Mental Health Strategy 2017-2027

Access to treatment and joined-up accessible services

Ambitions:

• Access to the most effective and safe care and treatment for mental health problems should be available across Scotland, meeting the same level of ambition as for physical health problems.
• Safe and effective treatment that follows clinical guidelines.
• Safe and effective treatment accessed in a timely way.
• Services that promote and support recovery-based approaches.
• Multi-disciplinary teams in primary care to ensure every GP practice has staff who can support and treat patients with mental health issues.
• Appropriate mental health professionals are accessible in Emergency Departments and through other out-of-hours crisis services.

Access to services for mental health problems within a clinically appropriate timescale is a basic issue of health equality. There must be access to high quality, specialist mental health care for those who have higher levels of need, as well as general health care which can deal with an issue there and then for people with a mental health problem. General health care must also address the conditions that can contribute to people becoming unwell, with the ultimate aim of reducing the need for specialist services.

Workforce

One of the keys to ensuring that the principle of 'ask once, get help fast' is met is ensuring the right workforce is in place. We will be working at a local and national level, through Community Planning Partnerships, Integration Authorities, NHS Boards, training bodies, and local and national government. As well as increasing the supply of the mental health workforce with different skill mixes across different services, we need to make careers in mental health more attractive with clear career pathways.

• Action 15: Increase the workforce to give access to dedicated mental health professionals to all A&Es, all GP practices, every police station custody suite, and to our prisons. Over the next five years increasing additional investment to £35 million for 800 additional mental health workers in those key settings.

Perinatal mental health

According to the Royal College of General Practitioners, "Up to one in five women… are affected by mental health problems in the perinatal period. Unfortunately, only 50% of these are diagnosed. Without appropriate treatment, the negative impact of mental health problems during the perinatal period is enormous and can have long-lasting consequences on not only women, but their partners and children too." ^[17]

In 2016 the Mental Welfare Commission for Scotland recommended that the Scottish Government establish a national Managed Clinical Network ( MCN) for perinatal mental health. ^[18] There were 26 Managed Clinical Networks in Scotland commissioned by NHS National Services Division; none of these, however, covered mental ill-health. This MCN for perinatal mental health is therefore a first.

• Action 16: Fund the introduction of a Managed Clinical Network to improve the recognition and treatment of perinatal mental health problems.

A Managed Clinical Network is a network of specialist staff working together. They are virtual entities designed to drive upwards the standards of patient care through integration of services and collaboration. Getting it right for mothers is not only good for them - it's good for the health and wellbeing of their children, and can contribute to breaking the cycle of poor outcomes from early mental health adversity.

Child and adolescent mental health

Work on access to CAMHS, and on reducing waiting times, should ensure that CAMHS is available, accessible, acceptable, of a good quality, and pays particular attention to vulnerable children ( e.g. those living in poverty, children in care, children in contact with the criminal justice system and children with a learning disability and/or autism). Improvement work on access should also consider variations in levels of demand that cannot be explained by factors such as different socio-economic circumstances. It should also consider design of services and referral pathways, such as rejected referrals.

• Action 17 : Fund improved provision of services to treat child and adolescent mental health problems.
• Action 18 : Commission an audit of CAMHS rejected referrals, and act upon its findings.

Work on treatment pathways and development of CAMHS intensive treatment services outwith an inpatient setting are essential. As reported by the Mental Welfare Commission for Scotland in 2016, there have been improvements with fewer incidences of young people being admitted to non-specialist wards. ^[19] We want to see this improvement continue.

Where an admission to a non-specialist ward occurs it must be ensured that safe and appropriate care can be provided in the non-specialist setting and that the admission is clinically and socially appropriate for the young person. The Mental Welfare Commission has recommended that standards be reviewed. To develop protocols for admissions, there will be a discrete piece of work.

• Action 19 : Commission Lead Clinicians in CAMHS to help develop a protocol for admissions to non-specialist wards for young people with mental health problems.

Some children travel outwith Scotland to receive specialist care. While it is possible that, in order to provide the appropriate clinical care, some highly specialist services will always need to be provided out of the country where numbers of patients are very small, this should be minimised where possible. In order to reduce the need for our vulnerable young people to travel outside Scotland for their health care and to improve the pathways of care, the Scottish Government has offered funding to support the capital development of a forensic CAMHS inpatient unit. Planning proposals are currently with the NHS. The Scottish Government is also supporting work on potential mental health inpatient needs of children and young people with a learning disability (intellectual disability) and/or an autism spectrum disorder.

• Action 20 : Scope the required level of highly specialist mental health inpatient services for young people, and act on its findings.

