Mental health strategy 2017-2027: second progress report

15 Actions:

1, 3, 12, 16, 18, 20, 21, 22, 23, 25, 29, 31, 37, 38, 39

4 Actions:

2, 4, 19, 33

20 Actions:

5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 17, 24, 26, 27, 28, 30, 32, 34, 35, 36

1 Action:

40 (mid-point evaluation of Strategy)

1 - Review Personal and Social Education (PSE), the role of pastoral guidance in Local Authority schools and services for counselling for children and young people.

The final report and recommendations were announced and published 23 January 2019. The action is now complete.

2 - Roll out improved mental health training for those who support young people in educational settings.

The roll out of young people’s Scotland’s Mental Health First Aid (SMFHA) is being led by Education Scotland. All Local Authorities will have been offered the training by the end of the current academic year: i.e. by August 2020. There is continued work to support Scotland’s Mental Health First Aid trainers, which will be provided by NHS Health Scotland.

3 - Commission the development of a Matrix of evidence-based interventions to improve the mental health and wellbeing of children and young people.

Work has been completed on the product and prototype for Phase 1 (antenatal and 0-36 months) initiatives in the development of the Early Intervention Framework (EIF). Work has now commenced on Phase 2 of the EIF development (3-5 years pre-school). With the commissioning of the work, the action is now complete.

4 - Complete the roll out of national implementation support for targeted parenting programmes for parents of 3 and 4 year olds with conduct disorder by 2019/20.

Implementation of the Psychology of Parenting Project (PoPP) in mature sites is continuing, so that at least 55 new Psychology of Parenting Project groups will be delivered by end 2019. There has been creation of an online community of practice for PoPP coordinators hosted on the Knowledge Network (August 2019). Also, delivery of strengths-based communication skills, Train the Trainer training to 15 practitioners from PoPP sites took place in September 2019.

5 - Ensure the care pathway includes mental and emotional health and wellbeing, for young people on the edges of, and in, secure care.

An initial deliverable for this work will be developing pathways and transitions for those on the edges of, and in, secure care. A delivery plan is to be presented to the Children and Young People's Mental Health and Wellbeing Programme Board in December 2019. The deliverable is due to be completed by December 2020.

6 - Determine and implement the additional support needed for practitioners assessing and managing complex needs among children who present a risk to themselves or others.

The Cabinet Secretary for Justice launched two new resources for practitioners during the 12^th National Youth Justice Conference on 19 June 2019. The Scottish Government will continue to fund the Interventions for Vulnerable Youth (IVY) project initially until April 2020. With consideration to be given to a further proposal for funding beyond April 2020. Continuing work in this area will be taken forward as part of the work for Action 5.

7 - Support an increase in support for the mental health needs of young offenders, including on issues such as trauma and bereavement.

Evaluations of trauma, bereavement and loss services in Schools and Her Majesty's Young Offender Institution Polmont were published in summer 2019. An independent expert review of mental health and support for young people entering Her Majesty's Young Offender Institution Polmont was established in December 2018 and reported its findings in May 2019. An Expert Review Group is taking forward the implementation of the recommendations.

8 - Work with partners to develop systems and multi-agency pathways that work in a coordinated way to support children’s mental health and wellbeing.

The Children and Young People’s Mental Health Taskforce began work on this commitment in line with the Delivery Plan published in December 2018. The Taskforce put forward its final recommendations in July 2019 and the work will continue to be progressed through a package of nine deliverables overseen by the new Children and Young People’s Mental Health and Wellbeing Programme Board. One key deliverable is a delivery plan to strengthen local partnerships’ strategic focus on improving mental health and wellbeing. This, and the other deliverables, are due to be completed by December 2020.

9 - Support the further development of "Think Positive" to ensure consistent support for students across Scotland.

In 2018/19, record numbers of colleges and universities across Scotland signed up to take part in the ‘Think Positive Student Mental Health Agreement’ project. A brief was developed and put out to tender for Scotland-specific research on student mental health and provision of support across further and higher education sectors. Following commission of the work, the research will be completed by mid-2020.

