Mental health and wellbeing : workforce action plan 2023-2025

Section B - The Action Plan

Vision for the Mental Health and Wellbeing Workforce

The HSC Workforce Strategy sets out a national framework to achieve our vision of “a sustainable, skilled workforce with attractive career choices where all are respected and valued for the work they do.”

To complement this vision for the current and future mental health and wellbeing workforce is that they are supported to provide effective, person-centred, trauma- informed, rights based compassionate services and support.

Overarching Mental Health and Wellbeing Workforce Aim

As referenced in the Strategy, our aim is to support the development of a mental health and wellbeing workforce which is diverse, skilled, supported and sustainable. This will support our Strategy’s Vision of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible.

Diagram 1 provides an illustration of how the five pillars within the Action Plan relate to promote, prevent and provide, and the scope of the actions in relation to different parts of the mental health and wellbeing workforce in the context of this plan. Please note this is not an exhaustive list.

Diagram 1

Promote positive mental health and wellbeing for the whole population, improving, understanding and tackling stigma and discrimination

• Employers
• Community services (ranging from sports organisations, community wellbeing initiatives, citizens’ advice, housing)
• Faith organisations

(Train)

Promote and Prevent mental health issues occurring or escalating and tackling underlying causes and inequalities wherever possible

Primary prevention (detect, distress, assess risks, signpost support):

• All health, social care and social work staff
• Unpaid carers
• Workers in front facing roles in communities, justice, early years and education settings, who support the wellbeing of service users

(Train; For unpaid carers only: Train, Nurture)

Secondary prevention (early intervention, further signposting; recovery support):

• Counsellors in a variety settings including schools further and higher education, and third sector community organisations
• Chaplaincy, Spiritual and Pastoral care workforce operating in various settings

(Plan, Attract, Train)

Promote, Prevent and Provide mental health and wellbeing support and care, ensuring people and communities can access the right information, skills, support, services and opportunities in the right place, at the right time

Responding to severe and complex mental health as part of multidisciplinary teams, working across health, social care, and third and independent sectors and recovery support:

• Community Mental Health Nurses
• Psychological Therapies (PT), Interventions and Wellbeing Practitioners
• Peer support workers
• Allied Health Professionals who work in mental health services
• Social workers who work in Mental Health services
• Community Mental Health Pharmacists

(Plan, Attract, Train, Employ, Nurture)

Responding to severe and complex mental health:

• Psychiatrists
• Clinical psychologists
• Mental Health Nurses
• Allied Health Professionals who work in Mental Health services
• Mental Health Officers

(Plan, Attract, Train, Employ, Nurture)

Table 1 in the pages below sets out the outcomes we want to see as a result of this Action Plan in order to meet the ambitions set out within the Strategy.

Overarching Aim - Plan

Evidence-based planning across the system, to ensure the right workforce numbers, with the rights skills, to provide the right support, at the right time and in the right place.

Short-term (2023-25) outcomes:

1. Improved understanding of the population’s mental health needs, including local and regional variations, to inform workforce planning.

2. Improved understanding of the factors influencing workforce supply, demand, retention and capability, at local and regional levels.

3. Improved understanding of the workforce impacts of relevant national policy commitments and strategies including the Mental Health & Wellbeing (MH&W) Strategy and associated actions.

4. Improved capability, capacity and digital infrastructure to workforce plan at a local, regional and national level, including using workforce data.

Medium-term (2026-28) outcome:

1. An improved understanding of the population’s mental health needs and workforce supply, which then formulates the key building blocks upon which service planning and models are based.

Overarching Aim - Attract

MH&W careers are attractive, with inclusive and diverse routes to recruitment, with clear progression pathways and where all are respected, empowered and valued for the work they do.

Short-term (2023-25) outcomes:

1. Increased nationally co-ordinated national and international recruitment.

2. More diverse, fair and inclusive workplaces across the MH&W system.

3. Improved public perception of MH&W roles, leading to an increase in recruitment to MH&W roles.

4. Increased routes and experiences available for entry into the workforce, including those with lived experience, to pursue careers within the MH&W system.

Medium-term (2026-28) outcome:

1. Increased applications to careers in MH&W across the MH&W system.

Overarching Aim - Train

The MH&W workforce is skilled, trained and supported to work agilely and flexibly, embracing new technologies and are informed by evidence to support a whole person approach.

Short-term (2023-25) outcomes:

1. Increased education and training opportunities and uptake to provide the workforce with appropriate skills to achieve the outcomes from the MH&W Strategy, including the delivery and access to evidenced-based interventions.

2. Education and training increasingly provide the workforce with appropriate skills to support the MH&W needs of the population, taking into account protected characteristics, socio-economic and geographical needs.

3. Improved and consistent access to training and education, including trauma-informed approaches, for volunteers and carers.

4. The workforce report being more knowledgeable about other services in their local area and how to link others into them.

