Mental health strategy 2017-2027: second progress report

1

There should be a standardised framework to measure the success of mental health services for young people.

Accept

Through Mental Health Strategy Action 38 we have developed a Quality Indicator (QI) Profile which measures the quality of services that people receive. The QIs are complemented by a Mental Health Strategy Framework which illustrates population mental health and wellbeing, strategic impact and parity of esteem between physical and mental health.

2

There must be a person-centred approach to mental health services. 

Accept

The Children and Young People’s Mental Health and Wellbeing Programme Board will be supported by a lived experience group to ensure the voices and experiences of children, young people and their families are at the centre of this work.

2i

Young people should have control over the length, regularity and location of appointments, to ensure they feel comfortable and secure with the care they receive and to aid their recovery. This is not to undermine clinical support but to give the young people the choice of the best options available to them.

Accept

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification which includes agreeing a care plan with the child or young person. This is scheduled to be published in the coming months.

2ii

When assessing young people’s mental health, the questions used need to identify more than if they are at a crisis point but understand how they are feeling both in the moment and generally. 

Accept

2iii. 

There should be transitionary support to address the gaps in services to allow young people to choose what their care looks like. This means there needs to be an overlap in services to allow for a more seamless transition. Young people should have a choice and have effective support throughout the process on when to transition to adult or young adults’ services. CAMHS services for young people should include:

a. Youth services available up to 18-year olds
b. ‘Young adult’ services made available from 16-25
c. Adult services available from 21 

Accept in Principle 

In August 2018 we published our Transition Care Plans which support young people as they transition to adult mental health services. Additionally the Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification which further embeds the use of TCPs. With respect to the part of the recommendation relating to the age range of services, see response to Services recommendation 2iv. 

2iv

There should be a service for 16 to 25-year olds that is focused on stages of life instead of the patients’ age. Such as when a person is moving from compulsory education into independence and employment and supporting them through this stage.

Accept In Principle

The 2017 Programme for Government includes a commitment to exploring the expansion of CAMHS to include flexibility for patients to continue their care and treatment until age 25. We are carefully considering our approach to this recommendation and exploring options on how this might be achieved.

2v

Less clinical language should be used when communicating with young people around their care. The language used while talking to young people should be easy to understand, respectful, and comforting. 

Accept

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification which includes making sure staff are appropriately trained to support and treat children and young people. This is scheduled to be published in the coming months.

2vi

Initial assessments of young people and their mental health should be face to face until they can identify their care plan. This process should not extend past four weeks. 

Accept 

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification and CAMHS referral criteria. This is scheduled to be published in the coming months.

2vii

When a young person moves Local Authority their mental health support and care should not be disrupted or halted. Transitions to new service, no matter the Local Authority should be supported in a way that is appropriate for the individual.

Accept in Principle 

In August 2018 we published our Transition Care Plans which support young people as they transition between services. The TCPs will be crucial in ensuring a smooth transition in the event of a move between NHS Board areas. There are technical and equity challenges that need to be explored, and will be scoped as part of follow-up work to the development of the CAMHS Service Specification.

2viii

Medication should not be the only or automatic option. There should be a variety of care options available to the young person. Other complimentary therapies should be offered and encouraged where appropriate (e.g. art therapy, group therapy, etc.) 

Accept in Principle

Medication often has an important role in care and treatment, however, other options relating to individual care and treatment will always be carefully considered by the relevant clinicians involved in the young person’s care. Those options will depend entirely on the circumstances of the young person, and will be offered with good clinical judgement.

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification which includes services providing recommendations for interventions and treatment options which provide engagement, flexibility and choice. This is scheduled to be published in the coming months.

2ix

Clear monitoring processes should be created and consistently implemented with patients to ensure they are put on the right medication and this is continually reassessed, in line with NICE guidance. Medication may not be suited to the individual even if it ‘treats’ their mental health. This must be consistently used to ensure they are on the right course of action for each individual patient

Accept in Principle

We recognise the importance of good and appropriate prescribing. Options relating to treatment will be made by the relevant clinicians involved in the child or young person’s care. We expect that all clinicians will follow the relevant clinical guidance when prescribing medication, and will keep this under review.

2x

The workforce of all mental health services for those up to the age of 25 must be increased to meet demands and ensure that young people’s needs are being met

Accept

We have invested heavily in CAMHS staffing in recent years, including £4 million in 2019/20 for 80 additional CAMHS staff. We are seeing the impact of this investment – with CAMHS staffing up 4% in the last year and up by 76% under this Government.

