Mental health strategy 2017-2027: second progress report

Support the third sector to provide counselling (for 11,000 women a year).

£50 million investment being overseen and directed by Perinatal and Infant Mental Health Programme Board which will develop new services to support those 11,000 women who might benefit from additional support in their community.

In 2020/21 the Scottish Government will invest in the third sector to develop counselling, befriending, peer support and other services to support women and families experiencing perinatal mental health problems who would benefit from support in their community, this will include specific funds to address some of the groups identified who might find it difficult to access services, such as those from BME communities, women experiencing domestic abuse and women with involved with substance misuse.

Ensure rapid access to psychological assessment and treatment (for 5,500 women in need of more specialist help).

Invest £825,000 to increase specialist staffing levels at the two current Mother and Baby Units at St John's Hospital in NHS Lothian and Leverndale Hospital in NHS Greater Glasgow and Clyde, enabling them to become centres of expertise.

This will develop regional perinatal networks to coordinate and lead service development and ongoing monitoring and evaluation.

Develop more specialist services and consider the need for a small number of additional inpatient beds or enhanced community provision (for 2,250 women with the most severe illness).

Invest £825,000 to increase specialist staffing levels at the two current Mother and Baby Units at St John's Hospital in NHS Lothian and Leverndale Hospital in NHS Greater Glasgow and Clyde, enabling them to become centres of expertise

Develop training to grow the number of staff able to provide specialist perinatal care.

This will develop regional perinatal networks to coordinate and lead service development and ongoing monitoring and evaluation.

An options appraisal will be undertaken looking at how we could increase capacity in specialist mother and baby units including what specialist support is required in the North of Scotland. This will be completed by the end of 2019, after which we will set out the next steps.

Put in place recommendations from Taskforce on Children and Young People’s Mental Health Improvement.

The Children and Young People’s Mental Health Taskforce made its final recommendations to the Scottish Government and COSLA on 4 July 2019. 

Delivery of the recommendations will be overseen by the new Children and Young People’s Mental Health and Wellbeing Programme Board jointly chaired by the Scottish Government and COSLA. The Board met for the first time in August 2019.

Invest over ￡60 million in additional school counselling services, creating around 350 counsellors in school education across Scotland, and ensuring that every secondary school has counselling services.

The Scottish Government and COSLA agreed on the distribution of funding for Local Authorities in August 2019. The Scottish Government has also engaged with COSCA and BACP to ensure that appropriate standards will be followed by counsellors. It has worked with the Scottish Qualifications Authority to enable additional training to become available for already established counsellors to work with children and young people in seven colleges across Scotland. 

Implementation plans will be presented by Local Authorities on the counselling plans by the end of 2019.

Put an additional 250 school nurses in place by 2022 to provide a response to mild and moderate emotional and mental health difficulties.

NHS Boards have provided intake numbers for September 2019 and January 2020 and are ready to recruit. An oversight group through the Scottish Nursing Directors Group is being established.

The first tranche of 50 nurses in training is starting in the 2019/20 academic year.

Enhance support and professional learning materials for teachers on good mental health, including ensuring that, by the end of academic year 2019/20, every Local Authority will be offered training for teachers in mental health first aid (using a ‘train the trainer’ model to disseminate to all schools).

Since 2014, Education Scotland has been rolling out Scotland’s Mental Health First Aid Training for Children and Young People to Local Authorities. 

All Local Authorities will have been offered Scotland’s Mental Health First Aid Training by the end of the 2019/20 academic year.

Provide more than 80 additional counsellors in Further and Higher Education over the next four years, with an investment of around £20 million.

An approach to the allocation of resources to the sector was agreed between the Scottish Funding Council and the Scottish Government. The additional resource will enable institutions to recruit access additional counselling services for students.

The first tranche of counsellors will be in place in the 2019/20 academic year. 

Put in place systems to fast-track those with serious mental illness to specialist treatment.