Medium-term (2026-28) outcome:

1. Post-registration Education and Training programmes across the MH&W system reflect positive values, and support career progression through continuous professional development.

Overarching Aim - Employ

Underpinned by Fair Work principles, create sustainable and inclusive growth within the MH&W workforce, in line with Scotland’s population demographics and the demands on services.

Short-term (2023-25) outcomes:

1. Increase in the workforce reporting feeling valued, rewarded and supported wherever they work across the MH&W system.

2. Improved diversity (in terms of roles and demographics) of the workforce and leadership.

Medium-term (2026-28) outcomes:

1. Workforce report feeling valued and supported to deliver high quality user centred services, support and compassionate care.

2. Leadership is more demographically diverse.

3. Those in formal leadership roles are increasingly capable of enabling and delivering change, and actively supportive of the needs of the workforce.

4. Retention rates across the MH&W workforce have improved.

Overarching Aim - Nurture

The MH&W workforce are valued, empowered and supported.

Short-term (2023-25) outcomes:

1. Increased focus on achieving safe working conditions, including safe staffing levels, and manageable workloads for the workforce.

2. Increasingly effective partnership working between the workforce, volunteers, carers, employers, peer support and recovery workers and partner organisations.

3. Improved wellbeing support for staff, volunteers and carers.

4. Mentoring, coaching, improved professional supervision and reflective practice is increasingly available.

Medium-term (2026-28) outcomes:

1. Workforce is supported to improve services and workplace practices.

2. We have created consistent conditions for the workforce, volunteers and carers to support and enable improved physical and mental wellbeing.

Our Actions

This section describes the key actions we will take with partners over the next three years, noting how they align with both the actions in the Strategy Delivery Plan, and under the HSC Workforce Strategy’s five-pillar framework.

Plan:

The Strategy Delivery Plan sets out a range of actions that are relevant and interact closely with the Plan pillar in the HSC Workforce Strategy. This includes actions under the following priorities:

Priority 2: Improve population mental health and wellbeing, building resilience and enabling people to access the right information and advice in the right place for them and in a range of formats.

Priority 3: Increase mental health capacity within General Practice and primary care, universal services and community based mental health supports. Promote the whole system, whole person approach by helping partners to work together and removing barriers faced by people from marginalised groups when accessing services.

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.

Priority 6: Improve mental health and wellbeing support in a wider range of settings with reduced waiting times and improved outcomes for people accessing all services, including Child and Adolescent Mental Health Services and psychological therapies.

Priority 7: Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery.

Priority 9: Strengthen support and care pathways for people requiring neurodevelopmental support, working in partnership with health, social care, education, the third sector and other delivery partners. This will ensure those who need it receive the right care and support at the right time in a way that works for them.

In working to support the progression of these priorities in relation to the Plan pillar, this Action Plan will focus on:

Data improvements

Whilst NES holds data for NHS Scotland workforce, there is currently no single source of data for the mental health and wellbeing workforce in Scotland. Given the scope of the mental health and wellbeing workforce, we recognise that there is a need to consider where there are data gaps and take appropriate and proportionate actions to address these.

Through our engagement, we heard the need for improved comprehensive workforce data at national, regional and service levels on the core mental health and wellbeing workforce to enable improved planning of support and services. This includes addressing issues raised around access to workforce data, inconsistency and accuracy of current workforce data and the need to better understand all roles within the workforce and mapping of these roles. Through the work of Healthcare Improvement Scotland’s Healthcare Staffing Programme, there is an opportunity to influence the development of contemporary multi-disciplinary staffing level tools to inform workload and workforce planning. In addition, the national implementation of e-healthroster also provides new opportunities to access robust workforce intelligence.

Therefore, building on the work currently being undertaken as part of the Health and Social Care Workforce Strategy Actions and the Health and Social Care Data Strategy, we will undertake new activity to improve mental health and wellbeing workforce data, including equalities data. This will serve to better align current and future population needs and individual workforce, pre-registration education and practice based learning requirements. This work will also support the development and publication of Scotland’s first mental health and wellbeing workforce technical document, which will provide a comprehensive summary of the available data, challenges and recommendations for improvements on existing mental health and wellbeing workforce data. As part of a phased approach, this will initially focus on the core workforce.

Workforce planning, flexibility and co-design

Actions will be undertaken to support workforce planning, flexibility and codesign. This includes:

Health Boards will be expected to use the Mental Health Outcomes Framework 2023/24 funding to plan and deliver Mental Health and Wellbeing services, in partnership with their workforce and local communities, and ensure support that will deliver against the outcomes of the Framework, and by extension the Strategy and this Action Plan.

Local Authorities, NHS Boards and HSCP published the first suite of three-year workforce plans in 2019. Workforce planning leads analyse the health and care needs of the population and develop their three- year plans in partnership with stakeholders (including those in third and independent sectors and in primary care) and Trade Unions, to present an aligned and cohesive picture of health and care workforce need across their geographic areas.

