Mental Health Strategy 2017-2027

Rights, information use, and planning

Ambitions:

• That a human-rights based approach is intrinsic to actions to improve mental health.
• That legislation related to mental health is fit for purpose.
• That people who have experienced mental health problems can be supported back into the workplace.
• That people who develop poor mental health are supported to stay in work just as they would be with physical health problems.

A human rights-based approach is intrinsic to actions in this Strategy. This is being addressed through the PANEL principles: Participation, Accountability, Non-discrimination and equality, Empowerment, and Legality.

Our mental health and incapacity law sets out principles which have been at the forefront of a rights-based approach to law in this area. International law continues to develop and other jurisdictions have taken the step to overhaul their mental health and incapacity legislation. The approach taken here is to take account of supranational observations, build on existing good practice, and learn from other jurisdictions and about what works well. ^[27]

Mental Health legislation

The implementation of mental health law will promote the realisation of the human rights of people experiencing mental health problems. This will also be a focus of a co-ordinated approach to any review of incapacity legislation and its interaction with mental health law. We will continue to work with partners on support for decision-making.

• Action 32: Use a rights-based approach in the statutory guidance on the use of mental health legislation.
• Action 33: Commission a review of whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 Act fulfil the needs of people with learning disabilities and autism, taking forward new legislative measures if necessary.

Adults with Incapacity Legislation ( AWI)

Adults with Incapacity legislation should fully reflect the requirements of the United Nations Convention on the Rights of Persons with Disabilities ( UNCRPD), with particular emphasis on provision of supported decision making, addressing issues around deprivation of liberty and the interaction of AWI legislation with the legislation on mental health and adult support and protection.

• Action 34: Reform Adults With Incapacity ( AWI) legislation.

Mental Health Officers

The independent role played by social work Mental Health Officers ( MHOs) is central to ensuring that people's human rights are protected and upheld when their care and treatment involves compulsion or can include detention. With the increase in local government's statutory duties in relation to mental health, there has been a corresponding increase in the workload of MHOs. This can impact on the proportion of time available to focus on prevention, early intervention and recovery. ^[28]

• Action 35: Work with key stakeholders to better understand Mental Health Officer capacity and demand, and to consider how pressures might be alleviated.

Getting a job and staying in work

Work can be good for mental health. Not being in work can be a factor in poverty, which is a determinant of mental ill-health. People with poor mental health are less likely than people with poor physical health and people with good health to transition from unemployment to employment. ^[29]

Labour market policies should focus on assisting people with poor mental health to move from unemployment into employment, and public health and employment initiatives must focus on assisting people to stay in work.

NHS Health Scotland works with employers to provide appropriate training opportunities to support workplace mental health and wellbeing: this offers opportunities for employers to support and implement policies on mental health in the workplace.

• Action 36 : Work with employers on how they can act to protect and improve mental health, and support employees experiencing poor mental health.

There is already a range of different devolved and reserved support services in Scotland that could potentially help individuals with mental health conditions to sustain or return to fair work, improve the ability of employers to promote good mental health in the workplace, and support employees with mental health conditions. The current landscape of support can, however, be fragmented and complex, with a range of different eligibility criteria and some gaps and duplication. This can mean that people with mental health conditions do not find their way to support at an early enough stage to make a real difference to their ability to sustain or return quickly to fair work when they encounter problems.

• Action 37: Explore with others innovative ways of connecting mental health, disability, and employment support in Scotland.

Support people to manage their own mental health

Evidence indicates that where people have the tools to manage their own health - including being supported to do so, such as through social prescribing - then their wellbeing may be improved. ^[30]

Training in first aid approaches for mental health should be as common as training in physical health first aid. Other opportunities also exist through peer support, digital tools and better use of electronic information because these offer huge potential for widening access, supporting co-production and self-management.

The Scottish Government's ambition is for a sustainable health and social care system which helps to build resilient communities. There needs to be a strategic shift towards recovery models focused on assets, strengths and self-management. This is fundamental not only to how mental health services are designed and provided, but fundamental to the design and provision of all services that have the potential to improve mental health and wellbeing. This goes substantially beyond the scope of health services.

The importance of the approach and culture of staff in public services, including, but not limited to, mental health services and other health and social care services, in working with people with mental health problems, cannot be overstated. Every contact is an opportunity to promote health (both physical and mental), and to take a recovery-oriented approach.

Integration Authorities and Local Authorities will therefore wish to mainstream a recovery-oriented and rights-based approach throughout clinical services, through workforce development and use of tools like IROC (Individual Recovery Outcomes Counter) and SRI2 (Scottish Recovery Indicator). The Scottish Government will also consider how its support to the Third Sector can help to mainstream throughout health and social care services a recovery-oriented and rights-based approach.

Self-directed support

The aim of the Social Care (Self-directed Support) (Scotland) Act 2013 is to allow people, carers and families to make informed choices about what their social care support is and how it is provided. It aims to empower people to be equal partners in their care, to support decisions and to participate in education, work and social life. This, of course, includes people accessing social care for support with their mental health. The actions in the 2016-18 Self-Directed Support implementation plan should help to ensure that Integration Authorities provide more creative and flexible support.

Future Direction

The introduction of the Mental Health (Care and Treatment) Act 2003 provided the most recent significant shift in how mental health services were provided. Partners have said that it is time for the next big change in how mental health services are provided and what they look like. Integration of health and social care creates the conditions for this next transformation of mental health services, to use the whole system to empower and support people to recover and stay well.

We have set out actions in this Strategy that address the most immediate challenges and priorities for the first 3-4 years of the Strategy. Other priorities will emerge. However, we are signalling now that the next phase of the Strategy will have a focus on mental health services in secondary care including inpatient and community services. This will allow Integration Authorities and partners in all sectors to start planning what that could mean now, so national support, including workforce planning and improvement support, can be aligned to support the changes that are needed.