Mental health and wellbeing : workforce action plan 2023-2025

Annex A – Case Studies

Plan, Train

The Enhanced Psychological Practice (EPP) programme

The Enhanced Psychological Practice (EPP) programme is a new post-graduate certificate level education programme, funded by Scottish Government, that has been developed to enable staff to deliver high-quality, evidence- based psychological interventions for mild to moderate difficulties in a way that can be efficiently brought to scale with appropriate specialist supervision. NES aim to grow the newly established programme using a phased approach, with a view to delivering up to 100 qualified staff per annum when at full capacity, thereby enabling an additional 1,500 people (approximately) per year to receive help.

The EPP Programme has been implemented in a variety of Adult and Children and Young People services, including Primary Care, Perinatal and Prison settings. Some of the positive experiences we have heard about the programme include:

Service User: “This service quite literally changed my life. Lucy^[6] was fantastic –she availed my fears, provided reassurance, was proactive in supporting me and crucially, encouraged me to have the confidence to tackle my worries by myself. I think having the clinical knowledge alongside the therapeutic skills really helped make this an extra special patient centred service.”

Self Help worker who has completed Adult EPP programme and is working in primary care: “Introducing the EPP interventions to the Guided Self-help Service has resulted in an expansion of service and increased access to evidence- based psychological approaches.”

Assistant Psychologist who has completed the Adult EPP Programme and is working in prisons: “My role has protected time to deliver psychological interventions in prisons. Many of the patient population have difficulties with emotional regulation and identifying emotions. The psychological interventions provided are very beneficial in supporting clients to identify their feelings and emotions and explore ways they can manage their emotions. We are able to offer immediate and time-limited input.”

Specialist Midwife: “The Maternity & Neonatal Psychological Interventions service is an acute, hospital-based service for women with mild to moderate psychological difficulties associated with complex pregnancy, birth, neonatal complications or loss and consists of ourselves as specialist midwives, and clinical psychologists. We provide EPP interventions in the perinatal setting. The real value is in a thorough assessment and realistic goal setting and doing as much meaningful work as possible prior to the inevitable disruption of treatment as a result of the birth and early postnatal period”.

Recognising ongoing service need, a Short Life Working Group (SLWG) has been established to progress the implementation of the EPP Programme and consider how this could lead to new job roles being created in delivering psychological interventions in Adults and Children & Young People’s (CYP) psychological services. The aim is to provide additional and complementary capacity that is integrated with current service provision. The SLWG membership includes representatives from Scottish Government, NES, Trade Unions and NHS Employers.

Attract

‘Earn While You Learn’ – Widening Access to Registered Mental Health Nurse Education and Training: A collaboration between NHS Lothian and the Open University, Scotland.

To tackle vacancy gaps, the Royal Edinburgh Hospital and Associated Services (REAS) developed a pilot in partnership with the Open University (OU), School of Health, Wellbeing and Social Care, to increase the numbers of Registered Mental Health Nurses within NHS Lothian by widening access into BSc Honours Degree nursing education to people who may not be able to access nursing through the conventional Student Bursary route.

A recruitment advert for the program went out to a wide range of employment websites with the strap line ‘Earn while you Learn’. he timing of the advert was after local universities had allocated their places, so as not to divert potential full-time students from the traditional entry pathway to student nurse training. The intent was to have 20 Trainees recruited in each academic year.

The response to the programme has been very positive, with interest far surpassing the places available. In 2022 there were 105 applicants for the 20 places available and in 2023, 265 applicants applied, with 23 trainees appointed. Applicants were from a very mixed demography with several already educated to degree level.

These Mental Health Nurse Trainees have been recruited on permanent contracts to vacant Health Care Support Worker posts within NHS Lothian, whilst undertaking their academic study. They are paid at Agenda for Change Band 3 for Parts 1 and 2 of their program and will be paid as Band 4 Assistant Practitioners once they successfully enter Part 3 of the program. Post qualification, candidates would be automatically employed by NHS Lothian into a staff nurse (band 5) post if all requirements are met to be registered with the NMC.

NHS Lothian has met the cost of course fees, clinical educator support and supervision and study leave to attend tutorials. The Trainees also receive 15 hours study leave per 4-week period to support them to complete academic study whilst employed. The program has attracted significant interest from the other NHS Boards in Scotland and there are plans to evaluate the programme going forward. Some of the feedback we heard from trainees include:

“I’d always wanted to be a nurse from when I was younger but had my family and then it was out of my reach. This program is fantastic.”

