Children and Young People’s Mental Health and Wellbeing Joint Delivery Board: information bulletin - February 2023

Mental health overview

Mental health in primary care

Plans for the initial investment into mental health and well being teams in primary care have all been to the oversight group and each system has had feedback and approval to progress. Delays in agreement of budgets have meant delays in decisions for the next phase. It is likely that a re-phasing and possibly some reshaping of the approach will be required once budgets are clarified. 

Quality and safety board

The quality and safety board continue to develop quality standards to support general adult secondary mental health services.  A draft set of standards is currently out for consultation until 17 March 2023, the link can be found here.  They are also supporting the development of standards for psychological therapies. This is part of a wider ambition to develop a suite of standards for mental health services,  to improve their quality and safety and to ensure that individuals, their families and carers know what they can expect from mental health services, ensuring a person-centred approach is at the heart of the approach. The standards should provide an opportunity to build a collective understanding of performance and enable effective benchmarking to drive improvements in quality of care. In addition, they should reduce scope of unwanted variation of quality of care and therefore reduce inequalities in experiences and outcomes. The standards should provide a basis for continual improvement though enabling greater scrutiny and assurance of services against the standards.

The quality and safety board are also supporting the delivery of two of David Strang’s recommendations from his independent review of mental health services in Tayside. These are:

Recommendation 12: Conduct a national review of the assurance and scrutiny of mental health services across Scotland, including the powers of healthcare improvement Scotland and the mental welfare commission for Scotland.

Recommendation 32: A national review of the guidelines for responding to substance misuse on inpatient wards is required.

Healthcare improvement Scotland infection prevention and control inspections

The Scottish Government have funded healthcare improvement Scotland to develop and rollout intelligence-led and risk-based inspections of inpatient mental health settings, with a focus on infection prevention and control. This work aims to bring parity between mental health and physical health settings, which currently have a robust inspection programme in place. It will look to improve the conditions of mental health settings and to contribute to the safety and wellbeing of patients and service users. Healthcare improvement Scotland have spent the summer recruiting an inspection team and working with a short life working group to develop a bespoke inspection methodology. They have begun piloting their infection prevention and control inspections and will roll these out fully in December 2022. The Scottish Government will continue to support the delivery of these inspections, including follow-up with services regarding healthcare improvement Scotland findings and recommendations.

Perinatal and infant mental health programme board

The perinatal and infant mental health programme board is taking a strategic oversight of the commitment to improve perinatal and infant mental health services across Scotland. This includes the development and implementation of community and inpatient statutory services, third sector provision, workforce/training development and awareness raising/stigma reduction. The priorities for each year are laid out in the annual delivery plan and the plan for 2021/22 is available here: Perinatal and Infant Mental Health Programme Board: delivery plan - September 2021 to September 2022 - gov.scot (www.gov.scot).

Current priorities for the perinatal and infant mental health programme board include the ongoing provision of statutory services (including regional working and development of a service specification for perinatal mental health services), work on requirements around additional perinatal mental health inpatient provision.

Programme board chairs and officials are working on the next steps for future governance structures across perinatal and infant mental health to support ongoing service implementation and a strategic overview of key issues. Future governance structures will include cross government links across children/families, substance use and rights

Mental health in schools working group

The mental health in schools working group continue to work together to embed the new online professional resource which was published in June 2021. The free online professional learning resource supports school staff to understand and recognise the range of mental health and wellbeing concerns that children and young people may experience. The resource complements the Whole School Approach Framework for schools to support children and young people’s mental health and wellbeing.

Digital mental health programme board

 The digital mental health programme is progressing several workstreams:

• computerised CBT (cCBT) treatment for anxiety has been rolled out across the 14 health boards and is available in 11 health boards through CAMHs referrals channels
• new treatments for low mood and depression and currently being introduced through test of change across 3 health boards
• work is currently underway in partnership with the NES LIAM programme to open supported access to cCBT through secondary schools
• welf-referral psycho-educational support  for parents and carers is now available across all areas with a new national digital platform developed to further support access and increase usage
• work continues across the programme to develop digital services for young people as a priority activity.