3

There should be services available out with the working hours (9am to 5pm).

Accept

This year our Programme for Government contained an action to develop a 24/7 crisis support will be developed for children and young people and their families. We will build on existing pilots to ensure children and young people can access crisis services in a way that best meets their needs, whether that’s face to face, on the phone, or by text. 

3i

Crisis support should always be available to all young people, 24 hours a day, 7 days a week, 365 days a year. Counselling should also be available outside 9am-5pm but not necessarily overnight to suit the need of young people in school. This will ensure that all young people have access to appropriate services and don’t have to take time off of education, work etc. to attend appointments. 

Accept

4

Services should not be centralised but standardised, to allow access for every young person to quality and appropriate mental health services. 

Accept 

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification to ensure that all CAMH services across Scotland are delivering an agreed standard of service. This is scheduled to be published in the coming months.

4i

A ‘basic standard of care’ should be developed and monitored continuously across Scotland, specifically for young people accessing services. This should ensure that all young people receive an appropriate level of care.

Accept

4ii

Young people should have the same support no matter where they live. A young person’s background, culture, ethnicity and location should not limit the amount of care they receive.

Accept in Principle

We recognise and support the principle behind this recommendation, however, it is important to note that there will sometimes be some differences in care due to the location of services. For example, services in a rural location will inevitably differ in how they provide specialist or condition-specific care to those in a more urban area. 

However, we expect outcomes to be the same, regardless of where in Scotland the service is provided. That is why the Children and Young People’s Mental Health and Wellbeing Programme Board is developing a CAMHS Service Specification to ensure that all CAMH services across Scotland are delivering an agreed standard of service. This is scheduled to be published in the coming months.

4iii

Services within rural areas should be mobile to allow access to all young people when accessing public transportation might be difficult. This would help focus on providing more quality support services within rural areas (including Highlands and Islands).

Accept In Principle

We recognise and support the principle behind this recommendation, and will carefully consider our approach.

5

Waiting times need to be reduced to eight weeks without compromising the care provided to each individual young person. This should be achieved incrementally by 2029.

Cannot Accept

A substantial number of children and young people are seen within the 18 week standard, with the median wait for first appointments below 18 weeks. However, we recognise the need to improve waiting times, and appreciate the Youth Commission’s passionate and articulate views on this. Nevertheless, in line with Sir Harry Burns’ review of Targets and Indicators for Health and Social Care in Scotland (2017), we are clear that the focus needs to be on providing access to treatment in a timescale that supports clinically effective treatment. 

The forthcoming Service Specification for CAMHS will set out expectations for what is to happen during any waiting period, including assessment and signposting to other services where appropriate.

We accept that current waiting times performance for CAMHS currently falls short of the 90% standard in many Boards, and there are a range of actions and investments set out in the Mental Health Strategy, Children and Young People’s Taskforce recommendations and Programmes for Government to reduce waiting times. In addition, NHS Boards have also been asked to provide trajectories to meet the standard by December 2020 in their Annual Operational Plans which means that funding will be tied to performance in a way which was not the case in previous years. We will work closely with Boards on delivery against these standards, intervening where Boards fall short of what they have said they will do.

5i

While on the waiting list for CAMHS young people should be linked to other mental health support services that may not necessarily be clinical services. This may be local community support; speaking to a specialist mental health nurse; peer to peer support or other resources. This will ensure they are immediately beginning to address their mental health, and where possible avoiding reaching a crisis point. 

Accept

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification to ensure that all CAMH services across Scotland are providing the right care and treatment options, including options while on a waiting list. Additionally, we have committed to develop a new community wellbeing service to support the mental health needs of children and young people, using an open access model that also allows self-referral. The availability of this resource will help to ensure that young people are able to access the right support at the right time.

5ii

 Following their first assessment or referral, young people should be referred not only to CAMHS but to other support services. CAMHS may not provide the appropriate support for all young people, so they should have the choice to be directed to other local and community-based services. 

Accept

5iii

Young people should not have to wait more than eight weeks to receive regular and appropriate care but by providing support immediately in some form young people can start to address their own mental health. For some young people this might be enough, and they may not need to access CAMHS, or it may stop their mental health from worsening while they wait for support. 