Through our engagement, we heard the need to ensure local decision making around workforce planning and the need to build in time for workforce planning and job planning for training and development. This local planning should take into account the needs of local communities, including the workforce and volunteers and should provide flexibility to adapt. Assessing local need and effective deployment of workforce and resources is particularly important within remote and rural settings. This process aligns to activity within the Employ, Attract and Nurture Pillars, which includes better partnership and collaborative working with the third sector, informed by those with lived experience, and provide adequate funding for the sector.

We also heard about opportunities in workforce planning that have the potential to support the management of high demand. These included the development of new roles and the reform of existing job roles, alongside evolutions in service models, investment in technology and artificial intelligence and new skills.

Our actions related to this include, working with stakeholders and delivery partners to improve access to support, assessment and treatment in primary care mental health and wellbeing services across Scotland, including development of multi-disciplinary teams in general practice, strengthening the role of community mental health teams and considering the roles of digital mental health and NHS 24 to ensure access is simpler, quicker for those needing support and that care and quality is aligned with the principle of Getting it Right for Everyone (GIRFE). This work will build on existing best practice and we will produce an initial report, which will include equality impacts, by November 2024.

Additionally, Scottish Government will continue to include primary care and community mental health as priorities within the Mental Health Outcomes Framework to assist with delivery against the outcomes of the Framework, and by extension the Strategy and this Action Plan.

We will also use the Mental Health Leads Network and other established working groups as set out in the Nurture pillar, to promote and share good practice identified from workforce plans, as well as ensuring that the future iterations continue to be developed in partnership with the mental health and wellbeing workforce.

Scottish Government will support the implementation of the electronic rostering and time recording for all staff groups across NHS Scotland. There are a number of improvements that can be derived from its introduction, for example:

• For Scottish Government: real-time insights into workforce demand and fulfilment.
• For Boards: ability to design and forward plan rosters around the number and clinical needs of patients; providing real time visibility of current and future rosters, staffing levels and demand for temporary staff; ensuring compliance with policies and legislation.
• For Staff: providing transparency, fairness and equity in the allocation of shifts (standard and additional) and leave; improving the work-life balance by providing extended forward visibility of rosters particularly important for staff with caring responsibilities.
• For Patients: driving out poor rostering practice which causes sub-optimal clinical cover and incorrect clinical skill mix; ensuring that wards are correctly staffed; and improving the quality of care through more effective use of local staff and less reliance on agency staff, who are less likely to be familiar with the care setting.

Through Scottish Government’s phased approach to implementing the psychological therapies specification, Scottish Government will scope and review workforce gaps in particular areas of delivery (e.g. learning difficulties, older adults, in-patient provision) and develop action plans to address workforce supply. This will be done in collaboration with HOPS, NES and wider stakeholders. It will set out the required workforce needs and take account of all grades of staff who can train in and deliver psychological treatments. Recommendations will be provided to support recruitment and retention with the aim of supporting the public to have access to timely quality evidence-based care.

Other actions within the Plan pillar include:

• Undertake and publish a CAMHS scenario planning project to help improve workforce planning for CAMHS services.
• Undertake workforce planning for psychological therapies delivery linked to the new national specification for psychological therapies and interventions.
• As part of the development of the Social Work Workforce Joint Improvement Plan to address the acute recruitment and retention challenges facing the Social Work profession, prioritise looking at Mental Health Officer (MHO) workforce capacity. This will include a gap analysis to inform planning, measuring demand and vacancies and to set future direction.
• Develop a Health and Social Care Rural Workforce Recruitment Strategy by the end of 2024, to support employers to ensure that the health and social care needs of people who live in these communities are met, as part of this we will ensure that this takes into account the MH&W workforce.
• The National Centre for Remote and Rural Health and Care, launched in October 2023, will have an initial focus on Primary Care in remote, rural and island communities, and play a key role in maintaining a rural focus on Recruitment and Retention, Education and Training, Research and Evaluation, Leadership and Good Practice.
• The Association of Scottish Principal Educational Psychologists (ASPEP) is currently working with Scottish Government and COSLA to develop a strategy to promote more widely the role that Educational Psychologists play in supporting the mental health and wellbeing of children and young people.

Attract:

The Strategy Delivery Plan sets out a range of actions that are relevant and interact closely with the Attract pillar of the HSC Workforce Strategy. This includes actions under the following priorities:

Priority 1: Tackle mental health stigma and discrimination where it exists and ensure people can talk about their mental health and wellbeing and access the person-centred support they require.

Priority 3: Increase mental health capacity within General Practice and primary care, universal services and community based mental health supports. Promote the whole system, whole person approach by helping partners to work together and removing barriers faced by people from marginalised groups when accessing services.

