NHS Recovery Plan 2021-2026: annual progress update report 2024

Mental Health, Dementia, Learning Disabilities and Neurodiversity

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. We recognise that a highly effective mental health system must address all levels of need. Our Mental Health and Wellbeing Strategy published jointly with COSLA in June 2023 has three key areas of focus, Promote, Prevent and Provide. We want to promote positive wellbeing for the whole population, prevent mental health issues occurring or escalating and tackle the underlying causes, and provide mental health and wellbeing support that ensures people and communities have the information, skills and services at the right place and time.

To accompany the Strategy, a Delivery Plan and Workforce Action Plan was published in November 2023 shaped through extensive stakeholder engagement. The Delivery Plan illustrates the work necessary to progress over the next few years to ensure the right support is in place for those who need it.

Despite the current challenging financial context, we will continue to prioritise our vision for mental health and delivery on our targets for Child and Adolescent Mental Health Services (CAMHS) and Psychological Therapies (PT). As the Strategy confirms, meeting the waiting times standard for CAMHS and psychological therapies remains a critical goal. And we will continue to publically report and monitor performance closely and provide enhanced support to those NHS Boards with the longest waits, including commissioning NHS Boards to produce annual trajectories for when they expect to meet the standard.

Investing in our Mental Health Services and Workforce

The draft 2025-26 budget increases the direct programme budget for Mental Health by 1.2% to £270.5 million In the last five years, the direct programme budget for mental health has more than doubled, from £117.1 million in 2020-21, to £270.5 million in 2025-26.

We continue to grow the mental health workforce and have exceeded our commitment to recruit 800 additional Mental Health Workers to A&Es, GP practices, police station custody suites, and prisons. An additional 958.9 whole time equivalent (WTE) Mental Health roles in A&Es, GP practices, police station custody suites, prisons and community settings, were recruited under Action 15 of the Mental Health Strategy 2017-27.

We have exceeded our commitment to provide funding for 320 additional staff in Child and Adolescent Mental Health Services (CAMHS) by 2026, increasing capacity for cases by over 10,000. As at end September 2024, there was 1,490.2 WTE CAMHS staff in post within NHS Scotland, an increase of 59.1% (553.8 WTE) in the last decade and an increase of 8.6% (118 WTE) in the last year.

Improving Access to Services

The Mental Health and Wellbeing Delivery Plan sets out our shift in the balance of care across mental health to ensure a focus on prevention and early intervention in the community, including a focus on providing high quality mental health care in General Practice. We will shortly publish a Mental Health in Primary and Community Care Report on improving access to support, assessment and treatment in primary care mental health and wellbeing services.

Performance does still vary across NHS Boards, and support is being targeted to those Boards not on track to meet the standard, providing access to professional advice, ensuring they have robust improvement plans in place and monitoring their implementation.

Latest data for quarter ending September 2024 for Psychological Therapies shows that one in two people referred are starting treatment within three weeks. This is being closely monitored and support is being targeted to those Boards not on track to meet the standard. At the same time, we are focusing on improving the quality of care in Psychology Services through supporting implementation of the National Specification for Psychological Therapies, published in September 2023.

Psychological Therapies waiting times statistics covering quarter ending September 2024 show that 80.0% of Psychological Therapy (PT) patients started treatment within 18 weeks of referral in the quarter ending September 2024, an improvement from 79.4% in same quarter in the previous year

We have expanded the number of digital therapies available to a total of 35. Our pilot on the use of digital therapies in prisons continues, developing a best practice model. We are expanding the use of cross-border group therapies using video conferencing, allowing people to access group mental health sessions with people beyond their own NHS Board. We are working with a digital inclusion project to see how digital inclusion could be incorporated into mental health service design. We are engaging with lived experience and stakeholders to determine how our digital mental health offer can be expanded to address unmet needs and support clinician capacity.

Driving improvement

In September 2023, we published core standards for mental health to support general adult secondary mental health services. To help service providers implement and meet these standards, we developed and piloted an assessment tool in Spring 2024. HIS is now using this tool to carry out local self-assessments on implementation of the standards with boards over winter.

Supported by additional investment from the Scottish Government, NHS 24’s Mental Health Hub has continued to increase its workforce capacity. This has allowed average waiting times for support to reduce from their peak of 20 mins in February 2021 to under 3 mins over the last 12 months.

The Mental Health Hub continues to operate a 24/7 compassionate national service. It is staffed by Psychological Wellbeing Practitioners who triage people using a psychosocial assessment to either help manage their needs or direct them to the most appropriate form of support such as their GP, community psychiatric nurse, the 999 service or local emergency department. We continue to:

• explore opportunities to increase the number of care outcomes available to the NHS Mental Health Hub;
• support the integration of NHS 24’s mental health services and digital offers;
• continue to deliver the award winning, Enhanced Mental Health Pathway to allowing calls to Police Scotland and the Scottish Ambulance Service to be directed to the Hub when callers require mental health support.

All Boards are providing local clinical support to Police Scotland. The number of Boards offering this clinical support to the Scottish Ambulance Service has increased over the last year. This allows first responders to provide improved care, closer to home, without the need to convey an individual to the emergency department.

We will continue to increase awareness of available pathways into support and care and develop tailored messaging for specific population and equalities groups during the next reporting period.

We also published a scoping report on the feasibility of implementing an additional safe space as an alternative to people being conveyed to an Emergency Department (ED) when in crisis and the use of ED as a legal place of safety in October 2024

Dementia, Learning Disabilities and Neurodiversity

We have invested over £9.5m over the last 3 years in Dementia Post Diagnostic Support, in addition to the routine spending on dementia support services by local partnerships. We have invested in community supports, providing additional funding of £1.5m over three years to Age Scotland to expand and sustain locally led support. We are committed to enhancing the quality and impact of post diagnostic support (PDS). An independent evaluation of Scotland’s PDS policy and delivery will be carried out over 2025-2026. The evaluation will support decision making regarding the future direction of national PDS policy and/or the modification and widening out of existing PDS service models. It will also enable us to evidence the potential for improvements to access, uptake and quality.

The adult neurodevelopmental pathways report was published last year. Ministers accepted the recommendations within the report. The recommendations set out the steps required to establish local neurodevelopmental pathways for support and diagnosis. We are working with NAIT on the implementation of the recommendations. We are working with NHS Boards to improve access to diagnosis, by upskilling health professionals on ADHD and supporting local health partners to develop, enhance and redesign existing local neurodevelopmental services.