Mental Health and Wellbeing Strategy, Delivery Plan and Workforce Action Plan: Business and Regulatory Impact Assessment

Mental Health and Wellbeing Strategy, Delivery Plan and Workforce Action Plan - Business and Regulatory Impact Assessment

Title of Proposal

Mental Health and Wellbeing Strategy and its accompanying Delivery Plan and Workforce Action Plan.

Purpose and Intended Effect

Background

Our previous ten-year Mental Health Strategy was published in 2017. It set a vision to transform the mental health of people in Scotland, the way we all think about mental health and wellbeing, and the mental health services we use. The landscape in which the 2017 Strategy was developed was markedly different from now, as a result of the several global events which have since unfolded. That is why it was important that we publish a new strategy which acknowledged the changes people wished to see in relation to:

• A need for a stronger focus on prevention and early intervention;
• The importance of tackling poverty and inequality;
• Supportive person-centred and whole family approach;
• Placing mental health and wellbeing on an equal footing with physical health;
• A need for increased community-based support and services;
• Increased and longer-term funding for mental health and wellbeing services, including the third sector;
• Growing the workforce – developing a skilled and diverse mental health and wellbeing workforce which could operate at safe levels, addressing talent attraction, recruitment, and retention challenges.

The new Mental Health and Wellbeing Strategy (the Strategy) published in June 2023 sets out the vision to improve mental health and wellbeing – including the need to address the role of other key areas such as poverty, housing, employment, and our communities. The Mental Health & Wellbeing Strategy, Delivery Plan, and the Workforce Action Plan, were jointly published with Convention of Scottish Local Authorities (COSLA), reflecting the crucial role of local government in delivering the outcomes set within the Strategy.

Objective

The scope of the Strategy is wider than that of its predecessors, with an increased focus on wellbeing and prevention. It considers every part of what supporting mental health and wellbeing means. This includes addressing the underlying reasons behind poor mental health and wellbeing; challenging the stigma around mental health; providing early support, specialist help and support for mental illness and helping to create the conditions for people to recover and thrive.

Our vision is of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible.

Our outcomes describe the differences or changes that we want to see as a result of this Strategy. They are;

• Improved overall mental wellbeing and reduced inequalities.
• Improved quality of life for people with mental health conditions, free from stigma and discrimination.
• Improved knowledge and understanding of mental health and wellbeing and how to access appropriate support.
• Better equipped communities to support people’s mental health and wellbeing and provide opportunities to connect with others.
• More effective cross-policy action to address the wide-ranging factors that impact people’s mental health and wellbeing.
• Increased availability of timely effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs.
• Better informed policy support, care, and treatment, shaped by people with lived experience and practitioners, with focus on quality and recovery.
• Better access to and use of evidence and data in policy and practice.
• A diverse, skilled supported and sustainable workforce across all sectors.

The vision for the Strategy, and the actions within the Plans support delivery of Scotland’s National Economic Strategy for Economic Transformation aim to “reorient our economy towards wellbeing and fair work, to deliver higher rates of employment and wage growth, to significantly reduce structural poverty, particularly child poverty, and improve health, cultural and social outcomes for disadvantaged families and communities”.

People with mental health problems can fall into a spiral of adversity where unemployment, income and relationships are affected by their mental health experiences, creating a poverty and poor mental health trap. There is a strong economic case for investing in early intervention and prevention, as the costs of poor mental health and wellbeing are clear. These include lost or unstable employment, reduced productivity, debt and money worries, poor physical health outcomes, and interactions with the criminal justice system.

Rationale for Government intervention

The Scottish Government acknowledges that the challenges we have all faced in recent years mean people across the country think differently about mental health. We have not all been affected in the same way, but we have all been affected in some way. Coming through the most difficult of times, we all have a heightened understanding that there is no health without mental health. We have asked people closest to us whether they are okay. More of us will have felt able to ask this question – or answer it – without feeling judgement or stigma. And increasingly, more people have known it was the right time to come forward and ask for help for their mental health.

We know that mental health does not just mean mental illness; mental health exists as continuum and comes with a range of needs, from having the right words to describe how we feel, through to everyday worries and feelings of distress or hopelessness. Part of the rational for the new Strategy and associated plans is to ensure that the right help is available to those who experience severe and enduring mental health conditions and to provide support to provide support to help people to need to maintain good mental health.

