Human Rights Impact Assessment (HRIA): Mental Health and Wellbeing Strategy, Delivery Plan and Workforce Action Plan

Accountability

Accountability requires effective monitoring of human rights standards as well as effective remedies for human rights breaches. For accountability to be effective there must be appropriate laws, policies, institutions, administrative procedures and mechanisms of redress in order to secure human rights.

We will work to strengthen accountability and ensure that we have appropriate scrutiny and assurance arrangements in place for the whole mental health system. This will support national scrutiny bodies and service providers and help drive continuous improvement in the overall quality and safety of all mental health services. It will also place continued emphasis on the experience and outcomes of people who use them.

The Scottish Government and its delivery partners are responsible for making sure that human rights are respected, protected and fulfilled. The Strategy has human rights and equalities as a foundation, being considered throughout, with several specific actions within the Delivery Plan and Workforce Action Plan.

In writing the Strategy, Workforce Action Plan and Delivery Plan, substantial engagement was carried out. Stakeholder workshops were carried out across 2022 and 2023 to consult on all aspects of the Strategy including vision, outcomes, priorities and actions. A statutory consultation also ran which included public workshops and allowed the public and organisations to contribute their opinions on the Strategy and what was important to them. The consultation had a specific section on equalities which supported evidence gathering for tackling inequalities and promoting human rights. Drafts of the Strategy and both plans were also shared with the Mental Health Equalities and Human Rights Forum (MHEHRF) and the Diverse Experiences Advisory Panel (DEAP). The Equalities and Human Rights Forum hosts 22 organisations who advocate for human rights and specific protected characteristics. The Scottish Commission for Human Rights sits on the forum and provided feedback on drafts, strengthening our commitment to embedding human rights in all aspects the strategy.

The DEAP consists of 25 members, all who have unique experiences of inequalities, discrimination and mental health struggles. The panel is run and facilitated by the Mental Health Foundation and the panel act as our central lived experience group. While developing the Strategy, we recognised it had to be informed by the voices of people who had real life experiences, to create outcomes and actions which would truly deliver effective change in services and support. There are several other lived experience projects across specific areas of mental health who are regularly consulted on policy development. The knowledge, insight and evidence we have gathered from the forum and lived experience groups has shaped the Strategy and Delivery Plan to have a positive impact on equalities and human rights. The MHEHRF and those with lived experience will continue to contribute to and comment on our policy work and progress, as part of the governance structure surrounding the Strategy.

We will work to strengthen accountability and ensure that we have appropriate scrutiny and assurance arrangements in place for the whole mental health system. This will support national scrutiny bodies and service providers and help drive continuous improvement in the overall quality and safety of all mental health services. It will also place continued emphasis on the experience and outcomes of people who use them.

Because many of the services will be delivered by national, regional and local delivery partners (NHS, HSCPs, IJBs, local authorities, third sector), a strong governance structure will surround the delivery of the strategy. A series of multidisciplinary groups and workstreams currently exist across the mental health policy landscape including advisory groups, Programme Boards and specific governance groups. Consideration will be given to how these are brought together to inform and progress the Strategy under a joint decision making body, the Mental Health and Wellbeing Leadership Board. The Mental Health and Wellbeing Leadership Board will be ultimately accountable for ensuring actions are delivered. There will be other governance groups monitoring the progress of specific groups of actions, who will report to the leadership group and any issues will be escalated where appropriate.

A monitoring and evaluation framework will be developed and published during the lifetime of the first Delivery Plan. This will set out how we will measure progress towards the outcomes. It will also take account of existing indicators and standards currently under development.

We have produced a Mental Health Equality Evidence Report to accompany the strategy. This report provides an overview of the current evidence relating to mental health inequality in Scotland. We know equalities and human rights are inextricably linked, and so this evidence report provides the basis for much of the evidence we used to incorporaterights into the Strategy and accompanying documents. The report provides a summary of available evidence relating to each of the characteristics protected under the Equalities Act 2010, with the exclusion of marriage and civil partnership. It also includes poverty and deprivation, geographical location and carers. The report explores the following topics relating to each characteristic: existing inequalities and mental health disparities (including social determinants impacting mental health); inequity in accessing services and support; experiences of using mental health services and support; impacts of the COVID-19 pandemic; and data and evidence gaps. The report is based on a rapid review of evidence from population level survey data undertaken in Scotland and the wider UK, relevant academic and third sector literature and insights provided by organisations participating in the Mental Health Equalities and Human Rights Forum (MHEHRF).