“I had looked at doing a Nursing degree for years but I could never afford it. I have a mortgage and couldn’t survive on a bursary.”

“I am loving it, I would never have been able to do my Nursing if this didn’t exist.”

The North of Scotland, International Recruitment Model

NHS Grampian are delighted to be working in a collaborative approach with Highland, Orkney and Shetland recruiting internationally educated nurses to our mental health services.

The North of Scotland international recruitment model was established in 2022/3 as a result of successful recruitment and education support of internationally educated nurses within NHS Grampian. The Board’s agreement to maximise the resources, provide a regional consistent approach in recruitment and education aims to support a seamless and co-ordinated approach.

The mental health education programme has been developed locally with input from practice education colleagues to equip all mental health nurses with the knowledge and skills to succeed in their OSCE to progress to entry on to the Nursing and Midwifery Council (NMC) register.

The mental health regional education programme will be facilitated across all NOS Boards taking a blended learning approach of self-directed study, in-person and virtual, together with an OSCE. Led by NHS Grampian’s Practice Education Team, the team work closely with other colleagues in boards to ensure support of all internationally educated nurses throughout their journey.

The education programme and OSCEs will run twice a year with two intakes of nurses. We have just appointed our first cohort, all nurses interviewed were of an extremely high calibre and Grampian will see 5 international nurses starting in November. The nurses as part of the programme with also receive tailored preceptorship and pastoral support throughout.

Employ

NHS Grampian, Action 15

In Aberdeenshire, Action 15 has funded 3 Full-time Band 5 Senior Workers in the Aberdeenshire Mental Health Improvement & Wellbeing Service (Formerly Community Link Workers). This has allowed the service to grow more quickly and has increased the rate and speed at which referrals are processed and appointments offered. During 2022-23 (April-March), there were a total of 500 referrals, 6% were self-referrals and 75% were submitted by GPs and other clinical services. During the first quarter of 2023-24 (April-June), we have processed 150 referrals. Self-referrals have risen from 6% to 50% of referrals, while GP and clinical service referrals have dropped from 75% to 34%.

This puts the service at an increase of 20% in referral rates overall in the first quarter of this year, which is forecast to increase further as we build public awareness and continue to establish and build upon relationships and links with other services and networks.

We have very recently gone live with a public launch of the service and new self- referral pathway. Self-Referrals are now coming in steadily, with a small growth week on week.

The general public are now able to access support for their mental health and wellbeing needs much quicker, and with ease. The reduction in GP referrals and increase in self-referrals evidence that we are alleviating pressure on Primary Care GP Practices by absorbing more of the non-medical/clinical support needs of their patients.

Peer Support, Angus Integrated Mental Health

In 2020, with the provision of Scottish Government funding, Angus Integrated Mental health service shifted the model of mental health care upstream towards prevention and self-management, and developed new roles to meet need at the right time, by the right person in the right place. The service embraced the ethos of no wrong door and no rejected referral and worked with primary care to develop a mental health and wellbeing peer support service in every GP practice in Angus, commissioned from third sector organisations.

Peer support provides easy, quick access to mental health and wellbeing support in people’s local area, and works in a referral triage hub model, where all agencies work together to promote recovery, treatment and support opportunities. This multiagency approach includes primary care, adult mental health, psychology, peers, and substance misuse staff.

The peer worker role is vital in Angus, offering a unique and empowering perspective, and their early intervention is often based on only a few words in a self-referral. During appointments, peers share a range of coping strategies they have used personally or which they have been trained to deliver. The peers offer up to three support sessions, and support access to a range of online, and local community resources, to meet ongoing need. The peers are a key part of the ECS hub, improving access to support, reducing demand on statutory services, supporting prevention and self- management, and meeting the needs of people whose needs may have been missed previously.

Nurture

Lifelines (Nurture and train pillar)

Lifelines Scotland is a national NHS project, hosted by the Rivers Centre for Traumatic Stress in NHS Lothian, working with government, statutory and voluntary partners to support the wellbeing of the emergency service staff and volunteers across Scotland. Lifelines takes a preventative approach and seeks to help people stay well as they work of volunteer in demanding roles.

The project is linked to other national initiatives (including the Trauma Training Plan, suicide prevention, Scotland’s Mental Health First Aid, the Rural Mental Health Forum) and shares Public Health Scotland’s vision of improving mental wellbeing by taking a public health approach.

The Lifelines website www.lifelines.scot has bespoke areas for ambulance, fire, police and volunteer responders. These resources are based on best practice and expert clinical knowledge and provide advice and information for people throughout their career (from recruitment to retirement) and for their family, friends and employers. By July 2023, the website has had almost 40,000 visits.

