Core mental health standards

Annex B

Core Standards which only Apply in Adult Secondary Mental Health Services

1. Standards Development Process

• Currently, there are no national standards specifically for adult secondary mental health services in Scotland. Both people with lived experience of using secondary mental health services and people who work in and lead services have identified this as a limitation in the delivery provision of quality care and support. The development of these standards aims to address this gap.
• The Mental Health Transition and Recovery Plan (published October 2020) outlines the Scottish Government’s response to the coronavirus pandemic. It addresses the challenges that the pandemic has had, and will continue to have, on the population’s mental health and wellbeing. It has a key aim of ensuring safe, effective treatment and care of people living with mental illness. It committed us to the development, implementation and assessment of quality standards for adult mental health services.
• Throughout the development of standards for adult secondary services, we engaged extensively with people who use mental health services, the mental health workforce and organisations who deliver mental health services. You can find copies of reports on this engagement on the Scottish Government website – Adult secondary mental health services - quality standards: consultation.
• We set up and worked with the Mental Health and Wellbeing Standards Working Group which was made up of people from each of these groups and chaired by someone who had used adult mental health secondary services.
• We have also reported regularly to the Mental Health Quality and Safety Board.
• We ran a public consultation between December 2022 and March 2023. A report on the results of this can be found on our website – Adult Secondary Mental Health Services: Consultation Analysis.
• The consultation results for the adult secondary standards showed a clear support for standards which applied to all mental health services. We have responded to that feedback by producing core standards for all mental health services.
• The majority of the core standards were originally part of the quality standards for adult secondary mental health services which were published for consultation. However, there were some standards which apply to only adult secondary services rather than all mental health services. These specific standards are included in this Annex.
• Following a phase of initial implementation, these standards will be subject to review based on learning and feedback from service providers as well as people who use and work in services. This will include consideration of whether more detailed specifications are needed to support adult secondary services.

2. What are Adult Secondary Mental Health Services?

• Secondary mental health services are usually made up of community mental health teams (cmhts) and adult in-patient mental health wards.
• Secondary mental health care services are there to meet the needs of individuals who have longer term or complex psychological or mental health conditions (e.g. complex trauma, or psychotic illness) that cannot be met by their GP or other primary care services. These services are for those who are over 18 who do not meet the criteria for CAMHS (Child and Adolescent Mental Health Services) or Older People’s Mental Health Services.
• Secondary mental health care services are usually services which need a referral from your GP or another health and social care service.
• Secondary care services may be delivered in the community or in hospital by a team of mental health professionals who have the skills and training to meet people’s needs and support their recovery. Examples of these include Psychiatrists, Mental Health Nurses, Psychologists, Peer Support Workers, Pharmacists, Occupational Therapists and other Allied Health Professions, as well as Social Workers and Mental Health Officers.
• Integrated Joint Boards are responsible for providing these services. They may do this through Health Boards and/or Health and Social Care Partnerships.

3. What are Primary Care Mental Health Services?

• Primary care is all services that provide healthcare in a local area. It is usually delivered by or linked to a GP surgery. These services are usually the first points of access for people in the community who are seeking advice or help with a mental health concern.
• Primary care services provide support and care to people that seek help with a wide range of healthcare concerns, including mental health and wellbeing. Primary care services also direct people to secondary and more specialist services where required.
• If support can be accessed to help people within primary care services in their local area, this should be the default. If referral to secondary or specialist services is required it should be straightforward and timely.
• It is important that primary and secondary care services have strong links in order to be able to escalate treatment if needed, as easily as possible. People may also require ongoing access to support in primary care, while being treated in secondary or specialist services.
• While there are existing principles^[2] for mental health in primary care settings, driven by the same need to address the inequalities in outcomes and experiences for people, the core mental health standards and adult secondary services specific standards could also apply in primary care settings, where appropriate. The standards on moving between and out of services and those relating to access are of particular relevance to primary care services.

4. Structure of the Standards

The standards are structured around the themes that emerged from engagement with people lived experience of using adult secondary mental health services and the workforce. They only include themes where there were specific standards not covered in the core mental health standards.

• Access
• Assessment, Care Planning, Treatment and Support
• Moving between and Out of Services

1. Access

Adult Secondary Mental Health Specific Standards:

• Services will provide information on how they work with other agencies and services including primary care, CAMHS and drugs and alcohol services to improve experiences and outcomes for people using services.

2. Assessment, Care Planning, Treatment and Support

Adult Secondary Mental Health Specific Standards:

• Teams will include psychiatry, nursing, psychology, social work, pharmacy, peer support, and Allied Health Professionals and other expertise as needed.
• Services will ensure that the mental health care and support is provided in a community setting wherever possible. If people need in-patient care, this will be for the shortest necessary time and planning for returning to the community will begin as soon as they are admitted with an estimated date for discharge.

3. Moving between and out of services

Adult Secondary Mental Health Specific Standards:

• Services will work together to reduce delays between in-patient and community services, there must be joint processes and appropriate systems in place to enable seamless transitions.