Wellbeing and prevention

Early intervention and prevention are key priorities for the Scottish Government in taking forward our approach to mental health and wellbeing. Our aim is to support people to positively engage with their mental health at an early stage, promoting and supporting the conditions for good mental health and wellbeing at a population level.   

The Scottish Government is taking forward a range of key actions focused on prevention and early intervention by promoting and supporting the conditions for good mental health and wellbeing at population level and providing accessible signposting to help, advice and support.  These programmes of work are focused on upstream support for mental health and wellbeing with the aim of reducing the need for clinical interventions by helping to address some of the social determinants of mental health.

 Key actions include:

• the launch of Mind to Mind in May 2022, a new site to support the mental wellbeing of the general population in Scotland by offering tips and advice from people with lived experience of mental health issues and associated professionals. The site focuses on five themes - anxiety and panic, sleep, stress, grief and loss and low mood – and signposts to a range of trustworthy resources. Money worries can also have an impact on our mental health and wellbeing. Mind to mind ‘Coping with money worries’ page includes links to sources of practical advice to support people struggling with money worries and the cost of living
• an online platform for employers to support the promotion of mentally healthy workplaces, was launched on 11 August 2022. This provides an easy-to-access platform for employers with signposting to appropriate resources to help them support positive mental health and wellbeing at work
• support for grassroots community groups, through the communities mental health and wellbeing fund, to deliver activities and programmes for adults facing social isolation, loneliness and mental health inequalities. £21 million was made available in 2021/22  - involving over 1800 awards to community groups - and a further £15 million is being invested for a second year of the fund in 2022/23. Local application processes are underway for year 2 with more information available Communities Mental Health & Wellbeing Fund - TSI Scotland Network

Impacts of costs crisis on mental health and wellbeing

The Scottish Government know that poverty is one of the key drivers of poor mental health and that those already struggling with poor mental health and money worries are likely to be amongst the hardest hit. As the cost crisis continues, we are likely to see more people across the population experiencing rising levels of anxiety and increased levels of distress. We also anticipate an increased demand for signposting and community support as well as a rise in demand for specialist mental health services.

The Scottish Government has a range of work designed to ensure that the right help is available, in the right place, at the right time. This includes record levels of investment in mental health services, doubling our investment in community mental health services, and ongoing work to ensure the right advice and signposting is available for anyone affected by the crisis.

Key actions we have already taken to provide support on the cost crisis and mental health include:

• The Scottish Government has launched a dedicated Cost of Living portal, signposting to helpful information across a range of subjects including energy and bills; debt and money; children and families; and health and wellbeing. Cost of living crisis - Cost of Living Support Scotland (campaign.gov.scot)
• We have placed greater emphasis on mitigating poverty and deprivation within the £15 million ddult communities mental health and wellbeing fund in 22-23 supporting community groups and projects across Scotland
• We have developed specific content in relation to coping with money worries on mind to mind; and we have signposted this content, and other sources of mental health support, on the recently launched cost crisis portal

We are also working across government and with key partners to look at what else can be done to support people facing mental health issues as a result of the cost crisis.

Mental health strategy

Scottish Government are committed to producing a new mental health and wellbeing strategy in the coming year, building on the implementation of our Mental Health Covid Transition and Recovery Plan.

The new strategy will allow us to look ahead to make sure we are doing the right things to meet changing mental health needs over the coming years as we recover from the pandemic; and will set out a clear vision for future population mental health, wellbeing and care, and our priorities to help us get there.

The scope of the strategy will be wider than before, with an increasing focus on wellbeing and prevention. We will also consider how the strategy can take account of social factors and inequalities that may impact a person’s mental health and wellbeing.

Our public consultation closed on the 9th of September, and we are now in the process of having the responses independently analysed. Approximately 500 responses in total were received, and these will be considered alongside the information we have gathered from the various engagement events that have been held so far.

Scottish Government received a broad range of feedback to consider, and are keen to ensure there is ample opportunity to engage further on the important issues that have been raised. In light of this, a decision has been made to delay the publication of the strategy to Spring next year. This will allow more time for detailed work to take place to shape the strategy and delivery plan; and this opportunity will be used to work directly with stakeholders to develop and co-design the final documents. This will include further engagement with organisations working with and representing children and young people.