Lifelines has been working with Police Scotland, Scottish Ambulance, Scottish Fire and Rescue and a range of volunteer emergency responder organisations, to deliver a national training programme in resilience, supporting colleagues and providing Psychological First Aid following trauma. Between May 2021 and June 2023, the small Lifelines training team delivered 553 courses and trained more than 3000 people. Discussions are ongoing regarding the possible extension of the Lifelines project to other sections of Scotland’s public sector workforce. Some of the positive experiences we have heard:

“Opened my eyes into the subject of mental health and being a good manager... insightful and life-saving training”.

“Lifelines’ resilience course gave me tools to manage my mental health and resilience at work”.

“The concept of Psychological first Aid is something I will take forward on to the Incident ground”.

NQN Transitions Programme

The Senior Nurses in Mental Health within NHS Ayrshire & Arran have developed a reflective programme which supports Newly Qualified Nurses during their first year post registration. This programme has evolved from experience of supporting the 2021 NQN cohort where reflection sessions were introduced online to provide professional support throughout the first year post registration.

The Transitions Programme is a structured support programme which compliments local induction supported by clinical areas and the Flying Start NHS® programme. There is recognition that the transition between being a student nurse and becoming a staff can be challenging and stressful, as well as an exciting culmination of three years of academic work and clinical practice. Being supported with these learning opportunities enables Newly Qualified Nurses to feel valued by their organisation investing in them and providing opportunities for development (Ho et al, 2021).

This support begins with meaningful engagement with student nurses whilst they are in Part 3 of their mental health nursing programme. Also recognising that adapting to a new team and a new role within a team makes this a time of insecurity. The outcomes of this initiative are to develop well-supported reflective practitioners who feel confident in their role which is beneficial to patient care delivery.

In the past two years this initiative has evolved from online reflection support where NQNs would drop into more robust reflective development through the use of action learning sets. As Newly Qualified Nurses have attended reflection sessions, they have been encouraged to document their reflection within their eportfolio that will contribute to them developing reflective practice and provide evidence towards revalidation.

Feedback from the NQNs has illuminated the benefits of this process as there are shared experiences and commonalities in this transition time. So, by coming together with one another they feel less isolated and appreciate learning from these shared experiences.

Train

Scottish Government and Local Government, as well as employers themselves, continue to support training of the workforce. This includes but is not limited to:

Mental Health Workforce in Schools: School staff have access to a wide range of nationally and locally available mental health training such as Scottish Mental Health First Aid and ASIST suicide awareness training. In addition, in 2021, we published a professional learning resource for school staff supported by the Mental Health in Schools Working Group and a Whole School Approach Framework to assist in supporting children and young people’s mental health and wellbeing and that of staff in school settings.

National Trauma Transformation Programme: Since 2018, £9.6 million has been invested in a National Trauma Transformation Programme, which provides accessible and evidence-based learning resources, tools, and guidance to support a trauma-informed and responsive workforce. This programme aims to support a workforce who are trained to recognise where people are affected by trauma, alongside policies, systems and services that are designed to reduce barriers and establish a sense of trust, safety, choice, collaboration, and empowerment throughout every aspect.

Police Training: Police Scotland is one of the first police services in the UK to implement mandatory mental health and suicide intervention training for all officers; from probationary Constables up to the rank of Inspector, benefiting the workforce and the communities they serve. In addition, staff in C3 Division (Contact, Command and Control) as a first point of contact receive training in Risk and Vulnerability Assessment. Staff working in custody suites also receive Mental Health Awareness training. Dependant on their role within the organisation, there are additional opportunities to participate in further mental health and suicide prevention training, through the NES / PHS Mental Health Improvement, Prevention of Self-harm, and Suicide resources including SMHFA, ASIST, SafeTalk, DBI Level One sessions, and mental health awareness of Children and Young People through Early Intervention through Education course.

Scottish Ambulance Service (SAS): As set out in the SAS Mental Health Strategy work is underway to address the balance of mental health education, awareness, and attitude for the SAS workforce. This includes:

• Providing staff with appropriate knowledge and skills to feel best prepared to recognise people whilst dealing with their mental health. This will be targeted at all levels from receipt of the call to discharge of the patient.
• Accessing the resources provided through the National Trauma Transformation Programme and supporting all staff to implement a trauma informed approach in the delivery of high-quality care.
• Offering all staff mental health education within a variety of platforms so access can be increased and is appropriate for all staff.