There are many underlying factors, inequalities, and types of disadvantages mean that some people suffer disproportionate impacts on their mental health and in their access to support and services. These issues were highlighted within the Strategy’s evidence narrative and Mental Health Equality Evidence report.

The rational for the Strategy was therefore to set out the shared Scottish Government and COSLA vision to improve mental health and wellbeing – including the role of other key areas such as poverty, housing, employment, and our communities. To achieve this the Strategy covers all levels of need, from maintaining good mental wellbeing, to the support available in our communities, to recognising and responding to the many underlying social determinants, circumstances and inequalities that can affect people's mental health and wellbeing.

In 2019, Scottish Government commissioned an overarching independent review, the ‘Scottish Mental Health Law Review’. This looked at how our mental health, incapacity and adult support and protection laws can be further strengthened from a human rights perspective and how we can remove any barriers to care and support that people might face. The Review published its final report in September 2022 and provided over 200 proposals for reform. These were based on extensive engagement with a wide range of organisations and people with lived experience on the issues that matter to them. This wider review followed two earlier independent reviews: one into the delivery of forensic mental health services and one which considered how mental health law works for those with learning disability and autism. Our new approach needed to take into account this significant review.

On 13 September 2023, Audit Scotland published its report on Adult Mental Health Services. The report contained a number of recommendations for Scottish Government, local authorities, and our partners, many of which reflect the themes set out in our Strategy. Through the Workforce Action Plan and the accompanying Strategy Delivery Plan, we have looked to ensure that the actions set out, reflect, and respond to those Audit Scotland recommendations.

Consultation

The Mental Health and Wellbeing Strategy, Delivery Plan and Workforce Action Plan reflects what we heard from our partners and stakeholders during our consultation process. This included significant and welcome input from employers, the workforce, and people with lived experience of poor mental health and wellbeing and mental illness.

A series of workshops run in collaboration with Public Health Scotland (PHS) informed the Outcomes framework featured in the Strategy – these were attended by hundreds of people representing a wide range of organisations. Our public consultation received nearly 500 responses, and an independent analysis of these has been published online. We also held a series of consultation events in Summer 2022 that were attended by approximately 300 people representing 117 organisations. A wide variety of other ad hoc engagement was conducted alongside this, including with people with lived experience.

A first draft of the Strategy was shared with over 150 stakeholders in January 2023. The final draft of the Strategy has built on the feedback we received, with extensive changes made based on stakeholder comments.

Stakeholder workshops were conducted across 2022 and 2023 to consult on all aspects of the Strategy including vision, outcomes, priorities, and actions. A statutory consultation ran in summer 2022 which included public workshops and allowed the public and organisations to contribute their opinions on the Strategy and what was important to them. The consultation had a specific section on equalities which supported evidence gathering for tackling inequalities and promoting human rights.

Drafts of the Strategy and both plans were also shared with the Mental Health Equalities and Human Rights Forum (MHEHRF) and the Diverse Experiences Advisory Panel (DEAP). The Equalities and Human Rights Forum hosts 22 organisations who advocate for human rights and specific protected characteristics providing a breadth of evidence which supported the Strategy and Delivery Plan. Additionally, the DEAP consists of 25 members, all who have unique experiences of inequalities, discrimination, and mental health struggles. The panel is run and facilitated by the Mental Health Foundation and the panel function as our central lived experience group. While developing the Strategy, we recognised it had to be informed by the voices of people who had real life experiences, to create outcomes and actions which would truly deliver effective change in services and support. There are several other lived experience projects across specific areas of mental health who are regularly consulted on policy development. The knowledge, insight, and evidence we have gathered from the forum and lived experience groups has shaped the Strategy, Workforce Action Plan and Delivery Plan to have a positive impact on equalities and human rights. The MHEHRF and those with lived experience will continue to contribute to and comment on our policy work and progress, as part of the governance structure surrounding the Strategy.

Further consultation involving Business.