Workforce plan

In the Programme for Government 2021/22, and the green party agreement, Scottish Government have committed to deliver a longer term workforce plan in the first half of this Parliament. We want to ensure that commitments in the forthcoming Mental Health and Wellbeing Strategy are underpinned by a sustainable workforce, that feel valued and supported to deliver services and promote better mental health and wellbeing outcomes. This work will be informed by the consultation for the mental health and wellbeing strategy.

Following the publication of the mental health and wellbeing strategy, we will be working closely with partners to identify short, medium and long term actions for mental health workforce plan, to be published in 2023. The plan will build on the published National Health and Social Care Workforce Strategy, which sets out a new framework to shape Scotland’s health and social care workforce over the next decade, placing training, wellbeing, job satisfaction and the principles of Fair Work at its heart. It will look at the whole workforce journey and how we can plan for, attract, train, employ and nurture our mental health and wellbeing workforce.

Self-harm strategy

The Scottish Government is determined to improve our responses for people who self-harm, and has committed to developing a self-harm strategy which will be separate from but linked to our suicide prevention strategy. The views of people with lived experience of self-harm and their families will be at the heart of developing the strategy, and it will be informed by insights from services that already provide compassionate support to people who self-harm.

Although this is our first standalone self-harm strategy, we have some good work to build on, including engagement undertaken by Samaritans around their Hidden Too Long - uncovering self-harm in Scotland  report. However, many aspects of self-harm are hidden and not well understood and we will build our approach in an iterative way. The initial phase of the strategy will be exploratory, where we will listen to the views of people with direct experience of self-harm and organisations that support them. This will help us understand the changes that are needed, and how we go about delivering them and will be the foundation of the strategy.  We know how important it is to get this exploratory phase right, and so will be working alongside people with lived experience to design the programme of engagement.

Progress to date

• we have now set up a small self-harm strategy design group which brings together experts by experience and some services which support people who self-harm (Penumbra, Samaritans, Childline, Parentline, SeeMe) to help us plan a programme of engagement which will inform what the strategy and action plan could look like. This will include gathering insights from a wider range of services, including those working with children and young people and their families
• we have also held a self-harm data and evidence workshop bringing together a wide range of academics, analysts and practitioners. This was very positive and as a group we are continuing our conversations about how data and evidence can inform and support the development of the strategy
• given the exploratory nature of the work, we are not yet able to put firm timelines around the development of the strategy but will keep the Joint Delivery Board updated as the work develops

We have also provided funding to Penumbra to pilot new self-harm services in three local areas, which will test out a range of approaches, including some work with children under 16, and to develop an online national support portal and learning from this work will also inform the development of the strategy and action plan. Further information about the new pilot services will follow shortly.

Suicide prevention strategy – creating hope together

At the end of September, a new 10-year strategy and action plan for suicide prevention was launched. Currently we are in a transition period with work underway to establish the governance and delivery structures which will support implementation.

The strategy calls for a whole of society and cross government approach be taken to creating hope together and preventing suicide. With a number of new approaches to prevent suicide, including:

• taking a whole of government, whole society approach
• widening support to anyone affected by suicide – that includes families, friends and carers
• investing in peer support as a way of giving people the chance to meet with peers to help guide their wellbeing and recovery
• focussing on safety planning as a way to support people to stay safe if they have suicidal thoughts
• improving the way services identify, assess, and care for someone who is suicidal. This includes in primary care, mental health and in unscheduled care settings
• prioritising work on reaching people with heightened risk of suicide – which includes working in key settings and communities, and with key parts of the workforce and trusted partners
• bringing insights on poverty and marginalised groups into the work
• focussing on the particular needs of children and young people, and working alongside them to meet their needs
• working with the media to support responsible media reporting

Additionally, there was a mandate from the engagement undertaken to develop creating hope together that actions from the every life matters action plan (2018-22) remain ongoing. These are identified in the sections entitled ‘what we will keep doing’ in the initial action plan.