Accept in Principle

See the response to Services recommendation 5i above. 

The availability of enhanced community-based support will help to ensure that young people are able to access the right support at the right time, and will be a crucial factor in addressing mental health issues at an early stage.

6

There needs to be access to a trained mental health professional, not necessarily a GP, available in every health centre or surgery on a full-time basis. 

Accept in Principle

Providing enhanced support in health centres and GP surgeries is a policy priority for the Scottish Government. Action 15 of the Mental Health Strategy contains an action for 800 additional mental health workers in key settings which is supported by significant investment which will rise to £35 million by 2021/22.

6i

By providing a mental health practitioner, with an appointments system for 20 minutes slots, this will allow young people to either speak about their mental health issues or gain information about other services they may want to access locally, in an environment they feel safe and supported in so young people can access accurate information quickly or even just talk so they might not need to be signposted to another organisation.

Accept in Principle

7

All mental health referrals should be treated with the same importance as a referral from a medical professional. 

Accept

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification to ensure that referral criteria are standardised across Scotland. This is scheduled to be published in the coming months.

7i

Clear referral guidance and a process should be put in place to ensure that anyone with duty of care over a young person (e.g. youth workers, teachers, parents and carers) can make a referral which will result in support for the young person.

Accept

7ii

Clear criteria for CAMHS accepted referrals need to be created to help ensure young people are accessing and being referred to appropriate services. This gives also gives clarity to those who aren’t accepted to a service.

Accept

8

Crisis support needs to be improved to keep young people safe.

Accept

See the response to Services recommendation 3 above.

8i

Young people should not be turned away from hospitals or other services when at a crisis point for their mental health. All hospitals should have a crisis support team there to support the young person.

Accept

We accept and support this recommendation.

8ii

Hospitals should have a ‘safe space’ within accident and emergency for people going through a crisis. This may be an appropriate area that is quiet and welcoming but monitored by staff with mental health training. 

Accept in Principle

We recognise and acknowledge the principle behind this recommendation. This will require careful scoping in the context ongoing work to improve the response to mental health presentations at A&E.

8iii

A Scotland specific text service needs to be provided for those going through a crisis as some people may not be able to talk on a phone. This must be advertised effectively through online, schools, higher and further education, and mental health services etc.

Accept

See the response to recommendation 7 above. Our 2019/20 Programme for Government contained the commitment to develop a 24/7 crisis support service which will introduce a text service so children and young people can text as well as phone to access help.

9

Therapeutic spaces should be more welcoming to young people.

Accept

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification to ensure that all CAMHS is delivered in age-appropriate, accessible and comfortable settings. 

9i

Spaces need to be less clinical in order to make young people feel comfortable and safe, allowing them to make better use of the support being offered. These spaces should be co-designed with young people.

Accept

10

There needs to be a focus on preventative services not just support services, including education, support, advice and early intervention. 

Accept

Early intervention is one of the core areas of focus of the Mental Health Strategy 2017-27 and underpins the recommendations of the Children and Young People’s Mental Health Taskforce.

10i

Developing and providing services which prioritise early education and provides support before mental health intervention is required, allowing young people to build resilience and confidence in managing their own mental health. 

Accept

See the responses to Services recommendations 5iii and 10 above.

11

Mental health services need to actively embrace digital tools and technology, but patients should have the option to make use of technology if that suits their needs. This should not be the only choice and should not take priority over all other options available. 

Accept

We accept and support this recommendation. This was a recurring theme throughout the Children & Young People’s Mental Health Taskforce, and is being considered by the Children and Young People’s Mental Health and Wellbeing Programme Board.

11i

The ability to book appointments online should be available to young people accessing mental health services, this should also provide the ability to change or cancel appointments to allow flexibility while maintaining consistency.

Accept In Principle

We acknowledge the principle behind this recommendation, which would represent a significant service change. We will carefully consider our approach.

12

Mental health support should be immediately offered to young people who are diagnosed with long-term or enduring physical illnesses.

Accept In Principle

We acknowledge the principle behind this recommendation, which would represent a significant service change. We will carefully consider our approach as part of the implementation of the CAMHS Service Specification.

12i

Anyone offering primary care to young people should be equipped to refer to a specialist and specific mental health services where appropriate, this includes the knowledge and understanding of how a long-term condition may affect their mental health and knowledge of the support services available. This may include mental health specific services relating to the long-term condition.