In 2022, in partnership with PHS, the Scottish Government launched a new mental health and wellbeing digital platform to help employers in Scotland actively support and promote mental health at work as outlined by the PHS website. The platform signposts employers to a wide range of mental health and wellbeing resources, including sources of support and advice on understanding mental health, mental health and the law and staff learning and development opportunities, as well as contact details for crisis support services along with wider support services that can help to support mental wellbeing. This means that employers can now access the means of creating a culture of support and wellbeing at work from one single source. PHS helped to develop the content as part of a collaboration with a number of business organisations, mental health charities, trade unions and employers including:

• See Me Scotland
• Mental Health Foundation
• Federation of Small Businesses
• Confederation of British Industry
• Health and Safety Executive
• Skills Development Scotland
• Scottish Trade Unions Congress
• Scottish Enterprise

Actions to further support this work are outlined within the Workforce Action Plan and Delivery Plan.

Additional Specific Consultation on the Workforce Action Plan

In addition to a formal consultation process to develop the Strategy and Workforce Action Plan, a series of stakeholder events for the mental health and wellbeing workforce were conducted. These events were supplemented by engagement undertaken by the Mental Health and Wellbeing Workforce Advisory Group with stakeholders they represent. This generated additional detailed responses focusing on potential solutions to challenges from a range of partners, including:

• territorial and national health boards
• Scottish Social Services Council (SSSC)
• Social Work Scotland
• Association of Directors of Education in Scotland
• Royal College of Nursing
• Royal College of Psychiatrists
• Royal College of General Practitioners
• Senior Medical Managers Group in Psychiatry
• Mental Health Nurse Leads
• Royal Pharmaceutical Society
• Community Pharmacy Scotland
• Scottish Directors of Allied Health Professionals (AHP) (including AHP mental health leads and AHP Federation Scotland)
• Distress Brief Intervention Programme Board (including Lanarkshire Association for Mental Health, LifeLink, Penumbra, Police Scotland, Scottish Association for Mental Health, and Support in Mind Scotland)
• Scotland’s Mental Health Partnership (including British Psychological Society, Samaritans Scotland, See Me, Support in Mind Scotland, Penumbra)
• Mental Health Foundation
• Scottish Care
• Aberdeenshire Voluntary Action
• Engage Renfrewshire
• Fife Voluntary Action
• CVS Falkirk
• Scottish Recovery Network
• Heads of Psychology Services Scotland (HOPs)

Having the right workforce in place is fundamental to achieving the Strategy’s ambitions – and we recognise that we are not starting from scratch. We acknowledge and value the contributions of the workforce in providing high-quality mental health and wellbeing support, care, and treatment. A considerable amount has already been done to provide the right mental health care and support in the right place at the right time.

Our consultation with stakeholders identified themes around current barriers and challenges experienced throughout the mental health and wellbeing workforce. For example, a need to:

• Attract new recruits to particular job roles or sectors;
• Retain the current workforce and address issues around remuneration;
• Continue wellbeing support for the workforce;
• Address large workloads;
• Address difficulties with staff being able to participate in training;
• Tackle inequalities including those related to socio-economic determinants and protected characteristics;
• Improve data collection, including equalities data, for workforce planning purposes;
• Create alternative pathways and entry points/training opportunities into mental health and wellbeing careers; Understand and address the impact of negative image of services or sectors as portrayed in the media;
• Challenge stigma associated with working in mental health roles, as reported by some consultation respondents; Ensure there is adequate focus on early intervention and preventative support and services where appropriate;
• Increase collaboration across the sectors, with more multidisciplinary/agency and partnership working; and
• Further harness the expertise and capacity of the third sector and address issues around commissioning processes.

Some of these challenges are specific to those working in particular roles, sectors, and settings. Some are compounded by factors such as population demographics or geography. For example, the consultation highlighted that some of the issues above are exacerbated in rural and island communities. These recurring themes straddle across all the pillars of the workforce journey.

The Delivery Plan and Workforce Action Plan sets out a range of activity to address the key issues that have been raised in consultation with delivery partners. These Plans intended to replace existing plans, policies or work already underway. Instead, its purpose is to focus on key areas where action is required – doing so in a way that is pragmatic and realistic given the current financial challenges and the available supply of workforce. The Action Plan outlines areas for continued and / or enhanced activity and provides case studies that highlight examples of good practice from across mental health and wellbeing services. The Action Plan will support local partners and partnerships as they continue to make local decisions to plan and deliver the mental health and wellbeing workforce needed to provide excellent services as set out in the Strategy Delivery Plan.

