Adult secondary mental health services - quality standards: consultation

Overview

• We want to hear your views on the draft quality standards for adult secondary mental health services. We have asked a series of questions, and your answers to these will help us write the final standards and develop how we measure if these standards are being met.

What are Adult Secondary Mental Health Services?

• Secondary mental health care services are there to meet the needs of individuals who have longer term or complex psychological or mental health conditions (e.g. Complex trauma, or severe depression) that cannot be met by their GP or other primary care services.
• Secondary mental health care services are usually services which need a referral from your GP or another healthcare service.
• Secondary mental health services are usually made up of community mental health teams (cmhts) and adult in-patient mental health wards.
• Secondary care services may be delivered in the community or in hospital by a team of mental health professionals who have the skills and training to meet people's needs. Examples of these include, Psychiatrists, Mental Health Nurses, Psychologists, Occupational Therapists and other Allied Health Professions as well as Social Workers and Mental Health Officers.
• Integrated Joint Boards and Health Boards are responsible for providing these services.

What are Primary Care Mental Health Services?

• Primary care is all services that provide healthcare in a local area. It is usually delivered by or linked to a GP surgery. These are services that are usually the first points of access for people in the community who are seeking advice or help with a mental health concern.

Context

• Currently, there are no national standards for adult secondary mental health services in Scotland. Both people with lived experience of using secondary mental health services and people who work and volunteer in services have identified this as a barrier in the delivery provision of quality care and support. The development of these standards aims to address this gap.
• Demand for mental health services in Scotland had been growing gradually before the coronavirus pandemic in 2020. The pandemic has made the situation worse. The Mental Health Transition and Recovery Plan (published October 2020) outlines the Scottish Government's response to the coronavirus pandemic. It addresses the challenges that the pandemic has had, and will continue to have, on the population's mental health and wellbeing. It has a key aim of ensuring safe, effective treatment and care of people living with mental illness. It committed us to the development, implementation and assessment of quality standards for adult mental health services.
• We acknowledge that this work is ambitious and will take time to implement. It must compliment other ongoing and interlinking work, such as the creation of the National Care Service (NCS) and the findings from the recently published Mental Health Law Review.
• These standards have been published for consultation in the context of the development of the new Mental Health and Wellbeing Strategy for Scotland. The Strategy provides an opportunity to set out our aims for a high-functioning mental health and wellbeing system and the standards we expect 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.
• For more information on how these standards fit within the wider landscape of principles, standards and frameworks which impact mental health services, please see Annex A.

Aims

We want to support secondary mental health services which enable people to receive the right information, support, care, intervention, or service for their needs, as quickly as possible, with the fewest steps possible.

The aims of the standards for adult secondary services are as follows:

• To let individuals, their families and carers know what they can expect from a secondary mental health service.
• To ensure that person-centred and trauma-informed approaches are embedded within the services.
• To improve experiences and outcomes for people who use adult mental health secondary services.
• To ensure a consistent high quality of service is provided to everyone who needs it. To reduce the scope of unwarranted variation of quality of care.
• To be able to support the improvement of the measurement of the quality of services, in line with standards in order to support improvement.

Process

• Throughout the development of the standards, we engaged extensively with people who use mental health services, the mental health workforce and organisations who deliver mental health services. You can find copies of reports on this engagement alongside this consultation.
• We set up and worked with the Mental Health and Wellbeing Standards Working Group which was made up of people from each of these groups and chaired by someone who had used adult mental health secondary services.
• We have also reported regularly to the Mental Health Quality and Safety Board which is chaired by the Minister for Mental Health and Wellbeing.

Structure of the Standards

The standards are structured around the themes that emerged from engagement with people lived experience of using adult secondary mental health services and the workforce (see attached reports for more detail). The themes are:

• Access
• Assessment, Care Planning, Treatment and Support
• Moving between and Out of Services
• Workforce
• Governance and Accountability

Each theme contains a section which describes what a person can expect when using adult secondary mental health services: "What I can expect". Each section also contains a section which describes how services should be designed and delivered: "How services will support me".

Access and Equalities

A key priority in developing these standards has been addressing the inequalities in outcomes and experiences for people accessing mental health services. We know that access to and experience of mental health support and services is not experienced equally across the population.