Accept In Principle

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification and CAMHS referral criteria. We will carefully consider whether further specific work is required in respect of referrals involving a long-term condition.

12ii

All young people with a long-term condition should have access to mental health services when needed and are seen within eight weeks of diagnosis.

Cannot Accept

See the response to Services recommendation 5 above.

13

Improvements need to be made to mental health support specifically for young people in care. 

Accept

Work is ongoing to develop targeted pathways for vulnerable groups of young people, including young people in and around the care system as part of the programme of deliverables by the Children and Young People’s Mental Health and Wellbeing Programme Board.

13i

If a young person in care must move Local Authority, they should not be put to the back of a waiting list and their care should be continued, in as similar a way as possible to that which was being provided, in the new Local Authority. 

Accept in Principle

See the response to Services recommendation 2vii above.

13ii

Young people in care should have control over how they access mental health services and the information around their mental health, as well as consistency in the support they receive no matter the Local Authority or care provider.

Accept

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification which includes standardised criteria for the provision of CAMHS across Scotland . This is scheduled to be published in the coming months.

14

A service should be created to support children and young people with parents and carers who are struggling with their mental health.

Accept In Principle

We accept this recommendation in principle, and will carefully consider how work to develop crisis and community support services can reflect and support this type of need.

14i

A service that can support young people whose parents and carers are struggling with mental health should be created. This should include a source of peer-to-peer support where young people can make friends and meet others with shared experiences and take part in activities such as homework clubs, sports clubs etc.

Accept In Principle

15

When treating a young person, mental health professionals must take a holistic approach to their treatment, care and diagnosis. There should not be a reliance on a single policy or procedure, such as the use of Adverse Childhood Experiences (ACEs). Policies should adapt to reflect the needs of young people as they change and develop. 

Accept

We accept and support this recommendation. This principle will be reflected in the development of the workforce actions by the Children and Young People’s Mental Health and Wellbeing Programme Board.

1

Mental health and wellbeing education for pupils in both primary and secondary schools should be standardised across Scotland.

Cannot Accept

In Scotland there is no statutory curriculum. Curriculum for Excellence is the national approach to learning and teaching for young people aged 3 to 18 in Scotland. It provides significant flexibility, within broad national guidelines, for teachers to develop lessons which best meet the needs of individual learners. Teachers, head teachers and other professional educational practitioners are best placed to decide what is taught in Scotland’s schools. Education Scotland provide support and guidance  to ensure that high standards exist across the country.

1i

Education Scotland should work with young people to develop a universal resource on mental health and wellbeing to be used within schools to ensure consistency across Scotland. This will allow teachers to focus on their core tasks while also delivering quality and appropriate education on mental health to young people. 

Accept

The Scottish Government has established a working group made up of expertise within the sector, this includes Education Scotland, Health Scotland, Convention of Scottish Local Authorities (COSLA), Association of Scottish Principal Educational Psychologists (ASPEP), Local Authorities teaching unions and third sector organisations. 

The working group will develop a new mental health professional learning resource and training to help all school staff support the wellbeing of children and young people within their schools. This free resource and training will be available to all staff in primary, secondary and special schools and will enhance the strategies already available to schools.

2

Mental Health should continue to be embedded within education from an early age in order to strengthen the knowledge and awareness of mental health.

Accept

Mental health and wellbeing are already a crucial element of the curriculum and this is underpinned through a specific set of experiences and outcomes. Mental health education is already delivered through Personal and Social Education / Health and Wellbeing classes - Along with literacy and numeracy it is one of the three core areas that are the responsibility of all staff in the school and forms part of the whole approach of the nursery, school, college or other setting to improving outcomes for children and young people.

2i

Emotion and resilience classes should be provided to all students from primary one to teach students how to work through their emotions in a healthy way. This would normalise mental health from a young age, reduce stigma and prepare them to manage their own mental health. 

Accept in Principle

Every child and young person should have access to emotional and mental wellbeing support in school. However, mental health and wellbeing education cannot be prescribed across Scotland, it is up to Local Authorities and schools to determine how they will deliver the curriculum to best suit the children and young people in their area. The recently established working group has a focus on developing resources for use in schools, and will include resources covering emotion and resilience. 

3

There should be a whole school approach standardised across Scotland when it comes to Mental Health.

