability to progress within careers and to support people to enter/re-enter employment following training.
• promote career pathways to young people, including through media campaigns.
• scope and promote existing and alternative pathways into careers within the MH&W workforce, beyond traditional university and college routes and develop a targeted campaign to promote careers, including new roles, within MH&W.
• share best practice and learning with employers.

The Workforce Action Plan is aligned to the No One Left Behind and the Fair Work Action Plan and it also supports our national mission to tackle Child Poverty through providing good, well-paid jobs to measurably improve income for low-income households, helping people to move out of poverty. From an socio-economic perspective actions include:

• Embedding Fair Work First principles within all MH Directorate Grants. This includes encouraging the public sector, public bodies and agencies through strategic guidance letters, to take action to tackle the gender pay gap, disability employment gap and address racial inequality to create more diverse and inclusive workplaces
• Continuing to fund the Workplace Equality Fund to encourage fair work practice; promote the Fund to eligible mental health and wellbeing workforce employers and share best practice
• Ensure that HSC Partnerships share the lessons learned from Welfare Advice and Health Partnerships to support applications for welfare benefits and to address debt, housing, and employability issues and thereby reduce pressure on GPs and primary care services
• Supporting and promoting the work of the Anchors Workforce Strategic Group which is looking to ask health boards to baseline workforce metrics to measure impact at a local level with a primary focus on providing and sustaining employment for people most likely to experience poverty and health inequalities

There are also a number of training related actions within the Workforce Action Plan. These include:

• Scoping the implementation of the Children and Young People’s Mental Health And Wellbeing Joint Delivery Board (JDB) recommendations relating to quality learning resources and ensuring training opportunities are developed disseminated, supported, evaluated and accessible for the children and young peoples’ MH&W workforce.
• We will work with stakeholders to develop resources to support alternative caregivers to provide trauma-informed care for children and young people as part of the National Trauma Transformation Programme.
• Improving Equality, Diversity and Inclusion training for the MH&W workforce is another priority within the Action Plan. This includes incorporating up to date messaging within existing training and relevant information on equality including anti-racism, sexual harassment, ageism, transgender and non-binary, LGBTI+ equality, and identifying/reporting incidences of equality-based harassment. Successful implementation of this training will help to ensure that an intersectional approach is taken to supporting the mental health and wellbeing of children and young people.