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

The Perinatal Mental Health Managed Clinical Network published its needs assessment report in March 2019 with a list of recommendations. The Scottish Government established a Perinatal and Infant Mental Health Programme Board to implement those recommendations, and its initial delivery plan was published on 30 August 2019. The action is now complete.

17 - Fund improved provision of services to treat child and adolescent mental health problems.

It is now the final year of the £54 million package (2016-2020) of support to help Boards improve their performance against Child and Adolescent Mental Health Services (CAMHS) waiting times targets by investing in workforce development, recruitment and retention, and service improvement support. Expectation is for delivery of the 18-week standard (for 90% of patients) by end 2020. In addition, £4 million in funding was provided in December 2018 to support additional workforce capacity of CAMHS.

18 - Commission an audit of CAMHS rejected referrals, and act upon its findings.

The ‘Rejected Referrals’ report was published on 29 June 2018. The Children and Young People's Mental Health Taskforce was established to act on its findings, and its recommendations, published in July 2019, are being taken forward through the new Children and Young People’s Mental Health and Wellbeing Programme Board. With the development of a clear set of deliverables by the Programme Board to act on the report, the action is now complete. 

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

The protocol for admissions has been completed and submitted to the Scottish Government. The final protocol is due to be published in the coming months.

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

Following analysis and consultation, we have determined the need for a secure CAMHS inpatient unit for Scotland and this will be built in Ayrshire and Arran with a target opening date of 2021. A specialist Learning Disability Child and Adolescent Mental Health Services unit is proposed for NHS Lothian and NHS GGC a proposal for national service designation is to be considered by Board Chief Executives in December 2019. Capital funding is still to be agreed.

21 - Improve quality of 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.

Transition Care Plan documents, along with protocols for clinicians, were launched in August 2018. The Minister has written to all NHS Boards and Health and Social Care Partnerships to outline her expectations that the Transition Care Plans will be used Scotland-wide, and officials are following up on the comments received with a view to revising and updating the Transition Care Plans accordingly. The action is now complete.

22 - Support development of a digital tool to support young people with eating disorders.

The CARED site won the Alliance Scotland Self-Management Resource of the Year 2018. Ongoing promotion of online peer support via videos shared on social media and the CARED Scotland website. It has met the annual recruitment targets of 15 parents and carers and 45 young people to receive the service. The action is now complete.

10 - Support efforts through a refreshed Justice Strategy to help improve mental health outcomes for those in the justice system.

Development of the Enhanced Mental Health pathway is in progress to help those in crisis or distress (who come into contact with the Police) to ensure they are provided the most appropriate support. See entry on Action 15 for further information. There has also been the review of mental health services for young people in custody (Polmont in particular) with recommendations now being taken forward by the Expert Action Review Group.

15 - Increase the workforce to give access to dedicated mental health professional to all A&Es, all GP practices, every police 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.

268 additional whole time equivalent (WTE) staff have been employed as of 1 July 2019. A fourth quarterly update on the number of additional staff recruited as of 1 October will be provided before the end of 2019. 

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

The Scottish School of Primary Care published its National Evaluation of New Models of Primary Care in Scotland report in Spring 2019. It tested and evaluated new models of delivering mental health services in a primary care setting, such as a listening service for service users, training service users on self-management, improved support for self-directed support for mental health service users, wellbeing services for NHS staff and locating welfare rights advisors in General practitioner practices. The Scottish Government also published its ten-year Primary care: national monitoring and evaluation strategy in March 2019, which also informs the evaluation of such models. The action is now complete.

24 - Fund work to improve provision of Psychological Therapy services and help meet set treatment targets.

It is now the final year of the £54 million package (2016-2020) of support to help Boards improve their performance against waiting times targets by investing in workforce development, recruitment and retention, and service improvement support. Expectation is for delivery of the 18- week standard (for 90% of patients) by end 2020, as set out in improvement trajectories in the 2019/20 Annual Operational Plans of the Boards.

