Short Life Working Group for Mental Health in Primary Care: report

Annex B - Mental Health in Primary Care Short Life Working Group

Statement of Intent

1. Background

Approximately 1 in 4 people experience a mental health problem at some point in their lifetime and at any one time approximately 1 in 6 people have a mental health problem. Early evidence suggests mental health problems will increase following the Covid pandemic with a disproportionate effect on younger people, women and that a widening of already existing inequalities is likely.

The vast majority of mental health and wellbeing issues can be managed appropriately in the community with self-management, community assets, third sector, primary, community care and specialist mental health services all having a part to play. This can only happen if there is capacity across all parts of the system to support management of problems in a timely way

Approximately 1/3 of GP consultations (c8million/year) have a mental health component and this constitutes a significant workload within practice settings. While some need to access secondary care mental health services, many do not and the limited capacity of specialist services can lead to limits on access through waiting times and rejected referrals.

The Short Life Working Group (SLWG) will set out to describe what an improved range of options in the Primary and Community care settings might look like and how these could be achieved.

2. Aim

To improve outcomes for people with mental health problems and distress within the Primary and Community Care setting.

By Providing a vision of how mental health care could be delivered better in Primary Care and in localities, suggesting models that could be implemented by health and care systems across Scotland.

Possible elements of that vision:

That enhanced services within Primary and Community care sit within a wider system that emphasises the value of self-management, access to community assets and linkage to specialist services where required

That by enhancing access to mental health expertise and resources within the Primary Care setting we will:

• Improve the experience of support and care for those currently already managed in Primary Care through more rapid access to support, within a team that they know and trust, using a shared Primary Care clinical record.
• Reduce the referral burden to specialist services, allowing quicker access to specialist help for those that need it.
• Improve the outcomes for patients through earlier intervention and support.
• Raise awareness and confidence within the wider Primary Care team to support people with their emotional needs.
• Build interfaces with local specialist mental health services (for example, to offer clinical decision support, to plan discharges).
• Build interfaces with local schools, and work collaboratively to support the mental health needs of young people with a common approach and language.
• Support and enable ‘reflective practice’ for all clinicians managing mental health issues, to sustain compassionate practice and reduce professional burnout.
• Ensure that there is capacity to deliver CBT and other initial talking therapies to support patients with mental health conditions such as anxiety, depression and adverse trauma experience and that this can be accessed directly (face to face or digitally) from Primary and Community care or through self-referral.

This will be achieved by embedding mental health professionals, support workers and others with appropriate skills into Primary Care multidisciplinary teams within clusters or localities. Their role will be to directly assess and support people presenting with mental health problems and distress but also to support the wider Primary Care team in managing mental health problems.

Assessment, advice, support or intervention needs to be tailored as appropriate to the person and a range of skills, expertise and knowledge should be available within the team (or easily accessed by the team) to maximise the options available for individuals and facilitate person-centred care.

Mental health workers in the Primary Care team need to be able to directly access advice, support or make referrals to specialist community mental health teams (CMHTs), psychological therapies (virtual and face to face, individual and group), and Distress Brief Interventions (DBI).

Mental health workers within the Primary Care team would work closely with community link workers (CLWs), peer support workers and third sector and voluntary groups to maximise the assets of their local community.

Depending on the mental health resource and expertise available in the team, there would be the potential for training opportunities for practice based staff, community pharmacists and for all others within the cluster or locality (for example case-based discussion, PLT sessions).

Mental Health workers would support GP practices in the management of acute and ongoing mental health and addiction issues and engage with other community resources to achieve this.

The SLWG is tasked with using the expertise of those on the group to agree the vision and illustrate how this could be implemented by citing examples of good practice, and sharing the available evidence base. The group will also make recommendations about workforce that would be required to support implementation of these models and how that might be deployed.

Drafted with input and comments from Carey Lunan and Miles Mack, RCGP, Linda Findlay, RCPsychiS and Alastair Cook, PMO Mental Health

22/09/20