Accept in Principle

Implementation of Curriculum for Excellence is supported by a set of Experiences and Outcomes which span across all five levels of the broad general education phase – to recognise the nature of development and learning in mental health and wellbeing. There are already specific experiences and outcomes in mental and emotional wellbeing which are the responsibility of all practitioners. We are, following the recommendations of the Review of Personal and Social Education, implementing a PSE Toolkit which will provide all schools across Scotland with a one stop shop for all aspects of PSE learning, including mental health and wellbeing.

3i

i. The following things should be accessible by every school in Scotland:
- training for all staff involved in education;
- counsellors, youth workers and support workers in school environments;
- staffed safe spaces for young people to deal with their own mental health;
- A mental health crisis protocol that should be codesigned with young people

Accept in Principle

We have commenced work to design and develop a new mental health professional learning resource for all school staff. The aim of the learning resource is to equip all school staff with the necessary skills to confidently support young people exhibiting signs of distress.

The investment in school counsellors is part of a package of measures to ensure that children and young people get the support that they require. Local Authorities will be responsible for the recruitment of counsellors and on how best to deliver the service in their local area. It is intended that the Programme for Government commitment will be delivered in full by September 2020.

The placement of youth workers and support workers and staffed spaces in every school is a decision for the individual school or Local Authority and not something that the Scottish Government can prescribe. Each Local Authority should have a relevant protocol in place to deal with incidents occurring within a school environment.

4

There should be a peer-to-peer support service in every secondary school for young people that might want to access it as part of a whole school approach.

Cannot Accept

While the Curriculum for Excellence framework is set at a national level, it is up to Local Authorities and schools to determine how they will deliver the curriculum to best suit the children and young people in their area. Schools may choose to use peer support and mentoring programmes within their schools. Education Scotland provide training and support around peer to peer mentoring and support. In addition, third sector providers may provide training on peer to peer support and mentoring.

4i

There is a lot of pressure on ‘mental health ambassadors’, so there should be trained young people who can support each other if it is wanted. The training should be focussed on allowing young people to access the relevant support they need. 

Accept in Principle

We recognise and support the principle behind this recommendation, and will carefully consider our approach.

5

Higher and further education facilities should provide appropriate and ongoing support to all students when needed.

Accept

As part of our Programme for Government commitment (2018/19), the Scottish Government is investing around £20 million in more than 80 additional mental health counsellors over the next four years, which will strengthen the support available in every college and university in Scotland 

Our Student Mental Health and Wellbeing Working Group has also been tasked with developing an integrated approach to student wellbeing in colleges and universities. This is set out in the Group’s draft Work Plan. 

5i

There should be a variety of options available, such as but not limited to counsellors for students who want to talk to someone and peer-to-peer support. Other options should be available depending on the students’ needs. By providing support in further and higher education, it can help to reduce waiting times and help ensure students feel less isolated. 

Accept in Principle

The Student Mental Health and Wellbeing Working Group is developing a Work Plan, part of which calls for the development of a Whole System or Whole Campus approach. As part of this it will explore an integrated approach to student wellbeing. 

5ii

There should be monitoring procedures to ensure higher and further education institutions are reflecting on the reasons why students drop out or change courses.

Accept in Principle

This is the responsibility of institutions. The SFC, QAA and Education Scotland all consider withdrawal rates and ask institutions to report on this including plans to reduce these rates where required. There are a variety of reasons for students to withdraw from a course and not all of these are within the institutions control.

The Outcome Agreement guidance requires colleges and universities to have a Mental Health Strategy in place, which must include a commitment to an improvement in retention of students who experience mental ill health, and to monitor the number of students leaving a course early due to mental ill health

5iii

Education institutions must have follow-up meetings with students when they move classes or drop out to ensure they are supported and to give them the opportunity to say why they chose to leave a particular class. This should include students who are working on their dissertation. This can be a big part of their university career which can cause a lot of stress for students.

Accept in Principle

This is agreed in principle, but it is not something that could be managed by the Scottish Funding Council or through Outcome Agreements. The Agreements require that institutions identify and address barriers to retention, however we would not prescribe actions at this level of detail.

5iv

Students in placement related courses should be offered time and space to debrief between placement and university classes to help students manage their mental health

Accept in Principle

Although we acknowledge the intent of this recommendation, this would be up to individual institutions.

1

More work needs to be done to reduce stigma and educate the general public to ensure young people access services without feeling judged. This work should be co-designed with young people to ensure that it is relevant and meets their needs.