Options

Whilst undertaking this Business Regulatory Impact Assessment in conjunction with development of the Mental Health and Wellbeing Strategy, Delivery Plan and Workforce Action Plan, we considered the following options:

Option 1: Do nothing. We do not publish an updated Strategy and its associated Delivery Plan and Workforce Action Plan - going against the evidence gathered from consultations which highlighting the need to take stock and reset our approach in how we improve and support mental health and wellbeing in Scotland.

Costs: No direct financial costs or resource costs, however, by not updating the Strategy and developing solutions to the issues identified during the consultation it will have indirect costs to people’s health and wellbeing impacting upon Scotland’s labour market and on sustainable economic development.

Sectors and Groups affected negatively:

• Service users
• Scottish public
• Health Boards, Integrated Joint Boards, Local councils
• Mental Health and Wellbeing Workforce
• Third Party Organisations
• Employers
• Particular impact on those experiencing mental health inequalities.

Option 2: Publish an updated Mental Health and Wellbeing Strategy and accompanying Delivery Plan and Workforce Action Plan to enable Scottish Government to collaborate with partners to optimise all available resources over time to achieve the overall outcomes as set out in the Strategy.

Benefit:

Creating the conditions for better mental health and wellbeing in Scotland by

• Encouraging a stronger focus on prevention and early intervention.
• Recognising the importance of tackling poverty and inequality.
• Supporting person-centred and whole family approaches.
• Placing mental health and wellbeing on an equal footing with physical health.
• Increasing community-based support and services.
• Providing increased and longer-term funding for mental health and wellbeing services, including for the third sector.
• Growing the workforce – developing a skilled and diverse mental health and wellbeing workforce which can operate at safe levels, and addressing talent attraction, recruitment, and retention challenges.

Publication Cost: Publication of the Strategy- £3,405

Publication of the Delivery Plan and Workforce Action Plan - £3,977

The Strategy, Delivery Plan and Workforce Action Plan represent the proposed future plans and direction on mental health and wellbeing. There will be associated costs with delivering some of these commitments, when budgets allow, but are not fully forecasted as part of this BRIA.

Sectors and Groups affected Positively:

• Service users
• Scottish public
• Workforce
• Employers
• Health Boards
• Third Party Organisations
• Scottish economy

Regulatory and EU Alignment Impacts

No, given the Mental Health and Wellbeing Strategy, Delivery Plan and Workforce Action Plans are about mental health and wellbeing as a whole, we do not believe they will conflict with any regulations or EU Alignment. We have reviewed each action.

Intra-UK Trade

No, given the Mental Health and Wellbeing is about improving health and wellbeing implications fir Scottish economy as a who, we do not believe it will impact on intra-UK trade.

International Trade

No, we do not believe either the Mental Health and Wellbeing Strategy, Delivery Plan or Workforce Action Plan will impact on international trade and investment.

Scottish Firms Impact Test

There are no costs to be passed onto businesses from the development and subsequent publication of the Mental Health & Wellbeing Strategy, Delivery Plan and Workforce Action Plan. We also do not believe this will impact upon the competitiveness of Scottish companies.

Competition Assessment

The Mental Health and Wellbeing Strategy, Delivery Plan and Workforce Action Plan will provide benefits to people receiving care; so, no competition impacts will occur. We have reviewed each action against this framework.

Consumer Assessment

The Workforce Action Plan is designed to support growth and enhance the existing workforce. This should improve access to support and services for the Scottish public. As with general challenges in Scotland’s labour market, there is an ongoing need to build upon existing work to address issues such as widening access to mental health career pathways, make careers more attractive to support recruitment and retain a diverse range of students, trainees and existing staff; understand and overcome barriers in traditional recruitment routes; enable the workforce to access and participate in training and upskilling; improve and support career progression and further embed fair work practices to ensure that we can attract and retain the workforce.

Test Run of Business Forms

No new forms will be introduced resulting from the publication of either the Mental Health and Wellbeing Strategy, Delivery Plan or Workforce Action Plan.

Digital Impact Test

The Mental Health and Wellbeing Strategy recognises the impact that digital systems, therapies, and resources can have on supporting individual and public mental health. They are a key part of developing a "No wrong door" approach for people to access mental health support and advice. This includes current digital therapy apps Daylight and Sleepio, the online Mind to Mind wellbeing platform on NHS inform, and computerised Cognitive Behavioural Therapies (cCBT). The Scottish Government currently reports that there are 23 cCBT treatments available online, and there have been 70,000 digital therapies referrals in the last year. Expansion of digital therapies, systems and resources from private businesses will be considered and managed through existing procurement processes.

