Mental health: PfG delivery plan

Taking a 21^st Century Approach to Adult Mental Health

Across Scotland, the demand for services reflects both the spectrum of mental health – ranging from good mental health to severe mental illness – and the nature and understanding of the type and availability of services. It is vital that the full range of adult mental health services is considered in a coherent and complementary way. The traditional approach of moving through levels of health professionals – potentially resulting in specialist hospital mental health service – will continue to be appropriate for some. By putting in place a much broader range of services, we will ensure an approach that is preventative, built on the principles of early intervention and the right treatment at the right time.

The work being progressed in children and young people's services will deliver a significant dividend in the years to come as the benefit of treatment and support becomes clear. However, we know that for some, their needs will continue for many years and will require significant specialist support and timely access to these services.

We must ensure that our broader healthcare services, community services and our wider society are promoting and helping people across Scotland to maximise their mental good health. Our investments in primary care transformation, the pilot work on Distress Brief Interventions, the improved access to mental health workers in key community and others settings, and our commitment to seeing the delivery of the access waiting times standards are important drivers of this change.

Alongside this work, we must help people across Scotland to benefit from digital services. Services such as NHS Inform, Breathing Space, or computerised Cognitive Behaviour Therapy can be standalone services in their own right, work alongside other support or simply help to point people to other services.

Case study
NHS Lanarkshire Psychological Therapy services are aiming to have 90% of primary care referrals to its Airdrie and Coatbridge service offered telephone screening within ten working days of opting into the service. The changes being tested include patients receiving a telephone call from a skilled clinician, instead of the traditional appointment. After the call, patients are then signposted to the most appropriate service for their needs, which may include one-to-one or low-intensity group-based approaches. Initial results suggest that clinician time has been reduced as a result.

Getting the right help quicker

Public awareness and education

A key aspect of reform is the skills and capacity of our workforce across Scotland. In some areas this will mean continuing to support people across our communities to recognise and respond to mental health problems, both their own and those of friends and families. This will include population-wide work that will continue to deliver reductions in the number of people completing suicide, and the work being done to encourage individuals to reach out to access support services (typically of a listening or talking therapy nature). Elsewhere it will mean ensuring that people in distress are quickly and appropriately supported.

Our investment through the Mental Health Strategy to improve access to mental health workers in key settings including Accident and Emergency, prisons, custody suites and GP practices will underpin this important evolution in how services respond. We will work with the new Scottish public health body once it is established to develop both general and more targeted approaches to ensuring that these messages on mental health are embedded across services and brought to the public more comprehensively.

In addition, we willmake mental health and suicide prevention training mandatory for all NHS staff who receive mandatory physical health training. This includes doctors, nurses, psychologists, allied health professionals as well as pharmacists. This will be taken forward through the Suicide Prevention Action Plan and will start with the creation of a general education and training resource by May 2019.

Strengthening the content of current self-help platforms

Action
We will strengthen the content of current self-help platforms provided through NHS Inform.

NHS 24 offers a range of self-management tools and information, which have the potential to be further developed. This work aims to increase access to quality-assured self-management information, services and tools through the use of NHS Inform. It will provide streamlined access to online resources and support, making it simpler for those accessing information and resources.

NHS 24 will continue to enhance and refine its digital offering in relation to mental health by developing additional self-help online resources. This will include phased integration of the existing Moodjuice Self-help site into the current NHS Inform site beginning in January 2019. Phase 1 (focusing on depression and anxiety) will be completed by March 2019, Phase 2 (focusing on remaining content and resources) by March 2020, and the final phase of development will be completed by June 2021.

Enhancing the handling of mental health calls to the 111 service

Action
We will enhance the handling of mental health calls to the 111 service with more specially-trained staff providing specialist mental health advice.

NHS 24's 111 service provides a Scotland-wide phone triage service for people or carers seeking urgent health advice out of hours. There are currently a small number of dedicated mental health nurse practitioners working in 111, handling around 20% of the mental health calls received. We are committed to enhancing the handling of mental health calls to the 111 service with more specially-trained staff, and improved routing of mental health calls. This will deliver a better journey for those accessing the service, reducing the need for onward referral by ensuring people get the right help at first point of contact.

Work is already underway to build and grow a mental health 'hub' model within the 111 service to route those accessing the service for mental health to an appropriate mix of skills and access to pathways for onward care as needed. The mental health hub will be developed from February 2019, and evaluated before the model is extended from July 2019.

Improvements in primary care

Learning from the primary care innovation work across Scotland is being analysed by both the Scottish School of Primary Care and Healthcare Improvement Scotland, and a report will be delivered in early 2019. A model of better mental health provision in primary care is already being rolled out across Scotland. This will result in:

• a better informed public with easier access to information and self-referral;
• all members of the primary care team with mental health awareness and training to the optimal level of their role;
• specialist mental health workers assessing and treating mental health problems directly in all primary care teams, while linked to local secondary mental health care; and
• link workers in every primary care team involved in listening, problem solving, signposting and early intervention public health for people with physical, mental and social problems, working across the whole person.

Case study
NHS Lanarkshire and its North and South Lanarkshire Health and Social Care Partnerships have shown increased patient and GP satisfaction from placing six mental health liaison nurses in five GP practices in 2018. The mental health nurses take direct referrals for assessment and treatment, signposting and support. Patients are seen faster, there has been a reduction in antidepressant use and GPs have reported a reduction in their workload.

Better access to valuable support

Trialling an NHS 24 Breathing Space webchat service

Action
We will trial improvements to the NHS 24 Breathing Space service by introducing webchat with an NHS 24 adviser.

Breathing Space is a confidential phone and web-based service for people in Scotland experiencing low mood, depression or anxiety. The service aims to give people support to help improve their present situation and so prevent the development of more serious problems. In 2017/18 Breathing Space call demand was 92,000, with a year-on-year increase in demand. We are committed to trialling improvements to the NHS 24 Breathing Space service by introducing webchat with an NHS 24 advisor.

We will implement the commitment through recruitment for additional Breathing Space advisors, which is underway. This will provide additional capacity to respond to increasing demands on the service, as well as capacity to trial web-chat access to the service. A key element of the trial will be to understand likely demand for the webchat. Following evaluation, webchat availability will be expanded from September 2019 onwards.

Enhancing digital services provided by NHS 24

Action
We will help those with mild to moderate depression by introducing more widespread on-line access to Cognitive Behavioural Therapy.

NHS 24 will continue to improve its digital services supporting mental health, including extending access to online access to Cognitive Behavioural Therapy, trialling development of video conferencing for speciality clinics, and development of additional self-help online resources. In April 2018, NHS 24 successfully completed national roll out of computerised Cognitive Behavioural Therapy (cCBT). This provides a service for adults with mild-to-moderate depression and anxiety who require flexible treatment, which can be accessed from different locations at a time that suits them.

We are committed to introducing more widespread online access to cCBT through self-referral and extension of the service to targeted groups, including adolescents. From October 2019 NHS 24 will develop self-referral access to cCBT and the use of cCBT services for adolescents. This will include work to engage with potential users, and research and marketing activity to raise awareness of the service.

Improving access to psychological assessment and therapies in rural areas

Action
We will improve access to psychological assessment and therapies in rural areas through the use of technology such as video-conferencing.

As part of the broader programme of work to enhance digital services, NHS 24 will roll out video-conferencing clinics trials between October 2019 and March 2020. This will be evaluated alongside other changes to digital services in order to develop more detailed plans for improved services.