Psychological therapies and interventions specification: consultation analysis

1 Introduction

Introduction

In December 2022 the Scottish Government launched the consultation ‘Delivery of psychological therapies and interventions: national specification’. The consultation ran for 13 weeks and EKOS Ltd, an independent research consultancy, was commissioned to analyse the responses received. This report presents the findings from that analysis.

Background

Context

Psychological therapies and interventions are evidence-based techniques used to promote good psychological health, prevent psychological ill health, and provide mental health interventions. These techniques can help people make changes to their thinking, behaviour, and relationships to reduce distress, treat mental health difficulties, help manage emotions, and improve wellbeing.

Psychological therapies and interventions are delivered in a broad range of health, social care, and third sector settings in Scotland; across all ages and a diverse range of needs. The settings where psychological care may be delivered include adult mental health services, education, and community settings.

Psychological care refers to all psychological therapies, assessments and interventions delivered through self-help, by individuals or specific psychological teams or services. This care can be delivered in person, in groups and remotely and/or digitally.

The psychological care workforce can be categorised into four practice types:

• informed practice – this workforce requires to have knowledge and skills in recognising psychological issues (for example, a support worker identifying distress through a trauma-informed conversation with an in-patient who has cancer and informing the ward nurse)
• skilled practice – this workforce requires skills to deliver psychologically based education courses, as well as have good communication and listening skills (for example, a clinician providing support and education about anxiety and sleep in conversations with adults in a prison setting)
• enhanced practice – this workforce provides psychological assessment and treatments that have proven effectiveness as indicated in the Scottish Psychological Therapies Matrix (for example, an occupational therapist delivering evidence based cognitive rehabilitation with someone in a social care setting)
• specialist practice – this workforce requires formal training to develop expertise in at least one psychological therapy (for example, delivery of trauma focussed Cognitive Behavioural Therapy for people who have Post-Traumatic Stress Disorder and depression by a Clinical Psychologist)

The Scottish Government aims to ensure that there is a well-functioning psychological care system, which helps people to receive the right information, support, intervention, or service appropriate for their needs and to make an informed decision relating to their own care and support. However, it is acknowledged that currently not everyone has the same experiences or outcomes when they engage with individuals, teams or services when receiving psychological care.

Currently, there is no national specification for the delivery of psychological therapies and interventions in Scotland. People with lived experience of accessing psychological therapies and interventions and people who work and volunteer in services, have identified this as a barrier in the delivery of quality care and support. The development of this specification aims to address this gap.

Alignment with existing strategies, plans and workstreams

Demand for psychological therapies and interventions in Scotland had been growing gradually before the coronavirus (COVID-19) pandemic in 2020. The pandemic has exacerbated the situation. The Mental Health Transition and Recovery Plan (October 2020) outlines the Scottish Government’s response to the pandemic.

This Plan addresses the challenges that the pandemic has had, and will continue to have, on the population’s mental health and psychological wellbeing.

The Plan has a key aim of ensuring safe, effective treatment and care of people living with mental illness, and committed the Scottish Government to the development, implementation and assessment of the National Standards for Adult Secondary Care Mental Health Services. The Minister subsequently tasked the development of a national specification for psychological therapies and interventions.

The Psychological therapies and interventions specification has been published for consultation in the context of the development of the new Mental Health and Wellbeing Strategy for Scotland which is due to be published in June 2023. The Strategy will set out the Scottish Government’s aims for a high-functioning mental health and wellbeing system and the expected standard of services within that system to deliver. Measurement of the standards will provide indicators that can form part of our evaluation and monitoring of the Strategy and Delivery Plan.

The specification also complements other ongoing and interlinking work, such as the:

• creation of the National Care Service (NCS)
• the findings from the Mental Health Law Review (2022)
• the consultation relating to the Quality standards for adult secondary mental health services, which closed on 17 March 2023

Involvement of people with lived experience

Throughout the development of the national specification, the Scottish Government engaged extensively with people who use psychological care services and mental health services, the psychologically trained workforce and organisations who deliver psychological care. The reports were published alongside the consultation paper as supporting documents.

The Heads of Psychology Groups Scotland (HOPS) provided expert advice to support the development of the national specification.

The Scottish Government set up and worked with the Mental Health and Wellbeing Standards Working Group which was made up of people from each of these groups. The Working Group was chaired by someone with lived experience of psychological care and mental health services.

The Scottish Government also reported regularly to the Mental Health Quality and Safety Board which is chaired by the Minister for Mental Health and Wellbeing.

The consultation

The national specification is structured around seven overarching outcomes, which people with lived experience of accessing psychological therapies and interventions and the workforce were consulted on, Table 1.1.

A key priority in developing the national specification is to address the inequalities in outcomes and experiences for people accessing psychological therapies and interventions. The evidence base shows that access to and experience of psychological care and support is not experienced equally across the population. The specification has been developed to support equitable access to psychological care and support as well as equity in the experiences and outcomes of people using services.

The consultation sought views on a number of questions about the national specification. The feedback from the consultation will be used by the Scottish Government to write the final specification and to develop how it will measure if the specification is being met.

A standalone executive summary has been prepared that highlights cross-cutting themes arising from this consultation and the Quality standards for adult secondary mental health services consultation.