NHS recovery plan

Mental Health

Growing demand for mental health services was a challenge pre-Covid, but the pandemic has exacerbated this. As a result, record levels of funding are being invested to support recovery, tackle backlogs in care, focus on prevention and early intervention, and transform services.Our recovery will build on the responsive and innovative work undertaken across Scotland, including by the NHS, throughout the crisis. This will be supported by strong relationships and engagement with the voice of lived experience, staff and other key stakeholders (including the third sector).

This Plan commits to ensuring that at least 10% of frontline health spending will be dedicated to mental health with at least 1% directed specifically to services for children and young people by the end of this parliamentary session.

As a response to national lockdown, mental health staff developed new ways to ensure people were supported.Services were moved online, and telephone and video consultations replaced much face to face interaction. Over the course of the pandemic, there was a dramatic expansion in the use ofNear Me Online Video Health Consultations and Video Enabled Therapy. Over 6,300 video therapy consultations per week were conducted through Near Me in the last 12 months, compared with 700 prior to the pandemic.

A range of digital mental health services, including self-guided computerised Cognitive Behavioural Therapy, were developed in response to Covid.Feedback suggests that many patients prefer the convenience of digital access, although face to face treatment will always be needed and preferred by some. We will further expand the use of digital and telephone services and lock in new service innovations that have delivered good outcomes for people and ensured continuity of service provision.

Our Mental Health Transition and Recovery Plan is backed by a £120 million Recovery and Renewal Fund over 2021/22 – the single largest investment in mental health in the history of devolution. Our aim is to kick start a transformation in the support available for good mental health. The Plan contains over 100 actions, which focus on four key levels of need:

• Promoting and supporting the conditions for good mental health and wellbeing at population level.
• Providing accessible signposting to help, advise and support.
• Providing a rapid and easily accessible response to those in distress.
• Ensuring safe, effective treatment and care of people living with mental illness.

The Transition and Recovery Plan also commits to a trauma-informed approach to support the recovery from the pandemic. Abuse, neglect and other traumatic and adverse experiences, particularly those experienced in childhood, can have devastating effects on people's lives. Without the right support, adverse childhood experiences (ACEs) and trauma can result in poorer physical and mental health, and poorer educational, employment and justice outcomes. Actions on children's rights, child poverty, keeping 'The Promise' and Getting It Right for Every Child are being taken to better prevent and mitigate ACEs, as well as action to support adults negatively affected by their early life experiences or trauma experienced in adulthood. We have extended the National Trauma Training Programme for a further two years, to 2023, to facilitate trauma-informed workforce and services.

Allied to the Transition and Recovery Plan are separate plans covering dementia, learning disability and autism.

Despite the huge effort by frontline staff over this period, there is still a significant and growing backlog of children and young people waiting too long to access treatment from Child and Adolescent Mental Health Services (CAMHS). The number of children and young people waiting more than 12 months has tripled in 2020 – this is mostly those needing face to face treatment. While the number of referrals to, and the numbers starting, treatment in psychological therapies (PT) and CAMHS services were similar to pre-Covid levels in the first quarter of 2021, frontline service anticipate a rise in referrals as schools return.The direct impact on children and young people's wellbeing continues to be researched, however we recognise the potential for this to be significant, particularly for those children and young people who were already vulnerable.

To create transformational and lasting change, we will provide sufficient funding for around 320 additional staff in CAMHS over the next 5 years, with the potential to increase capacity for CAMHS cases by over 10,000. We have also already invested over £34 million of the Recovery & Renewal Fund to significantly improve access to, and the quality of, CAMHS services. This includes implementation of the CAMHS service specification, increasing age range for CAMHS services from 18 to 25, and clearing waiting lists in both CAMHS and Psychological Therapies by March 2023.

We will also use the Recovery & Renewal Fund to:

• Invest in Primary Care. By 2026, every GP Practice will have access to a mental health and wellbeing service, creating 1,000 additional dedicated staff who can help grow community mental health resilience and help direct social prescribing.
• Invest in digital service capacity. Over the next year, we will begin work on an expanded Digital Mental Health Programme, building on the substantial progress already made. This will include continued scaling up of new digital treatments and therapies, ensuring these are also accessible in rural areas, increasing the ability to self-refer to some Computerised Cognitive Behaviour Therapy treatments and establishing a Mental Health Innovation Hub to encourage the development and evaluation of technologies focused on the identified needs of the population.
• Initiate work to developa set of quality standards for all Adult Mental Health services so that people know what they can expect from their NHS services
• Support the needs of people with dementia to live well, including post diagnostic support. We will provide additional funding for dementia post-diagnostic support, to expand access to front-line services and to strengthen and support wider dementia community projects which benefit people with dementia and their families after a diagnosis.
• Develop our work on mental health and adult neurodevelopmental pathways to support people with a learning disability, autism and ADHD.

Progressively, from now until end 2022/23 we will also:

• Deliver a range of service improvement to CAMHS;
• Transform the integration of mental health within the unscheduled care setting by enhancing pathways for mental health presentations.
• Eliminate long waits for CAMHS and Psychological Therapies;
• Achieve our target of 90% of people referred to CAMHS and Psychological Therapies being seen within 18 weeks.

Over 5 years we will:

• Increase direct investment into Mental Health to ensure that 10% of frontline NHS budget is invested in mental health, with 1% directed specifically to children and young people'

Through the delivery of this programme of renewal, we will ensure our mental health services emerge stronger from the pandemic,with care and treatment being delivered effectively, safely, and in a timely fashion for anyone who needs it.