Accept

We fund the See Me programme to tackle stigma and discrimination which can be associated with mental health problems. See Me has a range of work specifically aimed at young people. Crucially, this work is co-created with young people because they know best how to tackle stigma in this area. The recent Feels FM campaign shows what is possible through this approach.

1i

More work needs to be done to reduce mental health stigma around anyone who identifies as male. This should include creating more awareness of the organisations who do work around men’s mental health, such as SAMH’s The Changing Room - this work should target young men up to the age of 25 as well. This would have the goal of reducing the high suicide rates amongst males.

Accept

We are committed to tackling the stigma associated with mental health problems and recognise that there can be particular barriers to seeking help for men. Our Suicide Prevention Action Plan includes a commitment for the National Suicide Prevention Leadership Group to target interventions toward at risk groups and we welcomed the recent recommendation to fund work to engage with groups of people with characteristics and experiences that may indicate an elevated risk of suicide. 

2

Available resources and where to access support needs to be advertised more effectively. If a young person is directed elsewhere, a follow up should be in place to ensure they are receiving the support.

Accept

See the response to Services recommendation 5iii above.

3

A resource should be created to educate young people on safe self-harm – this is not to encourage young people or glamorise self-harm, as some may see it, but to ensure people are being safe and have safer options, as well as allowing the public to understand the specific support required. 

Accept In Principle

We agree with the importance of providing appropriate help and support relating to self-harm. We are carefully considering our approach.

4

More community-based approaches need to be available nationally to support mental health.

Accept

See the response to Services recommendation 5iii above.

4i

There should be support that can be accessed in every local community. This will create a community-wide approach which can support young people; combat isolation; and help people deal with their issues in a more personal and effective way. This can help reduce strain on national services.

Accept

1

More funding needs to be available and sustainable across all sectors, including public sector, private sector and third sector, at both national and local levels to increase the capacity of services and ensure that young people have access to quality support.

Accept

Increasing the funding available for mental health is an ongoing priority for the Scottish Government, including £250 million of additional investment in the 2018 Programme for Government.

1i

Scottish Government should invest more funding to mental health services, covering all of the following; prevention, clinical, education and community. Funding should cut across multiple policy areas because Mental Health affects more than health and wellbeing (e.g. education or employment).

Accept

2

Funding needs to be monitored and documented across all mental health services to ensure services are held accountable and stop young people from potentially falling through the cracks. 

Accept

We encourage NHS Boards to improve and keep under review the accurate monitoring of mental health expenditure to inform improved planning and service delivery and ensure greater transparency and understanding of how funds are used. The Information Services Division of NHS NSS publishes all NHS Board health spending online. 

2i

Review of funding and spending of all mental health services to better understand how funds are distributed. Ensure that this information is accessible to public.

Accept

3

Policies around Mental Health should address young people’s rights, be clear and accessible, and have consistency across all sectors, to ensure young people have access to the support they are entitled to. 

Accept

We accept and support this recommendation, and will look to embed this approach in everything we do, including through the work of the Mental Health Strategy Delivery Group and the Children and Young People’s Mental Health and Wellbeing Programme Board.

3i

The Scottish Government should develop guidance for all employers of young people up to the age of 25, to outline the young person’s rights and how their mental health can be supported. Young people should also have access to this guidance to ensure that their rights are being met and they are being supported appropriately. This should be applicable across all sectors. The guidance should be co-designed young people.

Accept in Principle

Young people should be supported by their employers so that they understand their rights and how their employer should support their mental health. The UK Government has produced guidance titled ‘Employing disabled people and people with health conditions’ which assists employers to support their workforce with their mental health. 

3ii

Scottish Government should clarify and provide guidance how mental illness fits under the equality act and what young people with mental illnesses are entitled to.

Accept in Principle

The UK Government has already produced guidance titled “Equality Act 2010: Guidance on matters to be taken into account in determining questions relating to the definition of disability” which includes information about how mental illness fits within the Act.

3iii

Accessible guidance on Scottish benefits for young people struggling with their mental health should be produced to clearly outline what benefits are available, who is eligible and how to make a claim. 

Accept in Principle

Disability Living Allowance for under 16 year olds is available for children and young people who have disabilities or long-term health conditions which affect their care and/or mobility needs. This includes mental health conditions. Guidance on how to apply can be found on the UK Government website. 

