Coronavirus (COVID-19): mental health - transition and recovery plan

16. Mental Health Services

We will respond to Covid-19 with a focus on renewing Scotland's approach to the delivery of mental health services. These services span the NHS, Health and Social Care Partnerships, Local Authorities, and the Third Sector, and range across prevention, early intervention, community support and in-patient treatment. We will continue to place clinical and strategic priority upon achieving parity between and across mental and physical health. The two are symbiotic elements of overall health, and our approach must integrate the two.

During lockdown, we have supported the stability and continuity of NHS mental health services ensuring urgent and emergency services have continued where it is safe to do so. We have issued directives and principles to support this. We will continue to review these as the pandemic evolves. Additional support via NHS 24 has been developed while Boards have innovated in the use of virtual consultation and treatment.

We will support Boards to accelerate the progress that they outlined in their mobilisation plans, and to ensure that local and national service provision issues are addressed. This is a key priority in the weeks and months ahead.

The restart, recovery and renewal of mental health services is also a vitally important part of our approach. Mental Health was identified as a clinical priority for NHS remobilisation. This is essential for those who need access to urgent treatment. Looking forward, we will support NHS Boards and Integrated Joint Boards to move beyond the position at the start of the pandemic. This must lead to the delivery of a set of mental health services which are stronger and better, and which meet the evolving needs and expectations of the people of Scotland.

The health and social care workforce was fundamental to the success of the response to Covid-19. Supporting the wellbeing of the workforce and embedding the fair work agenda across the broadest range of mental health care services will be an important aspect of our renewal work.

By the end March 2021 we will be working with Boards to support the full range of services, restarting them safely with greater use of technology in order to improve service delivery options for patients. During the lockdown period we have seen new, innovative models of service delivery. We will look to see these examples of best practice, such as Mental Health Assessment Centres, embedded across NHS Boards to provide a broader range of care options to patients.

We will continue working with Boards to define service standards against modern expectations, and to ensure that there is a stronger assurance process that these are being delivered consistently. We will also continue our work with partners to improve pathways into mental health services. Throughout, we will maintain a focus on improving access to key services. We know that demand will be reshaped by the effects of the pandemic - but we will not accept that patients should have to wait for prolonged periods to receive the support and treatment they need from mental health services.

As well as NHS Services, we also recognise the crucial role of the Third Sector. The Sector has continued to tirelessly provide mental health services and support across Scotland, and it has been at the vanguard of innovation during the pandemic. This will continue to be centrally important, as will the Sector's role in the implementation and delivery of this Plan.

• 16.1 - An Immediate Focus on Services. Scottish Government will provide a tailored programme of enhanced improvement support for individual NHS Boards, based on our assessment of their mobilisation plans, current CAMHS and Psychological Therapies performance, and feedback from our engagement with mental health leads since the start of the pandemic.This will be accompanied bya programme of national support to Boards based on key themes emerging from the remobilisation plans. The key themes are likely to include workforce, digital services, and service reform.

• 16.2 - Renewal. We will develop a longer term renewal programme for mental health services, including CAMHS, to support the Covid-19 recovery process. This will build on the intelligence gained from boards of increasing demand for and sustainability of mental health services. It will include an assessment of future workforce needs.

• 16.3 - Unscheduled Care. We will continue to work with NHS Boards and other partners to embed, sustain, and develop the Mental Health Assessment Centres established during lockdown. These Centres provide the assessment of unscheduled mental health needs for anyone presenting in mental health crisis/distress, in a separate location to emergency departments. This work will be integrated into our broader approach to improving access to unscheduled care, and our response to distress.

• 16.4 - Workforce. We remain committed to increasing additional investment to £35 million for 800 additional mental health workers by 2021-22. This will give access to dedicated mental health professionals to all A&Es, all GP practices, every police station custody suite, and our prisons. We will work with partners to ensure this commitment supports new ways of working in these priority settings.

• 16.5 - Setting High Standards. We will support the collaborative development, implementation and assessment of quality standards for mental health services. These will build on the approach we took to develop a revised CAMHS Service Specification, which, for the first time, set a national standard of service to be received by children, young people and families who are supported by CAMHS anywhere in Scotland.Within this, we will publish a further Service Specification for children and young people who have support needs as a result of their neurodevelopmental profiles. Our Quality and Safety Board will play an important role in this programme of work.

• 16.6 - Access and Quality. Working with Healthcare Improvement Scotland and Public Health Scotland we will establish a new Performance and Quality Improvement Programme. The new Scottish Benchmarking and Quality Improvement Network will also play an important part in this. This work will seek to enhance access to and the quality of services against the new standards outlined above.

• 16.7 - Patient Safety. Through the Quality and Safety Board we will review the assurance and scrutiny of mental health services across Scotland, including the powers of Healthcare Improvement Scotland and the Mental Welfare Commission, as recommended by the Independent Review of Mental Health Services in Tayside. This will seek to ensure safe delivery against the new standards outlined above.

• 16.8 - Bed Availability. We will conduct the delayed 2020 Psychiatric Inpatient and Complex Hospital Care Census as soon as practicable in 2021. This will provide us with information on bed use following Covid-19. This will ensure that we can consistently manage access to in-patient support for those who need it when they need it.

• 16.9 - A Modern Understanding of Mental Illness. We will implement and promote the use of the International Classification of Diseases 11th edition (ICD-11) from Spring 2021 across all mental health services in Scotland. This will ensure that our approach to mental health services is based on the most up to date international understanding of mental illness.

• 16.10 - A Joined-up Approach. We will work with partners to explore opportunities for integrating addiction and general mental health services where possible. This will seek to provide better co-ordination of support for people with a dual diagnosis of mental health issues and alcohol or drug addiction.

• 16.11 - Clearer Pathways to Support and Treatment. We will work with Primary Care partners to improve capacity for mental health assessment, care and support within Primary and Community Care settings. This will build on examples of good practice already implemented through the Primary Care Improvement Plan, and through our work on Action 15 of the Mental Health Strategy. This will include the interface with specialist services to ensure that people receive the right care in the right place. This will ensure that there is a clear pathway to mental health services for those who need them.

• 16.12 - Early Intervention in Psychosis. From our engagement with specialist services, we believe there has been an increase in the number of people presenting with a first episode of psychosis during the pandemic. We will restart our improvement work on Early Intervention in Psychosis. This work will consider the impact of Covid-19 and lockdown on the prevalence of psychosis in Scotland.

• 16.13 - Eating Disorders. We will carry out a national review of Eating Disorder services which will take account of the effects of the pandemic and lockdown on access to help and support.

• 16.14 - Physical Health. We will work with NHS Boards to ensure mental health support is available to those whose mental health may have been impacted by the delay in treatment of physical health services due to the Covid-19 pandemic.

• 16.15 – Delivery Role of the Third Sector. We will ensure that third sector organisations are among our core strategic partners for the development and implementation of the actions in this Plan.

• 16.16 - Strategic and Partnership Work with the Third Sector. In light of the new challenges faced by third sector organisations, we will continue to work in partnership with the sector at a strategic and operational level to help build capacity to respond to the mental health needs in Scotland as we recover from the pandemic.