Mental health and wellbeing strategy: delivery plan 2023-2025

Priority 4

Expand and improve the support available to people in mental health distress and crisis, and those who care for them, through our national approach on Time, Space, Compassion.

Outcomes: 1, 2, 3, 4, 6, 7

Challenges and opportunities:

• Stigma and discrimination
• Delivering supports and services
• Primary and community care
• Workforce
• Trauma and adverse childhood experiences

Key area of focus

This priority focuses on providing support, care and treatment for people in distress. It also focuses on improving our response to people experiencing crisis, keeping them safe and preventing their situation from escalating further. This includes where distress may lead to self-harm, or suicidal thoughts and behaviours. We will work to make it easier for people to find the information, advice and support they need, including access to urgent care. We will also work to help people access self-care and community based support.

In September 2022, Scottish Government published our joint ten-year Suicide Prevention Strategy, Creating Hope Together, with our subsequent Suicide Prevention Action Plan which details the actions we will take over 2022-2025. We will continue to actively focus on groups at higher risk of suicide, including people living in poverty; men (particularly middle-aged men); women at key life stages (such as perinatal); children and young people (particularly where there are other risk factors, such as care experience); LGBTI groups; autistic people; unpaid carers. Further details of our work will be communicated via the Scottish Government and Suicide Prevention Scotland communications channel.

We are currently working with partners and people with lived experience to develop Scotland’s first dedicated Self-Harm Strategy and Action Plan. We are also continuing to consolidate and build on compassionate, trauma-informed support for people who are experiencing distress, so that they can access support where and when they need it this includes through our world-leading Distress Brief Intervention programme.

As part of our approach to addressing inequality across this Delivery Plan, we will work alongside the Equality and Human Rights Forum and people with lived experience to develop, test and learn from a good practice approach to implementation. This will include how we can direct our resources for maximum impact.

Outcomes

• The overall mental health and wellbeing of the population is increased and mental health inequalities are reduced.
• People with mental health conditions, including those with co-existing health conditions experience improved quality and length of life, free from stigma and discrimination.
• People have an increased knowledge and understanding of mental health and wellbeing and how to access appropriate support.
• Communities are better equipped to act as a source of support for people’s mental health and wellbeing, championing the eradication of stigma and discrimination and providing a range of opportunities to connect with others.
• Comprehensive support and services that promote and support people’s mental health and wellbeing are available in a timely way that meets and respects individual needs.
• Mental health policies, support, care, and treatment are better informed and shaped by people with lived experience of mental health issues and staff practitioners, with a focus on high quality provision that is recovery orientated.

Strategic Action 4.1: Implement the Year 1 priorities of our initial three year action plan which will take us measurably closer to realising the ambitions set out in Creating Hope Together Strategy (2022-2032).

4.1.1 Continue to raise awareness and improve learning about suicide, and target our approach in order to build understanding in sectors that support groups with a higher risk of suicide, e.g. staff working in money advice and homelessness services.

Lead and Key Partners: Scottish Government/COSLA Suicide Prevention Scotland

4.1.2 Improve suicide responses for children and young people by building more understanding of suicide risk and behaviour amongst this group. This work will draw on insights from the suicide prevention Youth Advisory Group and the new LGBT Youth Commission on Mental Health.

Lead and Key Partners: Scottish Government/COSLA Suicide Prevention Scotland

4.1.3 Develop insights on help seeking and test new approaches to suicide prevention through our current work in West Highlands and Skye with Samaritans Scotland.

Lead and Key Partners: Scottish Government/COSLA Samaritans Scotland, Suicide Prevention Scotland

4.1.4 Use evidence to prioritise focused work with groups with higher risk of suicide. This includes taking forward two tests of change aimed at improving the reach of our suicide prevention work into specific groups and communities, and work with partners in high risk settings for suicide, for example prisons, to build effective and compassionate suicide prevention action plans.

Lead and Key Partners: Scottish Government/COSLA Suicide Prevention Scotland

4.1.5 Continue to build the Time, Space, Compassion approach to improve our responses to people in distress and crisis, including people who may be suicidal, through a programme of work which builds resources and facilitates improvements to practice.

Lead and Key Partners: Scottish Government/COSLA NHS Boards, local authorities, third sector organisations, Suicide Prevention Scotland

Strategic Action 4.2: By the end of 2023, Scotland’s first dedicated Self-Harm Strategy and Action Plan will be jointly published by Scottish Government and COSLA. Recognising prevalence amongst young people and some marginalised groups, it will adopt an inclusive and tailored approach in order to deepen understanding and build effective responses for specific groups, communities and within key settings. The Strategy will create improved responses for people who self-harm across the life course.

4.2.1 Continue to place diverse and varied lived experience and a range of professional expertise at the centre of work to implement the action plan. This will ensure the needs of diverse groups are understood and prioritised across a range of supports and services.

Lead and Key Partners: Scottish Government/COSLA NHS Boards, local authorities, third sector organisations including equality groups

4.2.2 Review, improve, and share data and evidence to drive improvements in support and service responses.

Lead and Key Partners: Scottish Government/COSLA PHS, NHS Boards, local authorities, academic partners, third sector organisations including equality groups

4.2.3 Continue to build person-centred support and services across Scotland to meet the needs of people affected by self-harm.

