Mental health - distress framework for collaboration: multi-agency partnership approach

3. Introduction

Poor mental health and wellbeing has a significant impact on individuals and on those around them, including the services they often turn to for support. Mental health is as a cross-government priority, building on the partnership between the Scottish and Local Governments. We recognise a huge range of factors can contribute to our mental health and wellbeing, including poverty, employment, housing, our communities and many more. Evolving evidence on intersectionality also highlights that people are not homogenous and that different experiences or aspects of their identity can interact and combine to affect their mental health in ways that are not the case for everyone.

Work to promote positive and reduce poor mental health and wellbeing has been underway at a national and local level for a number of years. It is aimed at supporting individuals and ensuring the range of support, care, and treatment required is available. This includes improvements to the mental health unscheduled care pathway and response, ensuring that people seeking urgent or unplanned mental health support receive the right care, in the right place, at the right time, regardless of how or what time of day they access that support – there should be no wrong door.

We know that individuals experiencing distress or crisis, and who may need an unplanned assessment and care, tend to seek a response from a service that is not best placed to meet their needs. This might be from emergency services, a clinical healthcare setting such as an emergency department, or wider community-based supports and services. Supporting individuals to get the right care they need in a person-centred and trauma-informed way is critical and of high importance for all partners involved.

In developing this Framework, we built on the work already achieved as well as work currently underway through the Mental Health Unscheduled Care Network (Annex B) by bringing together and aligning existing and planned improvements to the mental health unscheduled care response. We also reflected on the feedback heard from partners, those delivering services, and those with lived experience of current provision.

Through this Framework we want to promote a multi-agency collaborative approach to improving local distress pathways, with the person-centred, trauma-informed and no wrong door principles at the heart of the improvement. This is why we see this Framework of being of particular interest to agencies and services supporting the mental health and wellbeing of their local communities, including mental health services, emergency services (such as the ambulance service and policing), and third sector organisations, particularly those working in the early intervention and prevention space. Recognising that many people experiencing distress need help accessing non-mental health services that contribute to improved mental health and wellbeing, this Framework will also be of interest to partners providing social care, social work, housing, and drug and alcohol support – just to name a few.

We envision that the work achieved through the Mental Health Unscheduled Care Network and the approaches set out in this Framework will provide assistance for these partners to discuss, agree, and implement local distress pathways that ensure that the individual receives the support they need from the most appropriate agency or provider as soon as practicable.

The aspiration that services work together across boundaries to connect people with the service(s) that meet their needs, thereby improving the person’s care outcome, is one we all share. We know, however, that the right service to meet the person’s need might not be available at the point of their distress; or it simply may not exist either in the local or national mental health unscheduled care pathways. We also recognise that current pressures across services mean that the existing services may also be unable to support the person at the time of their presentation. This is why positive collaborative behaviours, agreed processes, and joint training between agencies and services are important. While these will not resolve the wider issues, our aim is that the principles and processes outlined in this Framework will contribute to minimising boundaries as well as building relationships and trust between services and agencies, ensuring in turn that the individual’s experience of accessing support for their distress is improved.

Lastly, it is our aspiration that the Framework’s approach to creating multi-agency fora to discuss local pathways and process provides a solid foundation on which to implement the guidance and recommendations resulting from the national review of Psychiatric Emergency Plans.