This Action Plan will focus on:

Recruitment

Based on feedback from the workforce, attracting people to work in roles across the mental health and wellbeing system requires us to look at how we can recruit people into these roles during any stage of their career journey and across a range of age groups. Recruitment actions will seek to increase the diversity of the mental health and wellbeing workforce, attracting people from remote and rural areas as well as those with lived and living experience of mental illness, promoting career pathways to young people and considering ways to tackle stigma in relation to attracting people to mental health and wellbeing roles.

We heard the need to run campaigns to improve recruitment, which should also focus on improving the diversity of the workforce and address the difficulties of recruiting staff in remote and rural areas, including islands. Such recruitment campaigns should promote greater connection between Health Boards and Health and Social Care Partnerships, Local Employability Partnerships and wider partners on recruitment processes to improve efficiency and create increased flexibility.

Through the newly established Anchors Workforce Strategic Group, Scottish Government will develop and implement an ambitious workplan that will empower NHS Boards in providing job opportunities and building prosperity in our local communities. We will ensure there is mental health workforce and equalities consideration and input through the Strategic group.

Where appropriate, we will continue to promote inclusion of the mental health and wellbeing workforce in any existing and future nationally co-ordinated recruitment campaigns, including targeted and ethical international recruitment campaigns and identify ways in which to share good practice and innovation.

In addition to international recruitment campaigns, further recruitment efforts will include seeking to increase the diversity of the mental health and wellbeing workforce, including people with protected characteristics and marginalised groups, attracting people with lived and living experience of mental illness, promoting career pathways to young people and considering ways to tackle stigma in relation to attracting people to mental health and wellbeing roles.

Address vacancies and retention challenges

We heard the need to address current challenges around high vacancy levels, retention and training issues facing parts of the workforce. This includes, for example, psychiatrists, mental health nurses, allied health professionals, learning disability nurses, psychologists and MHOs. These challenges include addressing difficulties in securing placements for students, as there are often not enough registered staff to provide practice assessment and supervision. In all undergraduate nursing programmes, we are also seeing a drop in applications.

That’s why, through the newly established Nursing and Midwifery Taskforce, Scottish Government will consider and address issues to build exemplary workforce cultures, addressing operational barriers and improving working conditions, facilities and learning opportunities.

Building on this work, Scottish Government will commission a review into Mental Health Nursing in Scotland, which will consider what more needs to be done to attract, grow, support and develop the mental health nursing workforce and leadership.

Through the newly established Psychiatry Recruitment and Retention Working Group, Scottish Government will consider how we can better support the recruitment and retention of psychiatrists in the NHS in Scotland. The initial phase of the group’s work will look at the recruitment and retention of trainee doctors at Core and Higher Specialty training level, followed by a second phase which will consider the wider workforce including consultant and specialty grade doctors.

Scottish Government will engage with the implementation plan for Allied Health Professions (AHP) Education Review to ensure recommendations are implemented to address specific needs of the AHP mental health workforce. We will also engage closely with the implementation of the Learning Disability (LD) Nurse Education and Workforce Action Plan.

Scottish Government will also engage with HOPS and NES to ensure workforce supply for psychological therapists and psychologists and consider workforce gaps to support delivery of the new national specification for psychological therapies (PT) and interventions. Scottish Government will develop a workforce action plan to address the specific needs of PT delivery and harness the supply of undergraduate psychologists keen to train in and deliver psychological treatments.

A MHO Workforce Capacity Oversight Group has been set up in order to consider long- term solutions to address the shortfalls in MHO capacity caused by issues including increased service demand, as well as recruitment and retention challenges.

Other activity under the Attract pillar will include:

• Building on existing ethical international recruitment campaigns to capture the mental health and wellbeing workforce and scope out what actions, within the powers of Scottish Government, need to be taken to remove the barriers/ challenges facing health boards and local authorities from recruiting people into the MH&W workforce.
• This includes building on and learning from the International Recruitment Programme in Social Care Pilot, through NES and the Centre for Workforce Supply for Social Care and working with SSSC to progress initiatives for Social Work International Recruitment.
• Scoping and promoting existing, new and alternative pathways to widen access to careers within the mental health and wellbeing workforce, beyond traditional university and college routes and develop a targeted campaign to promote careers, including new roles where appropriate, within the mental health and wellbeing system.
• Working with colleges and universities, their representative bodies and the Scottish Funding Council (SFC), to better understand the numbers currently in training across a range of related disciplines and ensuring that there are sufficient funded places to support students at college and university studying in mental health, social work and allied professions.

Train:

The Strategy Delivery Plan sets out a range of actions that are relevant and interact closely with the Train pillar. This includes actions under the following priorities:

Priority 1: Tackle mental health stigma and discrimination where it exists and ensure people can talk about their mental health and wellbeing and access the person-centred support they require.

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.

Priority 5: Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk.

Priority 7: Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery.

Priority 8: Continue to improve support for those in the forensic mental health system.

Priority 9: Strengthen support and care pathways for people requiring neurodevelopmental support^[3], working in partnership with health, social care, education, the third sector and other delivery partners. This will ensure those who need it receive the right care and support at the right time in a way that works for them.

