Mental Health Strategy 2017-2027

Our Vision

Our vision for the Mental Health Strategy is of a Scotland where people can get the right help at the right time, expect recovery, and fully enjoy their rights, free from discrimination and stigma. ^[1]

Over the 10 years of the Strategy, we will work on achieving parity between mental and physical health.

The scale of the challenge to achieve parity is considerable:

• Only 1 in 3 people who would benefit from treatment for a mental illness currently receive it, on current estimates.
• People with life-long mental illness are likely to die 15-20 years prematurely because of physical ill-health.
• People with a mental health problem are more likely than others to wait longer than 4 hours in an Emergency Department.

That there should be parity of esteem between physical and mental health is widely accepted, and through this Strategy we aim to ensure that it is more than just a worthy ambition and can be made real. Over the 10 years of this Strategy, we must see, and be able to measure, the following for mental health compared to physical health: ^[2]

• Equal access to the most effective and safest care and treatment: Demonstrated by increasing the proportion of people who receive treatment for a mental illness, who would benefit from that treatment. This will also require improvements in prescribing and follow up care.
• Equal efforts to improve the quality of care: Demonstrated by achieving the same level of access to services and the same efforts to improve standards, infrastructure and staffing in mental healthcare as in physical healthcare.
• Allocation of time, effort and resources on a basis commensurate with need: Including addressing higher rates of premature mortality by targeting efforts at higher smoking rates and improving access to physical healthcare for people with a mental illness.
• Equal status within healthcare education and practice: Demonstrated by supporting core skills and competencies in mental health for a variety of staff.
• Equally high aspirations for service users: Recognising service users as equal partners in their own healthcare and emphasising expectations of good health and a good life.
• Equal status in the measurement of health outcomes ^{: Met by robustly} measuring people's responses to treatment, and people's experiences of mental health services, just as in physical health care.

To measure progress toward parity we will introduce a measurement framework similar to those used in physical health. This will draw on a range of information to understand the differences that are being made to, for example, premature mortality, what money is being spent, how long people wait to access services, rates of employment, and poverty levels.

Working to improve mental health care is not just the preserve of the NHS or the health portfolio. We will be working not only across the Scottish Government, but also across the wider public services to harness the broadest range of opportunities to improve the population's mental health. This work is broad and far-reaching, for example:

• Poverty: Poverty is the single biggest driver of poor mental health. The Fairer Scotland Action Plan sets out how we will help tackle poverty, reduce inequality and build a fairer and more inclusive Scotland. We will work with partners in local government, the third sector and communities to deliver this ambition and to recognise the importance of this activity in delivering good mental health for the whole population of Scotland.
• Education: Support from teachers and other school staff can be vital in helping ensure the mental wellbeing of children and young people. We will empower and support local services to provide early access to effective supports and interventions at tiers 1 and 2 and to use specialist CAMHS expertise where it will be most effective.
• Justice: We will support the justice system to work effectively with local partners to improve outcomes for people with mental health problems. We will facilitate work with Police Scotland and Integration Authorities to ensure that people with mental health problems or who are in distress are supported. We will work with the Scottish Prison Service and partners to improve the mental health of prisoners, including supporting young offenders.
• Social Security: Our overarching aim is to create a social security system in Scotland that is based on dignity, fairness and respect. This will be a system that helps to support those who need it and when they need it. We will ensure that this works for people with mental health problems.
• Employment: Not having a job is the single biggest inequality that people with mental health problems can face. We will use our new employability powers to work across health and employability services to support people with mental health problems to stay in work and to support people to get back into work. We will also encourage employers to support the mental wellbeing of their employees. ^[3]

Improvements will be supported by increasing resources for mental health, including an increasing share of the NHS frontline revenue budget, and investing in innovation in services. We will also require transparent reporting of how Integration Authorities use their resources to support mental health in different settings and services, so we can demonstrate progress without stifling innovation and cross-service working.

Within services that are led by the NHS we will take forward our plans for investment twinned with reform to help deliver the best mental health outcomes possible:

• Primary Care Transformation: We will support the development of new multi-disciplinary models of supporting mental health in primary care to deliver "ask once, get help fast". That will necessitate models that allow access to information about what help is available; information about what people can do to look after themselves; signposting and support to access facilities in the community ( e.g. leisure services and activities); and information about who is available to provide support so they can make informed decisions about what is best for them.
• Urgent Care Transformation: We will prioritise mental health pathways for people who need urgent care, including in emergencies in A&E. This means that when somebody has a mental health problem out-of-hours, they know how to, and are able to, access support as easily as they can for a physical health problem. This will include improving the range of support available through NHS24; ensuring that staff in A&E are able to support people in distress; and ensuring there is good access to specialist mental health support when it is needed.
• Child and Adolescent Mental Health Services ( CAMHS): While we have improved access to CAMHS, we're determined to go further. Demand for this specialism is continuing to increase and services could work together more effectively, or to intervene early. We need to achieve the best outcomes for children. Sometimes CAMHS is the right route, and at other times an alternative would be better. We will look at the whole system, recognising the importance of specialist services but also the importance of early interventions at tiers 1 and 2. This includes providing support for families through parenting programmes where appropriate. We will ensure that wellbeing is embedded across services and that staff are confident to support a child or young person with their mental wellbeing.

We will deliver a focus on prevention and early intervention for children, young people and adults (including over-65s), to help prevent the development of mental health problems and to step in promptly if they do develop.

We will ensure that improving mental health and wellbeing are central in our new public health priorities, and will challenge the NHS to prioritise the physical health of people with mental health problems, removing barriers to people accessing services.

We will tackle early deaths. People with severe and enduring mental illness can die 15 to 20 years earlier than they might otherwise do because of co-occurring but treatable issues, such as physical health problems and addictions. This is a major health inequality.

This is the first national strategy in health and social care since their integration. This provides new opportunities for local areas to develop their own approaches, to innovate and to work across service boundaries to meet the needs of the local population. This Strategy aims to make clear the scale of the ambition over 10 years, to focus national actions to support local delivery, to remove barriers to change, and to make sure that change happens.

This Strategy will require work at a local and national level, with additional actions developed over the 10 years to deliver the vision and ambitions and to respond to what is happening. There should be a human rights-based approach to the improvements needed, using the PANEL principles of Participation, Accountability, Non-discrimination, Empowerment and Legality.