Scottish Prison Service (SPS): As part of SPS’ overall approach to mental health support and trauma informed practice, SPS has worked in partnership to develop a range of trauma related training interventions for senior leaders and, in the first instance, staff working with young people and women. Additionally, a number of NES trauma training products are now also available to the broader SPS staff group via SPS’ online learning facility.

NHS 24 Mental Health Hub: Improving the unscheduled care pathway was a key aim in establishing a dedicated Mental Health Hub within the NHS 24 111 service. The Hub provides a vital service, bringing together frontline staff who are Psychological Wellbeing Practitioners (PWP’s) and Mental Health Nurses. They support people using a psychosocial assessment to either help them self-manage their care needs or direct them to the most appropriate form of support, such as their GP or mental health clinician in their Health Board area. The Mental Health hub provides a compassionate service for any individual calling the 111 service seeking support for their mental health, or if they are in distress 24 hours a day, seven days a week.

In order to ensure staff are appropriately trained and providing appropriate and proportionate advice, all PWP’s receive tailored training. The training covers:

• Suicide prevention and risk management
• Assessment and management of self- harm
• Knowledge and understanding of trauma-based practice
• Recovery and self-management techniques
• Safety Planning
• Distress Brief Intervention
• Sessions covering mental illness including dementia, delirium, intellectual disability, CAMHS and substance misuse
• Mental health specific pharmacy session
• Introduction to mental health services provided by NHS 24

Scottish Government is committed to the sustainability and development of the Hub, investing nearly £5m in 2021-22 and £4.4m in 2022-23 with funding continuing into this year to ensure a safe and sustainable service.

Supporting Children and Young People’s Mental Health has been a high priority for Scottish Government and COSLA. A range of resources were produced under our Children and Young People’s Mental Health and Wellbeing Joint Delivery Board, including a ‘One Good Adult’ resource for those who are first point of contact for a child in need of support, and a mental health resource aligned to the Promise (login required). These can be located via NES’s Digital Learning Map and are relevant to all who work with children and young people, whether in a paid role, or as a volunteer.

Primary care services - mental health and wellbeing: resources have been developed to support staff working as part of a multi- disciplinary team within General Practice. They are intended to support mental health workforce staff contribute to the link worker function within services, by providing a directory of additional sources of help and support, to which people can be connected and signposted and, to compliment the support, assessment, and treatment they will receive from the team. It brings together a range of national resources and tools that support and improve mental health and wellbeing. It includes guidance and learning and development opportunities for staff. We will continue to update this resource and ensure that it promoted to the workforce.

General Practice: Scottish Government are committed to increasing the number of GPs in Scotland by 800, by the end of 2027. The number of General Practice Specialty Training (GPST) places has been increasing, with 135 additional places having been created since 2016. This includes 35 places which are being made available in 2023. Scotland’s medical undergraduate intake has increased by 448 places since academic year (AY) 2015-16, from 848 to 1,296. This represents a 53% increase. Scottish Government’s GP recruitment campaign was launched in June 2022 and targets GPs who are looking to move to Scotland to work in the profession. To help retain the current workforce Scottish Government are continuing to invest in a range of recruitment and retention initiatives so that being a GP remains an attractive career choice in Scotland.

Distress Brief Intervention (DBI) is an innovative approach to reducing emotional pain in people who present in distress. It equips individuals with a range of skills and support to cope with emotional pain, both in the immediate term and for the future. There are two levels in the DBI programme. Level 1 is provided by trained front-line staff, who provide a compassionate response and – where assessed as appropriate – can offer individuals in distress the opportunity to be referred to Level 2. Specially trained staff in third sector organisations, who offer a brief (around 14 days), compassionate, community-based problem-solving intervention, provide Level 2. Two positive independent evaluations Distress Brief Intervention pilot programme: evaluation - gov.scot (www.gov.scot), 2 Introduction - Extended Distress Brief Intervention Programme: evaluation - gov.scot (www.gov.scot) of the programme made recommendations for improvement, including some on the preparedness, training, and development of DBI staff. Work is currently underway to take forward these recommendations. Scottish Government have committed to roll DBI out to all local NHS Board areas by March 2024 and are making strong progress towards that target – as at September 2023, 23 of the 31 HSC Partnerships have DBI live locally, with two more expected to go live in late 2023, and discussions underway with the remaining six.

Employers: In 2022, in partnership with Public Health Scotland. Scottish Government launched a new 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, 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. Public Health Scotland (PHS) helped to develop the content as part of a collaboration with a wide range of partners across the public, private and third sectors.