11 - Complete an evaluation of the Distress Brief Intervention (DBI) by 2021 and implement the findings from that evaluation.

All four key front-line Distress Brief Intervention Level 1 service pathways (Emergency Departments, Primary Care, Police Scotland and Scottish Ambulance Service) have continued to adapt and incrementally up-scale. Extension to 16 and 17 year olds commenced in all four pilot sites – Lanarkshire, Borders, Aberdeen and Inverness. In addition, the first Distress Brief Intervention Associate Site was established in Moray in June 2019.

12 - Support the further development of the National Rural Mental Health Forum to reflect the unique challenges presented by rural isolation.

The Scottish Government is funding the Forum at a total of £50,000 (per annum and split between Mental Health and rural policy). Membership of the Forum has now grown to 106 organisations. The Action Plan is also now in place with outcomes and timescales from 2018/19 through to 2021. Funding for 2019/20 has been confirmed and announced, funding levels have remained at 2018/19 levels. With plans for continuing support now in place, the action is now complete.

13 - Ensure unscheduled care takes full account of the needs of people with mental health problems and addresses the longer waits experienced by them.

Incorporation is underway into the work of a broader National Distress Intervention Group recommended by the Health and Justice Collaboration Board. The first meeting of the Group was held on 29 July 2019 when key themes were identified, which will be workshopped over the next 12 months. Recommendations on unscheduled care are due by summer 2020.

14 - Work with NHS 24 to develop its unscheduled mental health services to complement locally-based services.

NHS 24 has established a dedicated mental health hub within the 111 service where callers are routed directly to a new specialist mental health skillset, psychological wellbeing practitioners, who carry out a psycho-social assessment and are consistently resolving 60% of calls with no need for onward referral. The hub will also receive calls transferred from Scottish Ambulance Service or police 101, as part of a collaborative pathway to better respond to people in mental health distress. The SAS transfer capability is already in place, however, there were delays to roll out for police 101 calls due to information commissioner’s office review of data transfer between police and NHS, which has concluded transfer is not possible within current information governance legislative framework, however, joint work is now underway to develop a suitable alternative to transfer of callers.

25 - Develop more accessible psychological self-help resources and support national rollout of computerised CBT with NHS 24, by 2018.

Computer-based Cognitive Behavioural Therapy services have been operating across all NHS Board areas in Scotland since April 2018 – the key deliverable on this action has already been achieved.

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

The Scottish Government published ‘Our Vision to Improve Early Intervention in Psychosis in Scotland’ on 30 June 2019. It lays out a two-stage process with initial work taking place in two test boards which have now been selected and are currently recruiting improvement support. The formation of an Early Intervention in Psychosis Improvement Network (EIPIN) is now underway. The second stage of phased implementation across all NHS Boards and Health and Social Care Partnerships (HSCPs) will be guided by the EIPIN’s recommendations, as well as the learning from the improvement work in the test NHS Boards.

27 - Test and learn from better assessment and referral arrangements in a range of settings for dual diagnosis for people with problem substance use and mental health diagnosis.

Mental health and substance use policy colleagues are working with experts to support the development of effective joint working protocols between alcohol and drug services and mental health services. This has been set out as a commitment in the 2019 Programme for Government.

28 - Offer opportunities to pilot improved arrangements for dual diagnosis for people with problem substance use and mental health diagnosis.

Plans are progressing to provide a small grant to support 3-5 local areas to develop and test integrated services for people with mental health and alcohol/drug problems.

29 - Work with partners who provide smoking cessation programmes to target those programmes towards people with mental health problems.

IMPACT guidance has been rolled out to all NHS Boards. Quarterly training continues. Improvements in data are planned by end 2019. With these actions underway through joint working with partners, the action is now complete.

30 - Ensure equitable provision of screening programmes, so that the take up of physical health screening amongst people with a mental illness diagnosis is as good as the take up by people without mental illness diagnosis.