Priority 10: Reduce the risk of poor mental health and wellbeing in adult life by promoting the importance of good relationships and trauma-informed approaches from the earliest years of life, taking account where relevant adverse childhood experiences. We will ensure help is available early on when there is a risk of poor mental health and support the physical health and wellbeing of people with mental health conditions.

The education and training pipeline makes a significant impact on the skills of the workforce as well as to workforce supply. Skills are an important part of many individuals, professions and organisations identities, helping them to define who they are, and what they want to be.

In Scotland, our schools, colleges and universities, training providers, SSSC and National Health Boards such as NHS Education for Scotland, deliver high-quality education to learners at all levels helping to shape both our future workforce and upskill our current workforce. We also recognise that the mental health and wellbeing workforce receive training through their own employer, third sector organisations, independent employers, individual health boards and local authorities training, and some may also access training opportunities through their professional boards or independently.

We heard about the need to address stigma and discrimination relating to poor mental health and stigma faced by people with protected characteristics and marginalised groups through training. We also heard the need to improve and increase the availability and uptake of mental health literacy, wellbeing, training for the wider workforce, carers and volunteers. There were also calls to provide a national framework for mental health training and support for the wider mental health and wellbeing workforce and volunteers, including for example those working in courts, prisons and those working with children and young people.

Scottish and local government as well as employers themselves continue to support training of the workforce. Our Action Plan recognises the wide ranging existing mental health training and seeks to enhance rather than replicate these offers. This includes further details on some of the available training which can be found in Annex A.

Through this Action Plan we will also take forward a range of activity under the Train pillar. The newly established Mental Health and Wellbeing Workforce Education and Training Advisory Group will:

• Develop an induction training framework for the wider mental health and wellbeing workforce, volunteers, peer support/ recovery workers and carers.
• Scope implementation of the learning resources produced by the Children and Young People’s Mental Health and Wellbeing Joint Delivery Board along with the strategic recommendations, and ensure any further training opportunities are developed, disseminated, supported, evaluated and accessible for the children and young people’s mental health and wellbeing workforce.
• Scope options for increasing awareness of evidence-based prevention and early intervention approaches, within training and resources.
• Consider options to upscale training and awareness around the mental health and wellbeing challenges of disadvantaged groups (including our ethnically diverse communities, people who are neurodiverse, and people living with dementia).
• Consider the role of colleges and universities as providers of training materials and potential delivery partners.

Other actions under the Train pillar include:

• We will work with stakeholders to develop resources to support alternative caregivers (kinship, foster, supported lodging carers and adoptive parents) provide trauma-informed care for their children and young people, as part of the National Trauma Transformation Programme.
• Scottish Government will continue to provide additional funding to NES for mental health education and training for both the health and social care workforce to meet a broad range of workforce training needs including, but not limited to perinatal, substance misuse, learning disabilities, neurodevelopmental disorders.
• Develop a resource toolkit for Mental Health Unscheduled Care Practitioners, responsible for providing unplanned and emergency mental health care and support, to increase awareness of the range of additional options available to support individuals.
• Support improvement of equality, diversity and inclusion training for the mental health and wellbeing workforce to incorporate up to date messaging within existing training and relevant information on equality recognising the important role colleges and universities play in shaping and delivering such training.
• Continue to support our workforce and services across Scotland to embed sustainable trauma-informed approaches using evidence-based training and support available through the National Trauma Transformation Programme, including the publication of a new “Roadmap to Trauma-Informed and Responsive Change: Guidance for Organisations, Systems and Workforces in Scotland”.
• Scottish Government will fund training to increase knowledge, skills and awareness of suicide prevention and continue to expand and deepen knowledge and compassionate understanding of self- harm by providing learning for people, communities and healthcare settings building upon the bespoke self-harm resources already created.
• Explore further opportunities to include safe and evidence based self-harm learning content and materials in core training and continuous professional development for key professional groups.
• Promote training resources for peer support workers. This will include resources developed by the Scottish Recovery Network to introduce, manage and sustain peer support roles (Let’s do Peer Group Facilitation guides / Let’s Develop Peer Roles toolkit), to build capacity in peer support groups that support those in crisis, contemplating suicide or who have been affected by suicide. It will also include resources developed by the Scottish Recovery Network for peer support in the perinatal period (Let’s do Peer Support: Bump, Birth & Beyond – Scottish Recovery Network) and the Peer Support Evaluation Toolkit for Perinatal and Infant Mental Health Services created in partnership with Inspiring Scotland, Evaluation Support Scotland and Scottish Government.
• Progress actions within the Trauma Responsive Social Work Services workplan, which was developed and agreed with key partners to embed trauma responsive practice into social work services across Scotland, aligned with the National Trauma Transformation Programme.
• Consider ways to address the digital and data training and literacy needs within the mental health and wellbeing workforce, in line with the Health and Social Care Data Strategy and the Health and Social Care Digital Strategy, ‘Care in the Digital Age’.
• Through the National Scottish Steering Group for Educational Psychologists (NSSGEP), Scottish Government and COSLA have worked in partnership with key stakeholders within the profession to consider a move to a Doctorate model of training for Educational Psychologists. Agreement in principle to move to a Doctorate model of training has been provided by both the Cabinet Secretary for Education and Skills and COSLA Leaders. Scottish Government and COSLA are working closely with the University of Dundee and the profession to consider further feasibility work to inform the next steps to deliver this shift in approach.