We want to ensure that employers have the support they need to promote and support the conditions that enable good mental health at work. The Delivery Plan and Workforce Action Plan therefore includes actions that will continue to promote the Healthy Working Lives’ a mental health and wellbeing digital platform to help employers in Scotland actively support and promote mental health at work. The platform signposts employers to a wide range of mental health and wellbeing resources. These include information and advice on understanding mental health, mental health and the law and staff learning and development opportunities, as well as signposting to sources of support. The employer platform and the impact on businesses has been included in the Equality Impact Assessment.

Legal Aid Impact Test

We have reviewed each action against the framework and do not believe access to Legal Aid will be impacted by this policy or that there will be interactions from the implementation of the Scottish Mental Health Review.

Enforcement, Sanctions and Monitoring

At the time of publication, the Mental Health and Wellbeing Strategy, Delivery Plan and Workforce Action Plan do not propose regulations or legislation therefore enforcement and sanctions will not be required.

We will continue to review, monitor, and evaluate the actions within the Delivery Plan, which could be subject to future statutory or legislative actions.

Implementation and Delivery of the Delivery Plan and Workforce Action Plan

The Strategy’s Delivery Plan and Workforce Action Plan set out the actions that will be taken over the next 18 months (from November 2023) to make progress towards delivering the outcomes and priorities identified in the Mental Health and Wellbeing Strategy.

Both the Scottish Government and COSLA will continue to collaborate with relevant stakeholders including health, social care, education, the third sector and other delivery partners to implement the actions within the plans. A monitoring and evaluation framework will be developed and published during the lifetime of the first Delivery Plan and Workforce Action Plan. This will set out how we will measure progress towards the outcomes. It will also take account of existing indicators and standards currently under development.

As many of the services will be delivered by national, regional, and local delivery partners (NHS, HSCPs, IJBs, local authorities, third sector), a strong governance structure will surround the delivery of the Strategy and its plans. A series of multidisciplinary groups and workstreams currently exist across the mental health policy landscape including advisory groups, Programme Boards, and specific governance groups. Consideration will be given to how these are brought together to inform and progress the Strategy under a joint decision-making body, the Mental Health, and Wellbeing Leadership Board. The Mental Health and Wellbeing Leadership Board will be accountable for ensuring the commitments made in the Delivery Plan and Workforce Action Plans are delivered. There will be other governance groups monitoring the progress of specific groups of actions, who will report to the leadership group and any issues will be escalated where appropriate.

Summary and Recommendation

In summary we know that the current system is not delivering as we would wish despite the efforts of thousands of dedicated and skilled people across Scotland. We heard from individuals, families, and our workforce that there can often be issues with finding and receiving the right help, sometimes with dreadful consequences. We accept this reality and resolve to drive change and improvement going forward. Given that the last Mental Health Strategy was published in 2017 we also acknowledge that the current landscape is markedly different due to global public health crisis in the COVID-19 pandemic, the cost-of-living crisis, and many more significant events.

Scottish Ministers therefore expressed a clear preference for Option 2

We published the Mental Health & Wellbeing Strategy in June 2023, and the Delivery and Workforce Action Plans were published in November 2023. The publication a new Strategy also provides an opportunity to lay out what we think 'good' looks like and move forward with all partners towards that vision. The Workforce Action Plan sets out the steps that will be taken to ensure that the delivery of the strategy is undertaken by a diverse, skilled, supported, and sustainable workforce. The Delivery Plan sets out the actions that we will take to make progress towards the outcomes and priorities in our new Strategy.

Declaration and Publication

Sign-off for Final BRIAs:

I have read the Business and Regulatory Impact Assessment (BRIA), and I am satisfied that (a) it represents a fair and reasonable view of the expected costs, benefits, and impact of the policy, and (b) that the benefits justify the costs. I am satisfied that business impact has been assessed with the support of businesses in Scotland.

Signed:

Date: 20/08/2024

Minister's name: Ms Maree Todd

Minister's title: Minister for Social Care, Mental Wellbeing and Sport

Scottish Government Contact point: MHWorkforceUnscheduledPrimaryCare@gov.scot