Following a recommendation by the Taskforce £4 million was invested in 2019/20 to provide an additional 80 CAMHS staff. A CAMHS standard referral form is being developed which will help fast-track those with serious mental illness to specialist treatment.

One of the key deliverables to be taken forward by the Children and Young People’s Mental Health and Wellbeing Programme Board is the development of a set of CAMHS Service Standards, which are due to be published in the coming months.

Develop services for community mental wellbeing for 5-24 year olds and their parents, to provide direct and immediate access to counselling sessions, self-care advice, family support, peer-to-peer support and group work.

The Children and Young People’s Mental Health Taskforce made recommendations on how to develop these services in July 2019. 

Delivery of the recommendations will be overseen by a new Programme Board jointly chaired by SG and COSLA and this is one of the key deliverables.

Improve the training and awareness of people working with vulnerable families, and deliver improved infant mental health support for families that need it.

£3 million is to be made available to support the establishment of integrated infant mental health hubs across Scotland. 

These will create a multi-agency model of infant mental health provision to meet the needs of families experiencing significant adversity, including infant developmental difficulties, parental substance misuse, domestic abuse and trauma.

Launch a new website containing trusted help and information for young people and their families.

The Children and Young People’s Mental Health Taskforce considered options on delivering this as part of its work programme.

The options explored by the Taskforce are being considered by the Children and Young People’s Mental Health and Wellbeing Programme Board, with a view to concrete proposals being prepared.

Expand the Distress Brief Intervention (DBI) programme pilots during 2019 to include people under 18.

DBI referral became available for 16- and 17-year olds in two of the four pilots in May 2019, and in the other two in July 2019, so is now available in all four pilots. In addition, we have one area which has “joined” as a DBI Associate programme (Moray) – this happened in Spring this year, many months ahead of when we would have expected any Associate programmes to go live. Independent evaluation of DBI programme is underway and will report in March 2021.

Incremental building on progress to date is continuing. Work to undertake a scoping exercise to review the potential applicability of

DBI for those aged 15 and younger and considering the recommendations for

further extension is underway. A DBI associate programme is being established for other regions wanting to implement within existing programmes.

Make mental health and suicide prevention training mandatory for all NHS staff who receive mandatory physical health training.

Action 2 of Every Life Matters states that Suicide Prevention and Mental Health (SP/MH) Training should be mandatory for all NHS staff. A new Knowledge and Skills Framework and a Workforce Development Plan has been developed by NHS Health Scotland and NHS Education Scotland for NHS Boards. The Scottish Government Director for Mental Health, Donna Bell, wrote to all NHS Chief Executives and Integration Authority Chief Officers, asking them to include SP/MH training in their local workforce development plans.

NHS Boards will take forward the action to make SP/MH Training should be mandatory for their staff in a way that responds to local requirements.

Implement the recommendations made in the Audit of Rejected Referrals, to ensure that all children are appropriately triaged and where necessary directed to alternative support services. This will include ensuring that GPs and others have clear consistent guidelines for referral to CAMHS.

The Scottish Government accepted all 29 recommendations in the Audit of Rejected Referrals report. As a direct response to the Audit’s findings, we announced the establishment of the Children and Young People’s Mental Health Taskforce which produced their final recommendations on improving CAMHS in July 2019. In addition to the work of the Programme Board, the Scottish Government is working with ISD on a number of actions to improve the data that is collected regarding referrals to CAMHS. Additionally, the Minister for Mental Health wrote to all NHS Boards on 19 June 2019 to seek an update on how each Board processes referrals to CAMHS, what action each Board has taken to provide clearer referral criteria, and what action has been taken to better publicise out of hours and crisis supports. 

The Children and Young People’s Mental Health and Wellbeing Programme Board, which is chaired jointly by the Scottish Government and COSLA, is currently considering the delivery of these recommendations through nine key deliverables. This includes development of a set of CAMHS Service Standards. 

Put in place 24/7 crisis support for children, young people and their families.

The Taskforce recommended development of this support as part of its recommendations in July 2019.

