Psychological therapies and interventions specification: consultation analysis

Executive summary

Introduction

1. This document provides a summary of the consultation analysis of the Delivery of psychological therapies and interventions: national specification. As the consultation document contained a large number of questions this summary provides a high-level overview of the main findings.

2. The public consultation, which ran for 13 weeks from 14 December 2022 to 17 March 2023, received 95 validated responses. There was a relatively equal split of responses from individuals and organisations. The consultation attracted responses from a wide range of organisations, including: Health Boards, Health and Social Care Partnerships (HSCP) and services; mental health organisations; and organisations who support specific target groups.

3. The consultation was supplemented by several in-person and remote stakeholder events.

The consultation

4. The consultation was split into nine sections, with most structured in the same way (that is they contained the same closed-questions). In the main, this shows that a majority of consultation respondents agreed or strongly agreed that the specification:

• will improve the experience of people using services
• will improve outcomes for people using services
• clearly set out to individuals, their families and carers what they can expect from psychological care
• will help to meet everyone’s needs regardless of their background

5. In some cases feedback to closed-questions was mixed – for example, some questions attracted a relatively high proportion of “neither agree nor disagree” responses.

6. The following sections outline any additional qualitative feedback from respondents (that is, feedback that is not described above in the repeated points sub-section).

7. More specific feedback on individual statements is provided in Appendix D.

Key themes

8. Several themes emerged from the consultation responses leading to considerable repetition of points and views. Rather than repeat these themes throughout the summary, they have been summarised below.

The specification

• further clarity, detail, guidance and consultation was requested on how the specification would be operationalised, monitored, and audited – that is, what services they are intending to apply to, what needs to be in place to implement and measure the specification, and how the Scottish Government would ensure compliance and independent assessment

• there was a request for the outcomes within the specification to be clear, concise, appropriately described and defined, specific, measurable, and easily understood

• any terms used within the specification should also be defined, consistent and not interchangeable (for example, “care”, “support” and “treatment”)

Resources

• budgetary pressures and workforce challenges (for example, staff shortages, recruitment, retention, diversity, supervision, wellbeing, morale, burnout) mean that constrained resources may make it difficult for services to achieve the specification’s outcomes
• adequate and sustained financial resources and other support (for example, training and digital infrastructure/support) is needed to build capacity and capability within the workforce
• some outcomes and statements within the specification may also raise expectations of delivery of care which cannot currently be met. While the specification is aspirational it must also be achievable, and consideration could be given to where additional resource is required in order for the outcomes to be achieved

Services and service providers

• person-centred, collaborative care and holistic approaches are viewed as a key component of the delivery of psychological care
• inclusive information and communication was considered essential

• there could be more effective interfaces and improved information sharing, communication and collaborative working between services and professionals in the public and third sectors
• there could be more explicit reference to the role of primary care across the specification (for example, general practice and community pharmacy) as this is usually a person's first point of contact – this could include how the specification would interface with primary care, and how roles in primary care could complement psychological care services
• it was considered imperative that the specification seeks to understand the wider social determinants of health in seeking to reduce inequalities in mental health (for example, housing, income levels, education, access to transport) – but also recognise that these factors are complex and largely outside of the control or influence of psychological therapies and interventions

People with lived experience

• the specification needs to continue to foster a change in attitudes - people should be supported and empowered to be equal partners in their own psychological care

• the views, experiences, and priorities of people who use psychological therapies and interventions, their families and carers, and the workforce should remain connected to service development and policy

Feedback on the overall aims of the specification

9. Some respondents provided suggestions for how to ensure timely access to psychological therapies and interventions for people, including that:

• the specification should take into account that some groups of people face more barriers to accessing services – for example, older people, ethnic minorities, people with substance use issues, people with learning disabilities
• there needs to be clear referral processes from GPs and other practitioners, as well as a greater understanding of the broad range of psychological therapies and interventions available

10. Suggestions to improve accessibility and readability of specification included that more accessible and inclusive information and communication was needed – in plain English, in different languages, and in other accessible and user-friendly formats (for example, it could be presented visually using video, animation and/or infographics).

Outcome 1: High-quality care and support that is right for me

11. Around two-thirds of all consultation respondents who answered the question either agreed or strongly agreed (65%) that the statements within Outcome 1 will help to make sure that individuals get the right support that they need, all delivered by appropriately trained professionals.