Lead and Key Partners: Scottish Government/COSLA Local authorities, NHS Boards, third sector organisations including equality groups

4.2.4 Work with key partners and people with lived experience to design, tailor and disseminate national resources and support to ensure they effectively reach their communities (who are often at higher risk of self-harm). This work will support local approaches whilst also seeking to tackle stigma and discriminatory practice.

Lead and Key Partners: Scottish Government/COSLA Local authorities, NHS Boards, third sector organisations including equality groups

4.2.5 Continue to expand and deepen knowledge and compassionate understanding about self- harm and tackle stigma and discrimination.

Lead and Key Partners: Scottish Government/COSLA Local authorities, NHS Boards, third sector organisations including equality groups

Strategic Action 4.3: We will achieve full national coverage of the Distress Brief Intervention (DBI) programme.

4.3.1 Support local areas and national pathways to implement the DBI programme for people aged 16 and over, achieving full national coverage by March 2024.

Lead and Key Partners: Scottish Government DBI Central Team, Health and Social Care Partnerships (HSCPs), PHS, University of Glasgow

4.3.2 Over the lifespan of this Delivery Plan, build on the findings and implement the recommendations of the two independent evaluations of DBI, published in 2022.

Lead and Key Partners: Scottish Government DBI Central Team, HSCPs, PHS, Police Scotland, SAS

4.3.3 Assess the suitability of DBI for 14 and 15 year olds, publishing a formal evaluation of DBI for under 18s by spring 2025.

Lead and Key Partners: Scottish Government DBI Central Team, HSCPs, PHS, University of Glasgow

Strategic Action 4.4: We will prioritise, build and test delivery of compassionate, trauma-informed support for people experiencing distress or crisis (or at risk of) in specific contexts and settings.

4.4.1 Provide funding from 2023/24 to develop and enhance trauma-informed support for all children, young people and their families experiencing distress and crisis. In line with The Promise, this will include an increased focus on support for those with experience of care or on the edges of care.

Lead and Key Partners: Scottish Government Third sector organisations, local authorities

4.4.2 Throughout the lifespan of this Delivery Plan, work with mental health services to identify and embed changes to practice so they can proactively provide support which helps prevent people from becoming homeless. This aligns with Scottish Government’s intention to introduce new duties aimed at the prevention of homelessness.

Lead and Key Partners: Scottish Government NHS Mental Health Leads, frontline homelessness services (including Simon Community Scotland and Cyrenians)

4.4.3 Throughout the lifespan of this Delivery Plan, work with key partners to understand the mental health harms related to gambling and explore ways to raise awareness of these harms and support people effectively.

Lead and Key Partners: Scottish Government PHS, local authorities, academic and third sector organisations working in the field

4.4.4 Continue to build our understanding of the barriers people with No Recourse to Public Funds face in accessing mental health services, and agree practical actions for local authorities, Scottish Government and the NHS. This includes considering testing increased peer support, in partnership with third sector partners, using a new community-based peer model. We will draw on learning to improve future service provision by 2025 as we take forward Action 7 of the Ending Destitution Together (EDT) Strategy.

Lead and Key Partners: Scottish Government/COSLA Simon Community Scotland, local authorities, NHS Boards

Strategic Action 4.5: We will build on work already underway to improve unplanned and urgent mental health care, including for those in mental distress, utilising a multi-agency response. In doing so, we will take into account the findings from our Equalities Impact Assessment, in order to better understand and support different population and equalities groups, and will continue to ensure alignment with the national rollout of the DBI programme.

4.5.1 Continue to invest in NHS 24’s Mental Health Hub, with each Health Board providing access to a mental health clinician 24 hours a day, seven days a week.

Lead and Key Partners: Scottish Government NHS24, NHS Boards, SAS, Police Scotland, third sector organisations, HSCPs

4.5.2 Embed the Time, Space, Compassion principles and expand supports that can be accessed to meet a range of needs, increasing access to more existing and developing services and developing a mental health unscheduled care resource pack by autumn 2024.

Lead and Key Partners: Scottish Government NHS24, NHS Boards, SAS, Police Scotland, third sector organisations, HSCPs

4.5.3 Increase awareness of available pathways into support and care by developing national awareness raising activity by the end of 2023, followed by the development of tailored messaging for specific population and equalities groups in 2024.

Lead and Key Partners: Scottish Government NHS Boards, NHS 24, SAS, Police Scotland, third sector organisations

4.5.4 Continue to invest in the Enhanced Mental Health Pathway and promote partnership working to increase Police Scotland and Scottish Ambulance Service access to local clinical support over the duration of the Delivery Plan.

Lead and Key Partners: Scottish Government NHS 24, Police Scotland, SAS

4.5.5 Take action to respond to the recommendations of Her Majesty’s Inspectorate of Constabulary in Scotland’s (HMICS) thematic review of Policing and Mental Health published in autumn 2023, and the subsequent Police Scotland actions on mental health.

Lead and Key Partners: Scottish Government Police Scotland, Scottish Police Authority, NHS Boards, NHS 24, SAS, third sector organisations

4.5.6 Take an evidenced based approach to improvement work to better understand how people are accessing and receiving unplanned mental health care. Lead work will commence in 2024 to ensure that improvements to unplanned and urgent care are underpinned by robust data, including person demographic data.

Lead and Key Partners: Scottish Government PHS, NHS Boards, NHS24, HSCPs, SAS