Related policy areas

Keeping the promise

The Scottish Government is committed to keeping the promise by 2030, working in partnership with Local Government, the promise Scotland, the third sector, health boards and importantly the care community to do so.

In March of 2022, we published the Scottish Government’s Promise Implementation Plan that sets out how we will work across Government to Keep the Promise we have made to Scotland’s children and young people who are care experienced. The Plan has over 80 actions across nearly all ministerial portfolios that we will take to keep the promise. The plan is presented in 2 clear parts: Part one sets out the vision for what the future will look like and how as Scottish Government we will achieve this. Part two sets out the actions and commitments we will take.

This is a cross portfolio plan the covers the activities of 26 directorates across Government and brings our action together in line with the structure set out by the promise

The promise Implementation plan sets out a number of key commitments that we will take forward to keep the promise

In December of 2022, we published a Child Friendly version of the Promise Implementation Plan.

Further information can be found at Home - The Promise.

Whole family wellbeing funding 

The Scottish Budget was published on 15 December. This set out that £50m has been allocated to support the whole family wellbeing programme for 2023/24. This ensures that allocations to children’s services planning partnerships will be at the same level children’s services planning partnerships in 2023/24 (£32m in total). We remain committed to providing this baseline funding for children’s services planning partnerships transform holistic family support services in local areas over the lifetime of this parliament (to 2025/26). The distribution of this £32m will be the same for 2023-24 as for 2022-23.

Evaluation has begun on the Scottish Government’s commitment of £50m in 2022/23 to whole family wellbeing fund. To evaluate year 1 of whole family wellbeing fund, IFF Research, an independent research and evaluation agency, is working with six case study children’s services planning partnerships (East Ayrshire, Glasgow City, South Lanarkshire, Fife and North Ayrshire)  to understand their experiences of the funding, activity delivered, and lessons learnt for the future delivery of holistic family support.  IFF has also developed an Initial findings report for whole family wellbeing fund, based primarily on Initial Plans which were submitted. This will be shared with children’s services planning partnerships shortly.

A children’s and young people’s improvement collaborative whole family wellbeing fund learning into action event took place at Glasgow SEC on 15 November to provide the opportunity to share challenges and opportunities to improve support for families in Scotland. Many ideas were shared on how the learning into action could support children services planing partnerships to achieve the vision for family support in Scotland. Two regional and 2 national meetings are likely to take place per year, with action learning sets being the preferred type of support.

A guidance document to support children services planning partnerships to integrate whole family wellbeing fund in the annual reports is being developed.  An learning into action network session focusing on evaluation and reporting took place on 24 January.

Tackling child poverty delivery plan

The Scottish Government published ‘Best Start, Bright Futures’ - the second tackling child poverty delivery plan for the period 2022-26 - at the end of March 2022. The Plan outlines transformational action to deliver on scotland’s national mission to tackle child poverty.

The wide ranging action set out in the plan will help to drive progress toward the interim child poverty targets set for 2023-24, to lift more children out of poverty and to provide much needed support for families facing the cost of living crisis.

In June, the Scottish Government published its fourth annual tackling child poverty progress report which sets out the range of action taken across government to tackle and reduce levels of child poverty over 2021-22. This is the final report of progress delivered against the first tackling child poverty delivery plan ‘every child, every chance’, covering the period 2018-2022, and shows that all 68 of the actions committed have been delivered.  Over the life of ‘Every Child, Every Chance’ (2018-22), the Scottish Government invested an estimated £8.5 billion in supporting low income households, of which £3.3 billion directly benefitted children.

The national care service

The Independent Review into Adult Social Care (IRASC) recommended the establishment of a national care service, with Scottish Ministers being accountable for the delivery of consistent and high standards in health and social care services.

Last year the Scottish Government undertook a public consultation on its proposals for a national care service to achieve changes to the system of community health and social care in Scotland; and published an independent analysis of the consultation responses. The feedback received has been used to shape and develop new legislation - the National Care Service (Scotland) Bill was introduced to the Scottish Parliament on 20 June 2022. The Bill provides the foundation for the NCS, and enables the fine detail of the new service to be co-designed with people who have direct experience of social care services. Plans have also been published to explain how that collaboration will work. In parallel with further consultation about mental health services, independent research will be commissioned by the Scottish Government to build the evidence base on the current delivery models of children’s services. This research project will consider the different models of delivery to develop an understanding of which delivery models can most effectively implement The Promise and support the improvement of outcomes for children and families.