Currently, the Scottish Government is working on developing the devolved Scottish equivalent of Disability Assistance for Children and Young People, which will open for new claims from Summer 2020. Support for children, young people and their families will be available for those that require it.

4

Young people must be at the centre of the decision-making process regarding their care and supported to understand their rights. 

Accept

We accept and support this recommendation. We will carefully consider our approach as part of the implementation of the CAMHS Service Specification.

4i

Young people should have the option to choose what information remains confidential unless there is a risk of harm to themselves or others

Accept

Young people over the age of 12 and deemed to have the capacity to consent can choose what information is shared with whom. 

4ii

Young people need clear accessible guidance on what information is confidential and how this will be shared and with whom.

Accept

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification which includes ensuring guidance on consent and information sharing regarding a child or young person’s care is fully explained and documented. This is scheduled to be published in the coming months.

4iii

Young people need clear and accessible information on what care options are available for them and are able to choose what is best for them.

Accept

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification which includes agreeing a care plan with the child or young person. This is scheduled to be published in the coming months.

4iv

Before any changes to care, conversations must be had with the young person in question to ensure that all appropriate care options are explored. 

Accept

4v

There should be regular conversations to ensure young people are capable of making the best decisions for their care

Accept

4vi

Young people should be able to bring a trusted person into discussions around their care and be made aware that this person can be a friend as opposed to a parent or guardian.

Accept

We agree and support this recommendation. The importance of the role of a trusted person was also reflected in the results of See Me’s Feels FM campaign. We will carefully consider our approach to this recommendation as part of the implementation of the CAMHS Service Specification.

4vii

Young people should be educated about their rights around their mental health. Young people’s rights surrounding mental health should be brought together into a simplified, accessible document. This document should be distributed to schools, GP’s, colleges, all mental health services and online to start conversations surrounding young people’s rights. This information should be co-designed with young people.

Accept in Principle

The rights of children and young people are a key priority for the Scottish Government. We are absolutely committed to the incorporation of the UN Convention on the Rights of the Child. Incorporation will ensure that children’s rights are woven into policy, law and decision-making. It will also ensure that children and young people are empowered to know and understand their rights and, if necessary, defend those rights in Scottish courts.

5

Mental health care should not be refused. Signposting does not equal mental health care.

Accept

See the response to Services recommendation 5iii above.

5i

All young people who request support must be directly linked to a service, whether this is clinical or not, therefore ensuring the young person is supported appropriately.

Accept

5ii

NHS policies should be updated to state that young people in mental health crisis cannot be turned away. These policies should be clear and easily accessible to young people.

Accept in Principle

See the response to Services recommendation 3i above.

6

Young people should be supported to understand their rights through the Mental Health Act, including;
- Clarity on what care you can receive ;
- What your rights surrounding treatment are;
- Your rights when receiving any and all mental health care not just when receiving in-patient or compulsory care.

Accept in Principle

We agree that it is very important to help people understand their rights under the Mental Health Act. The Mental Welfare Commission have produced comprehensive guidance on patient rights under mental health law. In addition, the Scottish Government has a range of guidance material to help with understanding of the Act, some of which is in the process of being updated. We will consider whether further guidance is needed in respect of young people and the Mental Health Act.

7

An accessible and young person friendly version of the act should be created.

Accept in Principle 

An easy-read version of the Mental Health Act has been produced in the past. As above, we will consider whether further guidance is needed.

1

All training should be taught by a qualified trainer or be in line with a licensed course or standardised curriculum.

Accept

We agree with this recommendation. These principles will be mainstreamed in the delivery of the workforce workstream of the programme delivered by the Children and Young People’s Mental Health and Wellbeing Programme Board.

2

As times change, training needs to move with it. Anyone delivering mental health support should ensure their procedures and tools are up to date and relevant to young people.

Accept

3

Basic mental health training should be accessible and encouraged for everyone working with young people. This should include all current training as well as any refreshed or updated training.

Accept

3i

Training should involve some type of sensitivity or communication training so young people feel like they are being listened to, respected and taken seriously.

Accept

3ii

Within Scottish Mental Health First Aid Training, a section needs to be added to highlight both the positive and negative effects that social media can have on mental health and how young people can be supported through both.

Accept in Principle

We support the focus on healthier use of social media and screens. We have committed to co-produce advice on the healthy use of social media, which is being developed by children and young people. The guidance will be launched in early 2020.