Several cross-cutting themes were identified around mental health inequalities and social determinants of mental health, experiences of accessing and using services, and data and evidence, which relate to multiple different groups. While these impact different groups in a multitude of ways and are shaped by a variety of experiences and circumstances, they indicate key areas for future focus on equalities and mental health.

An extensive evidence narrative on mental health provides a review of currently available published data on what impacts positively and negatively on mental health and wellbeing across the population. The report looks at levels of population mental wellbeing, prevalence and burden of mental health conditions, trends within these and what influences mental health and wellbeing. It then reflects on some of the key challenges impacting upon population mental health and wellbeing that the strategy needs to tackle. It goes on to consider evidence-based approaches to addressing these challenges in both the immediate and longer term.

Key sources of quantitative data come from several population-level sources, including the Scottish Health Survey (SHeS) and Scottish Surveys Core Questions (SSCQ). Given the disruption to data collection during the COVID-19 pandemic, much of the evidence included from these surveys is taken from 2018 and 2019.

Additional quantitative and qualitative evidence targeting specific protected characteristic groups has been sourced from a range of relevant UK and Scotland-based government, third sector and academic publications through a process of rapid literature review. International academic evidence is used where relevant, primarily drawing on review-level evidence. Organisations participating in the Mental Health Equalities and Human Rights Forum (MHEHRF) contributed significantly to the evidence gathering via consultation throughout 2021, as well as highlighting evidence gaps and insights from the lived experiences of the people that they work with. This has been particularly valuable in providing insights across the period of the pandemic, in addition to the specific bodies of work which have taken place exploring the impact of the pandemic on mental health, wellbeing and influencing factors.

Many mental health services are provided by the NHS. NHS Scotland has a patient charter which sets out what people can expect when accessing NHS care in Scotland. It sets out what people are entitled to and what they can do if they feel their rights have not been upheld. NHS boards have their own complaints procedures. Information on how to raise a complaint is available online and displayed in NHS estates, these differ per board. For staff, NHS Boards have whistleblowing policies and procedures in place to support staff who want to report or discuss any breaches in rights or concerns about safety. Complaints and concerns about NHS services can be escalated to the Scottish Public Services Ombudsman or the Independent National Whistleblowing Office (INWO) respectively, if the complainant is not satisfied with NHS handling.

Similarly, if people want to complain about social care services, this can be done directly with the local authority providing the service and this is different for each council but specific information should be available on council websites. Complaints can be escalated to the Ombudsman.

Work is also underway to co-design a Charter of Rights and Responsibilities (‘the Charter’) for the NCS with people who have lived experience of social care, social work and community health support. The Charter will set out people’s rights and responsibilities when accessing NCS support. It will provide a clear pathway for complaints and redress if rights are not met.

Health and Social Care Alliance Scotland (the ALLIANCE) is the national third sector intermediary for health and social care, bringing together a diverse range of people and organisations from the third sector, statutory and private sector, disabled people, people living with long term conditions and unpaid carers. Their purpose is to improve the wellbeing of people and communities across Scotland and ensure the voices of third sector and people with lived experience is listened to and acted upon by Scottish Government and local authorities. The Alliance have a complaints procedure and whistle blowing policy in place to support staff in coming forward with concerns.

The Mental Welfare Commission was originally set up in 1960 under the Mental Health (Scotland) Act 1960. The Commission exists to uphold patient’s rights and provide information and advice to people about their rights in relation to mental health care and treatment. They also provide advice to Scottish Government in policy development, developing services that safeguard rights and improve care and treatment for people with mental illness, learning disability, dementia and related conditions. They provide an independent function to support people when they feel their rights have not been upheld when accessing mental health services. They act as a watchdog to make sure the Scottish Government is accountable when necessary. The Commission provides advice to both the public and professionals on rights and good practice in mental health care and treatment through its Advice Line including if someone feels that a breach of rights has occurred.

The Scottish Government will continue working with partners to develop Quality Standards and Specifications for mental health services, setting out clear expectations for what services will look like, recognising the need for local flexibility, whilst also providing assurance of high-quality care. These will be informed by the principles in this Strategy.

The Scottish Government will work with partners to strengthen the scrutiny and assurance of the delivery of mental health services. The quality and safety of NHS mental health in-patient services are important in supporting positive outcomes. Whilst some environments are modern and enable the provision of high quality care, others need improvement. A national tool will be developed to assess and support improvement in the quality and safety of the mental health built environment.

For workforce, while there are no specific human rights actions within the Workforce Action Plan, however human rights and equalities are embedded throughout. An essential learning module is being updated on equality and human rights and a specific resource on cultural competence is being developed. This should enhance NHS staff knowledge around human rights and sensitive support.