Realising Potential: An Action Plan for Allied Health Professionals in Mental Health

Introduction by the Chief Health Professions Officer

The allied health professions ( AHPs) in mental health are a key part of the workforce and have knowledge, skills and approaches that are highly valued by service users and carers. AHPs help individuals to maximise their potential and enable productive and independent living.

While each profession possesses core specialist knowledge and skills, AHPs collectively share many common attributes, such as a person-centred focus and skills in rehabilitation, which are vital in the pursuit of recovery from mental illness. The vast majority of AHPs offer direct interventions to service users either as individuals or in groups, but increasingly, they also work in partnerships with other disciplines and support services through consultancy.

The AHP "family" represents a diverse group of professions who, as members of multidisciplinary, multiagency teams, provide a wide range of interventions and contributions to promote good mental health and recovery from illness. This constitutes a very important resource for people accessing mental health services, but it also provides a challenge in ensuring that AHPs' skills are profiled and deployed to the maximum benefit of service users.

Some AHPs, specifically those who work in arts therapies, dietitians, occupational therapists, physiotherapists and speech and language therapists, work in core mental health services, with occupational therapists being immersed in mental health issues from their initial preparation for registration and arts therapists studying mental health approaches at postgraduate level. Other AHPs, such as podiatrists, are developing their roles in delivering valuable interventions that enhance people's sense of mental health and well-being and provide specific therapies that support people with mental health problems as part of their day-to-day work in mainstream health services.

Regardless of whether AHPs engage with people with mental health problems as part of their core function in mental health services or meet them as they access mainstream services for other health-related reasons, it is important that we acknowledge the importance of the contribution of allAHPs to improving mental health and well-being and supporting people with mental health problems and their carers. The comments from service users that feature throughout this action plan, and the testimony of those who feature in the accompanying DVD, bear vivid witness to the high value they place on their AHP services.

Need for change

So AHPs play a valuable, sometimes vital, role in mental health. But for too long the focus of their energies and interventions has tended to be in providing services "downstream" in secondary and specialist care settings for people whose mental health problems have become well-established and whose abilities and life opportunities have become curtailed as a result.

These services are important, and the skill and expertise of the AHPs who provide them are fully recognised. But AHPs have an equally important (or arguably even more important) role in focusing "upstream" on people whose conditions or problems are in the early stages. AHPs need to enable these people to keep active, stay engaged with their families, communities and social networks, avoid hospital admission and, where appropriate, remain in employment or continue their education.

The vast majority of AHPs in mental health are sited within the "downstream" services in secondary care and specialist mental health settings. A move towards a more "upstream" approach would therefore call for AHP services to be increasingly accessible to service users and carers in community, neighbourhood and primary care settings, as is shown in Figure 1. This would include enabling service users and carers to access AHP services through NHS 24.

The Way Forward (Figure 1)

An AHP focus on early interventions and timely access, engaging with service users and carers in community and primary-care based situations in addition to secondary care settings and working in partnership with a range of statutory and independent agencies, community-based groups and individuals, will play a big part in helping people avoid the challenges long-term mental health problems produce.

This will involve AHPs looking anew at the pathways service users follow to access their services and reconfiguring them to ensure access at an earlier point in the service user journey.

They should also consider what can only be delivered by AHPs and what contribution can be made by support staff and staff in third sector and community services. AHPs in mental health, with their understanding of the challenges service users face and the potential benefits they would gain from early AHP interventions, are in the best position to carry out this vital task in their own localities and to work with local partners to pilot and introduce change.

The action plan

This three-year action plan provides a blueprint for maximising the AHP contribution to supporting people with mental health problems of all ages, both within mental health services and in mainstream settings. It provides strategic direction for AHPs in mental health and is designed to promote their contribution to the modernisation of mental health services in Scotland.

The action plan's primary aims are to:

• enhance timely access to AHP services for service users and carers
• explore and develop the concept of supported self-management for service users and carers
• promote recovery and strengths-based approaches
• develop partnerships with service users and carers, other disciplines and agencies
• provide leadership for change
• develop the evidence base for practice
• promote mental health and well-being among the population.

It strives to meet these aims through a series of recommendations for delivery at national and local levels. The recommendations value the contributions AHPs currently make, but also recognise the need for transformation in the way the professions work to truly realise their full potential in improving mental health and well-being. They are based on what service users tell us works best for them and what they want from AHPs. And they reflect important national policy objectives in terms of increasing quality, improving access, tackling inequity, promoting self-management and enabling independence.

The action plan is structured around five key areas in which AHPs can have the most positive impacts and make the biggest difference to service users and carers:

• early intervention and timely access for service users and carers
• supported self-management and recovery
• promoting physical health and mental well-being
• designing and delivering psychological interventions
• integrating vocational rehabilitation in mental health.

These areas have been identified following interrogation of the evidence and wide consultation and engagement with key stakeholders - service users and carers, AHPs, professional organisations, service managers and other professionals in health and social care. They build on the rich foundation of existing mental health policy and legislation in Scotland and reflect the well-recognised underpinnings of a quality mental health service - a service-user focus, partnership working and an upstream, early-interventions approach to promoting meaningful and purposeful activity for people with mental health problems and their carers.

The action plan also addresses the underlying infrastructure that is necessary to drive high-quality practice - education and training, strong leadership, evidence-based practice and research.

Recommendations for action by NHS boards, AHP leaders and AHPs are presented. The implementation of these recommendations will mark a very positive step in the quest to modernise AHP services to ensure person-centred, recovery-based and strengths-focused services for service users and carers.

The processes of the action plan's creation are described in Appendix 1 and the membership of the National AHP Mental Health Action Group who oversaw its development is presented in Appendix 2.

Moving forward

The development of this action plan has followed an inclusive process that has been informed by the views, perceptions and aspirations of key stakeholders. I would like to thank everyone who has contributed, in particular the National AHP Mental Health Action Group and the AHP professional organisations who supported its development.

AHPs should now use the action plan to lead the reconfiguration of their services to promote greater efficiency and productivity and better use of resources by maximising the capacity and capability of the existing AHP workforce.

There is wide confidence among the stakeholders involved in the development of the action plan that implementation of the recommendations will result in material benefits for service users and carers. But being confident isn't enough - we need proof. That's why the NMAHP Research Unit is developing a formal framework for measuring impact which, in combination with the Mental Health Benchmarking Project and resources being produced by the Mental Health Collaborative, will enable us to achieve the aims of this action plan over time.

Delivering for mental health (1) is driving change in professional practice towards the adoption of recovery, strengths-based and self-management approaches, and The healthcare quality strategy for NHSScotland (2) demands improved experiences for people accessing mental health services. The aspirations of these key initiatives dovetail precisely with AHPs' ambitions for the people they serve, and they are vividly expressed in the vision for services set out in this action plan, which I commend to you.

I hope you will be as inspired by the service users' stories on the DVD as I am, and I look forward to many more stories of service innovation and personal triumphs supported by the interventions of AHPs across Scotland.

Jacqui Lunday
Chief Health Professions Officer

" I have been using the mental health physiotherapy department at the hospital. My physical health has improved immensely ... I also sleep better. The mood element of my illness is greatly helped with the weekly routine. I suffer less and [do] not [have] prolonged lows ... I knew previously what to do but could not put it fully into practice. "

Service user : Experience of physiotherapy