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently taking forward work on the development of a 24/7 mental health crisis support and prevention telephone and text service for children, young people, their families and carers.

Trial improvements to the NHS 24 Breathing Space service, by introducing web-chat with an NHS 24 adviser

A Breathing Space test of change was introduced at the beginning of 2019. Additional staff have been put in post and training completed to support introduction of web chat. Demand has grown to c.250 web chat requests per month on average. There is evidence that this is reaching new people rather than shifting from telephone so considering need to increase capacity. Evaluation framework has been agreed and on track as part of wider mental health evaluation work. 

To identify capacity requirements to increase availability of web chat within funding available. Evaluation is ongoing and is informing roll out of test of change from autumn 2019.

Introduce more widespread online access to Cognitive Behavioural Therapy (helping around 5,000 more people with mild to moderate depression).

eCBT in Western Isles operational for two months with 100 self-referrals, on target to meet 130 planned. NHS Lothian has completed initial set for July 2019.

A staggered approach across Scotland is being taken forward as part of the planned test of change.

Strengthen the content of current self-help platforms provided through NHS Inform.

Migration of Moodjuice is ongoing. Communication plan is in place with territorial Boards informing changes to Moodjuice.Two new self-help guides for anxiety and depression now live. 

Paired writing sessions arranged, which will develop additional self-help guides focussing on bereavement and problem-solving, self-esteem, chronic pain and PTSD.

Improve access to psychological assessment and therapies in rural areas, through the use of technology such as video-conferencing.

This workstream is due to start in autumn 2019.

This workstream is due to start in autumn 2019.

Enhance the handling of mental health calls to the 111 service, with more specially trained staff providing specialist mental health advice.

The test of change introducing a mental health ‘hub’ is progressing well. Further recruitment completed with 12 Psychological Wellbeing Practitioners in post and four going through final recruitment checks; eight Mental Health Nurse Practitioners in post and two in final recruitment stages, and three SCNs in post. One SCN post still to fill. Currently finalising plans to extend to seven evenings a week subject to funding in place.

Evaluation is ongoing and will inform roll out of test of change in autumn 2019.

Create and implement refreshed mental health and suicide prevention training by May 2019 for Scotland’s public and private sectors.

At the end of May 2019, the Minister for Mental Health launched a new SP/ MH learning and awareness-raising resource– developed by NHS Heath Scotland NHS Education in Scotland. These resources are applicable to the NHS and beyond. COSLA and the SFA announced that they will roll out the resources across their staff. 

Phase 2 of the workforce development is in the delivery plan of the NSPLG for 2019-21.

Informed by views of partners, NHS Health Scotland and NHS Education Scotland (NES) will undertake further work in the following areas:

• Continued promotion of the universal resource across sectors
• Developing and commissioning education and training to meet specific workforce needs
• Developing infrastructure to support delivery to specific workforces
• Launch specific workforce resources and programmes
• NES and NHS Health Scotland are undertaking work to support training in relation to suicide prevention amongst children and young people

Develop reviews of all deaths by suicide, ensuring lessons are shared and acted on.

The NSPLG has completed a review of the current system in terms of identifying and summarising the responsibilities on each institution for undertaking reviews of completed suicides. They have identified scope for improvement across these existing responsibilities but more importantly have identified that there is no requirement placed on any institution to undertake a review of completed suicide in a community setting.

Identification and testing of an appropriate methodology for reviews which will try to establish whether there was a missed opportunity to make a contact count across the system. A number of Health and Social Care Partnerships have expressed an interest in being involved.

Develop innovative ways to use digital technology to prevent suicide

The NSPLG have been scoping existing activity and identifying people’s needs to see where digital technology could have best effect. Animations were launched in May on various platforms were used to deliver awareness raising and learning resource for best reach. 

The NSPLG is looking to identify how to best enhance digital resources across initiatives of the Suicide Prevention Action Plan. Including engaging at risk groups, promoting suicide prevention training and improving support for those bereaved by suicide.