12. The main qualitative feedback aligned to the key themes presented earlier, as well as specific and detailed comments on the individual statements contained within Outcome 1.

Outcome 2: I am fully involved in decisions about my care

13. There was mixed feedback on whether the statements within Outcome 2 will help to support collaboration between professionals – almost half of all consultation respondents who answered the question either agreed or strongly agreed (45%). A similar proportion (43%) neither agreed nor disagreed and the remainder disagreed.

14. Additional feedback from respondents on Outcome 2 was that there could be more explicit reference to improved collaboration between professionals.

Outcome 3: High-quality interventions and treatments that are right for me

15. There was slightly mixed feedback on whether the statements within Outcome 3 will help to make sure that the best results are achieved for individuals – over half of all consultation respondents who answered the question either agreed or strongly agreed (55%). A relatively large proportion of respondents neither agreed nor disagreed (29%) and the remainder disagreed.

16. Similar to other Outcomes, much of the feedback from respondents chimed with the key themes presented earlier as well as comments on specific statements within Outcome 3. Where additional feedback was provided, a few respondents felt that there could be more emphasis within the statements on the linkages to the broad range of professions involved in service delivery (for example, occupational therapy).

Outcome 4: My rights are acknowledged, respected and delivered

17. Almost three-quarters of all consultation respondents who answered the question either agreed or strongly agreed (72%) that the statements within Outcome 4 will help to support individuals to be an equal partner in their care and make sure that values, rights-based, and person-centred approaches will be embedded in all practice.

18. In addition to raising key themes and providing feedback on specific statements within Outcome 4, other themes raised to a lesser extent included:

• that effective implementation of Outcome 4 may require greater knowledge and awareness of rights for people when they seek to access psychological care
• a human-rights based approach should be adopted where every person is treated with respect and dignity
• the importance of informed consent and care planning

Outcome 5: I am fully involved in planning and agreeing my transitions

19. Almost two-thirds of all consultation respondents who answered the question either agreed or strongly agreed (63%) that the statements within Outcome 5 will help to support a smooth transfer of care and make sure that it is effectively planned, communicated, and implemented – a relatively large proportion of respondents neither agreed nor disagreed (31%) with this statement and the remainder disagreed.

20. In addition to raising key themes and providing feedback on specific statements within Outcome 5, some respondents emphasised the importance of ensuring smooth transitions between Children’s Services and Adult’s Services.

Outcome 6: We fully involve people, their families and carers

21. The majority of all consultation respondents who answered the question either agreed or strongly agreed (71%) that the statements within Outcome 6 will help to ensure that services work in partnership with people, their families, and carers to shape aspects of service design, delivery and review.

22. Where additional feedback was provided on Outcome 6, some respondents highlighted:

• that there could be greater consideration of abusive/coercive family and carer relationships
• the need for, and importance of, support and resources for families and carers of people who access psychological therapies and interventions

Outcome 7: I have confidence in the staff who support me

23. Almost two-thirds of all consultation respondents who answered the question either agreed or strongly agreed (64%) that the statements within Outcome 7 will help to support service delivery and staff wellbeing to make sure workloads are shared, fair and clear where specialist and enhanced practice types of care are offered.

24. Where additional feedback was provided, some respondents felt that a culture change may be required within the psychological workforce and psychological therapies to ensure the deliverability of Outcome 7. It was felt that this could address any stigma that affects both people with mental health issues as well as the attitudes and behaviours of clinicians.

Implementation and measurement

25. To support services implement the seven outcomes of the specification respondents suggested that there was scope to improve communication, collaboration and coordination between services – including greater consistency in how (and what) information and data is collected, recorded, reported and shared.

26. For example, when asked what could reduce inequalities in the outcomes and experiences of people who use services, some organisations felt that relevant and detailed equality and diversity information and data should be routinely collected and reported on.

Self-assessment tool

27. Around two-thirds of all consultation respondents who answered the question either agreed or strongly agreed (64%) that the specification should be measured using a validated self-assessment tool – a relatively large proportion of respondents neither agreed nor disagreed (26%) and the remainder disagreed.

28. Some respondents were concerned that a validated self-assessment tool may increase the administrative burden on services and the workforce.

Indicators

29. The vast majority of all consultation respondents who answered the question either agreed or strongly agreed (86%) that the specification should be measured using a range of indicators.

30. Similar to the self-assessment tool, qualitative feedback highlighted that data collection and reporting on indicators should not place added burden on services and the workforce.