We want these standards to support equitable access to mental health care and support as well as equity in the experiences and outcomes of people using services. This is a key focus of our consultation on the standards.

We acknowledge that as we continue to shape these standards, there is more we need to do in terms of listening to and learning from people and member led organisations. In addition, we have undertaken an Equalities Impact Assessment (EQIA) and are using the findings from this to inform our engagement.

Groups of people who experience such inequalities include those with protected characteristics such as sex, gender reassignment, sexual orientation, race and ethnicity, and disability. Often these are the same groups in the population that are systematically disadvantaged in many different aspects of their lives. We also know that some people with neurodivergent differences will experience a higher risk of poor mental health and difficulty accessing the right support.

In addition, individuals living in the most deprived areas report higher levels of common mental health problems and mental ill health (including suicidal behaviour), with lower levels of wellbeing than those living in the most affluent areas. People can also experience disadvantage due to adverse childhood events such as being a victim of abuse, poor housing, traumatic events and poor working conditions. These groups have poorer mental health than others and face greater barriers in getting help.

We also know that people with severe and enduring mental illness are themselves more likely to experience poverty, homelessness, incarceration, social isolation and unemployment. They are also at greater risk of poor physical health and reduced life expectancy.

Therefore, it is important that inequality is not only considered in terms of single characteristics or experiences. In reality, people's lives are multi-dimensional and complex. We all have distinct experiences of inequality that need to be understood. This is known as "intersectionality". Whilst we do not have a complete understanding of intersectional inequalities for mental health, we know we need to do more to understand and improve experiences for people across Scotland.

Measurement

A key aim of the standards is to make them measurable and provide assurance that services are delivering for the people that use them. Making the standards measurable will allow us to understand how they are being implemented and whether they are being met. It will also make it easier for good practice to be shared and for any issues to be identified and addressed, therefore driving improvement in services.

Throughout 2022 and 2023, we will work with partners to ensure that we can measure progress against the new standards, developing a validated self-assessment tool and a set of indicators. We will carry out this work in co-ordination with other related work such as the development of the Mental Health and Wellbeing Strategy. This will ensure that our approach to data and measurement across mental health in joined up, making best use of the data we already collect and minimising the burden on services.

How you can help us / our next steps

In this consultation, we have asked a number of questions about the standards.

On pages 8 to 22 you can find a copy of the draft standards in their entirety.

• Part One of the consultation asks questions about the standards overall.

Parts Two, Three, Four, Five and Six ask questions about specific themes covered in the standards:

• Part Two: Access
• Part Three: Assessment, Care Planning, Treatment and Support
• Part Four: Moving between and Out of Services
• Part Five: Workforce
• Part Six: Governance and Accountability
• Part Seven asks questions about the implementation and measurement of the standards.

Some questions will be of more interest to some people than others. For example, some questions might feel most relevant to people who have experiences of mental health issues, while some questions might be of particular interest to people who provide care and support for those with poor mental wellbeing and mental health conditions.

If you have less time to complete the consultation, you may wish to focus on Part One. This contains six questions which will allow you to feedback on the standards overall. This part of the consultation may be of the most interest to people who have experience of using services.

Parts Two to Six of the consultation ask more detailed questions on each theme and may take more time to complete.

Part Seven contains more detailed and technical questions seeking initial views on how we implement and measure the standards. While we welcome everyone's views across the whole consultation, this part of the consultation may be of most interest to people with experience of working in or running services.

Whether you answer all of the questions, or only some, your views will be carefully considered by the Scottish Government when we are writing the final standards.

We will publish a summary of all of the responses to show what people have said. The final standards will be published in 2023.

Mental Health And Wellbeing Support

We want to hear about people's experiences of mental health and wellbeing, and any support they have received. However, we know that sometimes it can be difficult to talk or write about these experiences, whether they are your own or other people's.

You can respond to any questions in the consultation that you want to. There is no need to respond to them all.

If you are affected by any of the issues covered in this document and need support, help is available.

We have included links to some of those sources of support below.

• Breathing Space / phone 0800 83 85 87
• NHS24 / phone 111
• Mind To Mind
• National Trauma Training Program