Employ:

The Strategy Delivery Plan sets out a range of actions that are relevant and interact closely with the Employ pillar. This includes actions under the following priorities:

Priority 1: Tackle mental health stigma and discrimination where it exists and ensure people can talk about their mental health and wellbeing and access the person-centred support they require.

Priority 2: Improve population mental health and wellbeing, building resilience and enabling people to access the right information and advice in the right place for them and in a range of formats.

Priority 3: Increase mental health capacity within General Practice and primary care, universal services and community based mental health supports. Promote the whole system, whole person approach by helping partners to work together and removing barriers faced by people from marginalised groups when accessing services.

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.

Priority 5: Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk.

Priority 7: Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery.

Priority 8: Continue to improve support for those in the forensic mental health system.

Priority 9: Strengthen support and care pathways for people requiring neurodevelopmental support^[4], working in partnership with health, social care, education, the third sector and other delivery partners. This will ensure those who need it receive the right care and support at the right time in a way that works for them.

Stakeholder feedback called for continued appropriate growth of the core and wider mental health and wellbeing workforce and to ensure fair and meaningful work, so that the workforce feel valued and rewarded for the work they do. We heard about the need to support the core mental health and wellbeing staff to work at the top of their competencies, as well as ensuring that there are structured career pathways with opportunities for development. Some respondents called for the continued progress in embedding Fair Work practices across workplaces, as well as calls for better pay and conditions, with improved flexible working conditions, to allow for improved work-life balance.

We note that for members of the workforce who are parents and/or have other caring responsibilities, flexible working conditions are crucial to ensure these staff can balance their role alongside the other commitments in their lives.

In response, Scottish Government will seek to embed Fair Work First principles within all new Mental Health Directorate Grants, and we will continue to support projects currently funded through the Workplace Equality Fund to encourage fair work practice; promote the outputs and outcomes of the Fund to mental health and wellbeing workforce employers to share relevant best practice.

As set out in the Verity House Agreement, established negotiating arrangements for pay will be recognised and respected, and Scottish Government will work jointly with COSLA to ensure better strategic alignment on workforce issues across the public sector, including fair work.

Other work to support workforce capacity includes funding:

• Action 15 of the Mental Health Strategy 2017-27 outlined Scottish Government’s commitment to funding 800 additional mental health workers in key settings, including A&Es, GP practices, police station custody suite and prisons – ensuring local provision and support is at the heart of our plans. At the end of the commitment, around 960 Whole Time Equivalent (WTE) mental health roles were filled using Action 15 funding, exceeding the original commitment.
• Enhanced Psychological Practice (EPP) Programme, across a variety of settings
• Psychological Wellbeing Practitioners in NHS 24
• Peer support workers
• Community link workers
• School counselling services available through all secondary schools across Scotland for young people
• Increasing the number of GPs in Scotland by 800, by the end of 2027
• Access to digital psychological interventions

In November 2021, Scottish Government provided funding to NHS Boards for Mental Health pharmacist and technician recruitment as part of a wider investment from the Mental Health Recovery and Renewal Fund. A second phase of funding amounting to £1.6m was confirmed in February 2023. The Fund supports the delivery of actions set out in the Mental Health Transition and Recovery Plan to respond to the mental health need arising from the pandemic, and also benefits the wider agenda for mental health and wellbeing in line with the four areas of key need set out in the Plan. The Fund is aimed at improving how people can manage their mental health with appropriate early support and be referred for additional support when required. To date Boards have recruited 26.8 WTE pharmacists, 13.2 WTE technicians, and 3.2 WTE support staff to specifically work in mental health services.

The work of the Psychiatry Recruitment and Retention working group, the MHO Capacity Working Group, the Mental Health Nursing Review and the Joint Social Services Workforce Taskforce will also be applicable to the Employ pillar.

The Nursing and Midwifery Taskforce includes work relevant to the Employ pillar, including: building exemplary workforce cultures; addressing operational barriers; and improving workforce conditions, facilities and learning opportunities and supporting the implementation of the National Health and Social Care Workforce Strategy to ensure a sustainable workforce that delivers high quality care and reduces reliance on supplementary staffing.

As well as the work outlined above, Scottish Government will also implement the Band 2-4 framework for Mental Health Nursing and Work with Open University to target staff, including those in non-traditional band 2-4 roles, as part of promoting mental health nursing careers.