Young people can struggle to make the transition from children's mental health services into adult mental health services. Both children's and adult services need to cooperate to make this transition as seamless as possible. Smooth transitions between services are also part of achieving joined-up accessible services.

• Action 21 : Improve quality on anticipatory care planning approaches for children and young people leaving the mental health system entirely, and for children and young people transitioning from CAMHS to Adult Mental Health Services.

Eating disorders

The vast majority of people with an eating disorder are treated in the community by their local primary or community mental health care teams, with support links to specialist hospital or voluntary sector care where appropriate. To help ensure that young people with an eating disorder are able to access support in a way that reflects digital lifestyles, the Scottish Government will support the development of a digital tool for this.

• Action 22 : Support development of a digital tool to support young people with eating disorders.

Primary care and mental health

For health and social concerns, the person that many people turn to first is a primary healthcare practitioner, often their GP. Mental health issues are a common feature of primary care consultations and around a third of GP consultations have a mental health element. Strategic planning and commissioning for primary care services is the responsibility of Integration Authorities.

Scottish Government sees the transformation of primary care as key to delivering the National Clinical Strategy. The Scottish Government is working with primary care providers to test new models of service provision. We are also developing a Workforce Strategy, which will be crucial in ensuring that the broader NHS workforce is confident in dealing with mental health problems, and in ensuring the availability and capacity of specialist mental health staff.

Integration Authorities will want to consider how they can maximise the role of both clinical and non-clinical workers in primary care, such as Link Workers. Link Workers provide problem-solving, listening and signposting for physical, mental and social problems. They also work with people to optimise their own health, and monitor some chronic condition care plans. This approach will support the delivery of ask once, get help fast.

• Action 23: Test and evaluate the most effective and sustainable models of supporting mental health in primary care, by 2019.

Psychological therapies

NHS Boards are working hard to reduce waiting times for access to psychological therapies for all ages. The Scottish Government will continue to offer national support to NHS Boards with a programme of improvement and learning from good practice. There should be no unwarranted variation across the country, and no lower levels of access to psychological therapies for people who are already receiving other forms of mental health care, nor for people over the age of 65.

• Action 24: Fund work to improve provision of psychological therapy services and help meet set treatment targets.
• Action 25: Develop more accessible psychological self-help resources and support national rollout of computerised CBT with NHS 24, by 2018.

Better information technology

The Scottish Government's planned new Digital Health and Social Care Strategy will give an opportunity to connect the needs of mental health services and users into digital infrastructure investments that are being mapped out for health and community care over the next 5 years and beyond.

Parity of quality of treatment

There are clinical guidelines for which treatments should be delivered, and how, for mental health issues, just as there are for physical health issues. Best practice should be followed in the delivery of mental health treatment, with the evidence base and clinical guidelines as the basis for that best practice: this is about the right treatment, with the right number of sessions, with outcomes monitored and recorded. Using evidence-based clinical guidelines to treat mental health problems will be important evidence that parity between mental and physical health is being achieved. Using them will also help to deliver on non-discrimination.

Early interventions at the onset of a mental illness

Early intervention at the commencement of illness - especially for psychosis - has been shown to have positive impact on the development and severity of the illness, making a difference to people's life chances and quality of life.

Availability of fast and effective treatment for first episode psychosis matters especially, although not exclusively, for our young people and their families, because first episode psychosis:

"occurs most commonly between late teens and late twenties, with more than three quarters of men and two thirds of women experiencing their first episode before the age of 35". ^[20]

• Action 26: Ensure the propagation of best practice for early interventions for first episode psychosis, according to clinical guidelines.

People with equivalent life-changing, severe physical health diseases are entitled to expect and receive rapid, modern, evidence-based services. So should those with mental ill-health. Work in this area was also in the previous Mental Health Strategy and it is therefore likely that it will require additional improvement support, for example through Healthcare Improvement Scotland, to ensure impact.

Veterans

The Scottish Government supports the Armed Forces Covenant and, as set out in " Renewing Our Commitments" (Feb 2016), no one should suffer disadvantage as a result of military service. Armed Forces veterans, including those who have experienced trauma, may benefit from particular models such as peer support, combined with mainstream treatment. The Scottish Government will support efforts to meet the needs of veterans and their families, and local partnerships will want to consider how best to provide services locally for them.

Suicide and self-harm

Prevention of suicide and self-harm will continue to be the focus of separate work. Later in 2017, the Scottish Government will engage with stakeholders with a view to developing a new strategy or action plan for publication by early 2018.

Dementia

Dementia remains a priority for the Scottish Government and its partners. The forthcoming National Dementia Strategy will reflect the continued importance we attach to this agenda, building on the significant work which is already underway across Scotland.