Screening Inequalities Fund Stage 2 applications for 2019/20 funding are currently being considered and decisions are expected to be announced before the end of 2019.

31 - Support the physical activity programme developed by SAMH.

Since its inception in 2016, the Active Living Becomes Achievable (ALBA) programme has taken an innovative approach to combine Cognitive Behavioural Approaches with Physical Activity and Sport utilising digital technology to improve mental health, physical health and wellbeing of people with mild to moderate mental health problems resulting in:

• Recruiting 412 participants over five cohorts in Fife, West Lothian and North Ayrshire;
• Sustained increase in participant wellbeing, approaching parity with the general population;
• Significant improvement in adherence rates (57% vs. 20%);
• Sustained increase in physical activity levels;
• Increase in participants confidence and ability to self-manage their mental health and wellbeing;
• Decrease in reliance on statutory/primary/secondary care and/or medication;
• Increased chances of employment/training/volunteering;
• Facilitated six training sessions on our Supporting Behaviour Change training in conjunction with Napier University with 64 participants trained;
• Recruited 26 peer volunteers (target 24) to support ALBA participants; and
• 1,532 participants completed eLearning for Mental Health Awareness and 228 participants completed eLearning for Supporting Behaviour Change (target 1,500).

Through the support for the programme, the action is now complete.

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

NHS Health Scotland, Health and Work Directorate has continued to deliver training and review resources relating to the Mental Health at Work and the Work Positive Programmes. A one-year pilot of a new framework of workplace mental health standards for the public and private sector led by NHS Health Scotland Public Mental Health Team is planned to commence before the end of  2019.

38 - Develop a quality indicator profile in mental health which will include measures across six quality dimensions – person-centred, safe, effective, efficient, equitable and timely.

The Quality Indicators for Mental Health were launched in September 2018. Future steps are to operationalise this regular reporting, with the intention of full reporting of all 30 Quality Indicators by January 2021. The action is now complete.

39 - Establish a bi-annual form of stakeholders to help track progress on the actions in this strategy, and to help develop new actions in future years to help meet our ambitions.

Successful 3^rd annual forum was held in December 2018. Implementation of leadership and delivery structure of each theme in place. Publication of previous forum materials and up to date action delivery report on Scottish Government website for September 2019. The action is now complete.

32 - Use a rights-based approach in the statutory guidance on the use of mental health legislation.

Over the course of 2019, there has been extensive stakeholder engagement, including with service user representatives, to identify key practice issues requiring update or clarification within the new version of the Code.

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 disability and autism, taking forward new legislative measures if necessary.

This work is stakeholder driven and evidence led and as such is formed of three public engagement phases. Stage 1 finished in November 2018 and focused on finding out about people’s experiences as well as what is known already about the Mental Health Act. The responses have been analysed and were used to inform the work of Stage 2. Suggestions were sought on how the Act could better promote and protect the human rights of these groups of people. Stage 2 completed at the end of August 2019. Stage 3 is underway, the review will seek comment on options for change in an open consultation. The review will submit its final report to Ministers by the end of 2019.

34 - Reform Adults with Incapacity legislation.

Following the consultation in 2018 we have worked with stakeholders, including three working groups to distil the messages received into draft policy. We have also been working on producing guidance and amending the adults with incapacity codes of practice.

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

This work will be taken forward as part of the package of deliverables for the Children and Young People’s Mental Health and Wellbeing Programme Board, which is jointly chaired by COSLA and the Scottish Government, particularly under the workstreams to strengthen local partnerships and develop community wellbeing services.

37 - Explore innovative ways of connecting mental health, disability, and employment support in Scotland.

13 projects were supported until March 2019. Statistics were published in May 2019 and evaluations of all projects were completed and submitted to the Scottish Government by end September 2019. We launched Scottish Government’s Recruitment and Retention plan on the 29 August 2019 which sets out how we intend to increase the number of disabled people, including people experiencing mental health issues, employed in the Scottish Government. It also sets out how we will enhance support for new and existing staff. The action is now complete.