Through the Social Work Improvement Planning Workforce Group, we will review the current workforce pressures facing the Social Work profession, including MHOs, while actively supporting work to address recruitment and retention issues. We will work with institutions and the SFC to ensure that social work students remain engaged with their course and will continue the development of the Advanced Social Work Practice Framework which will set out the structures to support social workers through different career phases and will describe a cohesive and supportive series of academic, learning and development, and work-based opportunities to support the workforce.

In addition to the increase in pay for many parts of the workforce including for example through the Agenda for Change pay settlement for 2023/24, work is also under way on a wider review of Agenda for Change, as agreed alongside the latest pay settlement. Scottish Government will also reinforce the distinction between volunteering and paid employment by reviewing and relaunching the Volunteer Charter, introducing fair volunteering principles, and reinforcing its importance.

Other actions under the employ pillar include:

• Continuation of the Transforming Roles programme for nursing, midwifery and health professions (NMAHP) workforce. The programme aims to ensure nationally consistent, sustainable and progressive NMAHP roles and career pathways which will see an appropriately skilled workforce contributing to new models of care delivery, including the development of specialist and advanced practice for mental health.
• Continue to support projects currently funded through the Workplace Equality Fund to encourage fair work practice; promote the outputs and outcomes of the Fund to mental health and wellbeing workforce employers to share relevant best practice.
• Through Fair Start Scotland, Scottish Government will continue to deliver the Individual Placement and Support (IPS). This employability model supports people with severe and enduring mental health conditions to find and retain employment. An independent review was commissioned and published on 25 January 2023. We will share learning of this project across the mental health and wellbeing system.
• Scottish Government will continue to work with stakeholders to secure improved terms and conditions such as sick pay and maternity/paternity pay in 2023/24 for adult social care workers delivering direct care in commissioned services.

Nurture:

The Strategy Delivery Plan sets out a range of actions that are relevant and interact closely with the Nurture pillar of the HSC Workforce Strategy. This includes actions under the following priorities:

Priority 1: Tackle mental health stigma and discrimination where it exists and ensure people can talk about their mental health and wellbeing and access the person-centred support they require.

Priority 2: Improve population mental health and wellbeing, building resilience and enabling people to access the right information and advice in the right place for them and in a range of formats.

Priority 10: Reduce the risk of poor mental health and wellbeing in adult life by promoting the importance of good relationships and trauma-informed approaches from the earliest years of life, taking account where relevant adverse childhood experiences. We will ensure help is available early on when there is a risk of poor mental health, and support the physical health and wellbeing of people with mental health conditions.

Key to growing and transforming the mental health and wellbeing workforce is a fair, supportive and inclusive workplace culture with workforce wellbeing being an essential priority. This applies across all roles, settings and is important for retaining our current workforce, whilst making it positive career choice for attracting the future workforce.

We know that employers can play a key role in tackling mental health stigma by creating workplace cultures where open and honest discussion about mental health and wellbeing is supported and where discriminatory behaviour is challenged. Leaders and managers also play a key role in recognising how common psychological trauma is across the population including the people in their workforce, who may also be at a greater risk of exposure to traumatic events in the course of their work. Supporting and promoting good mental health and wellbeing through trauma-informed and responsive practice at work benefits both the individuals and employers^[5].

In consultation, we heard that support for wellbeing is essential for sustaining the current and future mental health and wellbeing workforce, with a need for greater access to mental health and wellbeing support including counselling and spiritual care. The workforce also highlighted the importance of tackling the stigma associated with working in mental health as well as supporting the workforce who may be experiencing mental health or wellbeing related issues. There were calls for taking further steps to listen to the needs of the workforce and addressing specific needs, including providing improved menopause and menstrual health support.

There were calls for improvements to supervision provision and ensuring that resource planning takes into account time for reflective practice and the principles of time, space and compassion.

The consultation highlighted calls for workloads to be more manageable and for there to be improved partnership working across the mental health and wellbeing system and increased opportunities to share good practice. There was a recognition that a range of activity is required to improve support for unpaid carers and volunteers. Therefore, we will explore options to further support staffs’ wellbeing, increasing connectivity and collaborative working across mental health and wellbeing services and promote examples where collaboration has been successful.

We will continue to support staff mental health and wellbeing through national initiatives such as the National Wellbeing Hub, the National Wellbeing Helpline, Coaching for Wellbeing, confidential mental health treatment through the Workforce Specialist Service and develop a national resource for peer support and reflective practices to complement support delivered within local communities, including by their employer.

We will support the development and implementation of the Improving Wellbeing and Working Cultures Framework and Action Plan. This will build on the HSC Workforce Strategy and our commitment to enable and improve the culture of our health, social care and social work organisations, through a collective focus on programmes of work at national level on staff wellbeing, leadership and equalities.

We will provide support for the implementation of trauma-informed approaches through the publication of a new “Roadmap to Trauma-Informed and Responsive Change: Guidance for Organisations, Systems and Workforces in Scotland” as part of the National Trauma Transformation Programme.