You can find out more information about the National Care Service.

Link to recent news article about the National Care Service.

Child development marketing campaign 2022-2023 summary

Campaign background

Emerging evidence (including from public health Scotland) shows that some aspects of child development have been negatively impacted through the pandemic, including speech, language and communication skills.  An increase in these concerns has been recorded at all three child health reviews (13-15 months, 27-30 months, 4-5 years).  Supporting parents to understand what they can do to help their child develop effective communication skills can therefore begin to help address the impact.

The role of parents and carers in responsive caregiving can’t be understated. A key ingredient in the brain developing healthily is ‘serve and return’, including consistent responsive interactions with a child. This promotes the development of secure attachment with the caregiver and strengthens brain architecture. Children develop strong language skills when parents ask open-ended questions (serve and return), ask children to elaborate and focus on topics of interest to the child, as well as respond positively to children’s communication.  Active listening also plays a major role, requiring the adult to listen attentively to their child, understand what they're saying, respond and reflect on what's being said, and retain the information for later.

Purpose – changing behaviour

Our advertising campaign therefore sets about trying to educate our audience that responsive interactions with their children during everyday tasks can help develop their brain (light up their mind), promoting new connections to form. The ultimate aim was to encourage parents and carers of 3-5 year olds to slightly amend their current routines to interact with their children is ways that help boost their speech and language.

Child development campaign - target audience

We’re targeting parents and carers of children aged 3-5 from lower economic groups (C2DE) across Scotland.

To inform the development of our behaviour change campaign, desk research and qualitative research was undertaken in August 2022 with our audience. This highlighted that the ‘science’ behind interacting with their child (the brain connections this activity forms) is new news, and of interest to them. They intuitively know that interacting with their child is good for example, when they read to them, but don’t know exactly why. 

Audience insight also indicated the immediate benefit to a parent is central to what motivates them, particular C2DE audiences as generally they are not motivated by benefits to their child, except benefits such as child happiness.

Supporting covid recovery

The campaign will directly support the Scottish Government covid recovery strategy, by helping to improve speech and language skills that the pandemic had a detrimental impact on.  All communication channels will drive our audience to a new hub on the Parent Club website for further advice. The hub will then link to further information on the website that can help and support parents on other associated topics, such as infant mental health, play talk read and read write count.  Key campaign messages will also be promoted on parent club social channels.

Following on from our wellbeing for wee ones campaign

This campaign led on from our highly successful 2020 and 2022 ‘wellbeing for wee ones advertising campaign. This campaign reinforced the message that, from the moment a baby is born, positive engagement with them is important to help them feel happy and loved. It’s also crucial to how their brains develop.  Our messaging got across the fact that doing things like pulling funny faces and speaking to them in a tuneful voice isn’t just playing - it’s a vital way to help their minds grow and develop. This campaign targeted parents and carers of newborns and up to three, so our child development campaign acts as a follow on from this, targeting parents of children just above this age group.

Creative

Marketing activity is due to launch 30th January 2023 and run for 6 weeks. Paid media channels of digital and social media advertising will be used within trusted environments where our audiences are known to engage. A particular focus will be on areas of high deprivation.

The campaign creative highlights specific interactions parents can easily incorporate into their everyday routine (without adding more pressure to their day). We’re encouraging parents to actively listen and then respond using ‘serve and return’ techniques such as asking questions about the characters in a book when reading, or chatting about what to cook. The ads also shows the immediate benefit to the parent as this central to what motivates them -

• https://vimeo.com/780672333/ec0689f59c
• https://vimeo.com/780672312/9ff7f89771
• https://vimeo.com/778535085/abce75dd3c

All channels will drive to a new hub on the Parent Club website for further advice and tips for parents on how they can help their child develop their speech, language and communication skills. The hub will then link to further information on the website that can help and support parents on infant mental health, play talk read and read write count. Key campaign messages will also be promoted on parent club social channels.