3iii

There should be mandatory mental health training for all people working in emergency services – this may include but is not limited to fire service, police, paramedics and other first responders. As well as Suicide Prevention (ASIST) and Scottish Mental First Health Aid must be provided to all first responders .

Accept in Principle

NHS Health Scotland has oversight responsibility for the delivery of Scotland’s Mental Health First Aid (SMFHA) and the Livingworks Suicide Prevention Training programmes (safeTALK/ASIST) in Scotland. Working in partnership with NHS Education for Scotland, they are jointly progressing activity to deliver Action 2 of our Suicide Prevention Action Plan. As part of this work, we wrote to NHS Chief Executives outlining the requirement for Mental Health and Suicide Prevention Training to be included as an essential element of local Workforce Development Plans as of June 2019.

3iv

Mental health training should be mandatory across the board for all NHS and primary care staff, primarily those who are public facing.

Accept in Principle

We wrote to NHS Chief Executives outlining the requirement for Mental Health and Suicide Prevention Training to be included as an essential element of local Workforce Development Plans as of June 2019.

3v

There should be mandatory mental health training for all people working in education who have direct contact with young people.

 Accept in Principle 

NHS Health Scotland and NHS Education for Scotland launched a package of new resources to support workforce development in relation to mental health improvement and suicide prevention in May 2019. Following this, a commitment was made from Local Authority Chief Executives to roll out these new products across Scotland’s Local Authority workforce.

The new Workforce Development Plan identifies areas of work that will support the recommendations of the Children and Young People’s Mental Health Taskforce. This includes working with Education Scotland and others to develop mental health improvement and suicide prevention learning resources that support teachers and other staff in educational settings.

3vi

There should be an increase in the number of Scottish Mental Health First Aid (SMHFA) trainers across Scotland to meet this demand to ensure there is a waiting time of less than four weeks from requesting this training to receiving it.

Accept in Principle

There has been increased interest in the existing Scotland’s Mental Health First Aid, Suicide Prevention and Mentally Healthy Workplace training programmes which will continue to be supported, subject to funding. In 2018, NHS Health Scotland facilitated an additional increase to the existing bank of trainers: 100 SMFHA trainers, an additional 20 safeTALK trainers and additional 30 Mentally Healthy Workplace trainers.

3vii

There should be regular training updates available to everyone who needs it. Refresher courses should take place at least once every three years

Accept 

Regular updates are provided to those who are accredited Mental Health First Aid Trainers which are published on the SMHFA website: www.smhfa.com

3viii

Mental health modules should be integrated within higher, further and secondary education for courses involving public facing professions. This must be included in higher education courses which will lead to working with young people between 11 and 26; and holding responsibility of the health and wellbeing of young people under their care. 

Accept

Initial teacher education (ITE) programmes already contain a strong element of pupil emotional and mental health and wellbeing to ensure that student teachers have skills in this area. In addition, the suite of Professional Standards managed by the General Teaching Council for Scotland (GTCS) are currently being revised and the mental health of both practitioner and learner will be given greater prominence in revised versions. As ITE programmes prepare teachers to meet the GTCS professional standards this action will also result in further changes to the content of these programmes.

4

Mental health services need more training in order to be more inclusive to minority groups – this will include but not is limited to ethnic minorities, LGBT+ and disabled people.

Accept

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS Service Specification to ensure that all CAMH services across Scotland are delivering an agreed standard of service, which includes ensuring that services take into account gender, sexuality, religion, ethnicity and other key characteristics. The Service Specification is due to be published in the coming months.

4i

Mental Health services should link up with specialised services to request training or gain further insight into working with these groups to address gaps in staff knowledge to ensure that young people are receiving appropriate care for their needs.

Accept in Principle 

See response to Training recommendation 3iii.

5

Young people should have access to mental health first aid training, if they want it.

Accept in Principle

The Scottish Government agrees in principle with these recommendations, however we note that the current license for Mental Health First Aid only extends to those over the age of 18. We will carefully consider our approach to this recommendation.

5i

Scottish Mental Health First Aid should be as readily available as first aid training is for young people.

Accept in Principle

6

Mental Health First Aid should be a standard requirement for all organisations working with young people in line with the laws on first aid training.

Accept in Principle 

The Scottish Government agrees in principle with this recommendation. We expect organisations and employers to ensure that appropriate training is available to their staff.