The new Anti-Racist Employment strategy gives employers practical guidance and support in addressing racial inequality in the workplace. This strategy provides resources for employers, and it will be promoted as part of the Action Plan to mental and wellbeing workforce employers.

The Women’s Health Plan, published in August 2021 aims to address health inequalities and improve health outcomes for women and girls. There are actions being delivered through the plan which are of relevance to the mental health and wellbeing workforce. This includes promoting the menopause and menstrual health workplace policy that is being developed for NHS Scotland Staff. We will promote use of this best practice example for all employers within the mental health and wellbeing system and encourage equivalent efforts. This will be supported by inviting a representative from the mental health and wellbeing workforce to participate in the Menopause and Menstrual Health Working Group which will consider the implementation of the workplace policy for NHS Scotland as an example of best practice.

We want to ensure that employers have the support they need to promote and support conditions that enable good mental health at work. We will continue to promote the Healthy Working Lives’ 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.

It is widely recognised that in addition to physical, emotional, and social needs; organisations and employers should ensure that the spiritual needs of staff are recognised and met. Scottish Government will promote the role of spiritual care for all staff across health and social care settings including end of life care and bereavement support, through the new Spiritual Care Framework. Scottish Government will produce targeted communication on mental health and wellbeing to ensure all stakeholders have access to information they need to support themselves or others and we will ensure that this communication addresses issues around stigma.

To improve support to unpaid carers there will be greater promotion of the mental health support that signposts to online resources – the National Wellbeing Hub (which includes a specific section for unpaid carers), Aye Feel and we will continue to promote the Triangle of Care across the mental health and wellbeing system. General population mental health and wellbeing resources including Mind to Mind and Supporting a mentally healthy workplace will also continue to be promoted and will benefit the mental health and wellbeing workforce.

Other actions under the Nurture pillar include:

• Gain a better understanding of the implications of new policy developments such as the Health and Care (Staffing) (Scotland) Act 2019 (which is due to be fully in force on 1 April 2024), and Mental Health standards and how these impact health and social care staff wellbeing. This will include developing a Mental Health and Learning Disabilities (MHLD) inpatient staffing tool.
• Following the National Autism Implementation Team (NAIT) report, Scottish Government will establish a Neurodiversity Affirming Community of Practice – NAIT will provide leadership to the Adult Neurodevelopmental Professionals Network to build relationships, facilitate support and combine expertise as work progresses. This network will be aligned to a new Community of Practice.
• Encourage participation in the Leading to Change programme, promote compassionate leadership practices and ensure appropriately trained and skilled in leadership to promote a culture of hope and security.
• Support the development and implementation of the Improving Wellbeing and Working Cultures Framework and Action Plan. This will build on the HSC Workforce Strategy and our commitment to enable and improve the culture of our health, social care and social work organisations, through a collective focus on programmes of work at national level on staff wellbeing, leadership and equalities.
• Ensuring that our aspirations for mental health workforce development are informed by the Purpose and Principles for post-school education, research and skills that were published in June of this year. This considers how we can deliver a post-school education, research and skills system that is supportive and equitable and which places equal value on all positive destinations, which would include our approach to widening access.
• A Newly Qualified Social Worker (NQSW) Supported Year will be implemented across Scotland from September 2024. Social workers will be supported throughout their first year in practice by the provision of induction, protected caseloads and learning time, facilitation of peer support and mentoring, regular professional supervision and structured development discussions, using an agreed set of standards.
• Through the Mental Health Leads Network and other partners, we will share good working practice in relation to workforce planning between Health Boards and Health and Social Care Partnerships.
• Publishing case studies from the Mental Health Strategy 2017 commitment to fund 800 additional mental health workers in key settings, including A&Es, GP practices, police station custody suites and prisons. Ensure that lessons learnt are shared, including the impact of these additional roles on the wider MH&W system.
• Ensuring that the lessons learned from Welfare Advice and Health Partnerships are shared to support applications for welfare benefits and to address debt, housing, and employability issues and thereby reduce pressure on GPs and primary care services.
• Promoting existing forums and best practice sharing locally, including MHO forums within local HSCP and the National MHO forum.
• In partnership with local services, explore other ways in which information on locally available services and support can be further shared.
• Update the resource pack which was developed to support mental health workers in General Practice settings. It brings together a range of national resources and tools that support and improve mental health and wellbeing.
• Scottish Government will establish a Coming Home Implementation Peer Support Network that will bring together professionals from a range of disciplines, as well as people with lived experience to learn and share best practice, and to get support with planning services for people with learning disabilities and complex care needs. We will also scope establishing a Coming Home Implementation National Support Panel that provides professional advice to local areas for people with learning disabilities and complex care needs.
• Work is also being taken forward to identify and develop examples of peer support in action which can be shared nationally to improve the understanding and profile of peer support.