Mental health and wellbeing in primary care services: resources

1. Learning and Development Opportunities for Staff

1.1 Introduction

This section contains information on learning, development and training opportunities for staff working in a Mental Health and Wellbeing in Primary Care Service.

You can work through the resource on your own, reading the different sections and following the links which are of interest to you and relevant for the people you are working with.

1.2 Trauma-informed Practice – Training and Implementation Support

Psychological trauma, including adverse and traumatic experiences in childhood and adulthood, is more common than we often assume.

Many of us will recover without the need for professional therapy or treatment, but if we are not supported, it can have a wide range of negative impacts, including on our physical and mental health and wellbeing. People experiencing multiple forms of trauma and adversity are more likely to experience greater inequalities in outcomes.

Trauma and adversity can impact our ability to feel safe in relationships, to manage strong emotions, and to view ourselves as worthwhile. Many settings can unwittingly provoke strong reminders of the trauma we experienced. For these reasons, and others, our experience of trauma can create invisible barriers to many services and opportunities in life.

What helps people to cope with and recover from such experiences includes having safe, supportive and compassionate connections with others, and trauma-informed care. Every interaction made with someone affected by trauma is an opportunity to support their recovery.

It is also important to remember that, as members of the workforce, we are also members of the general population and are likely to have experienced the impacts of trauma too, whether in our personal lives or through the course of our work. We know that we need to be well in order to support others to the best of our abilities. It is vital that as staff we feel safe and supported when we are caring for and supporting others, and Wellbeing in Primary Care Services particularly because those of us directly supporting people affected by trauma and mental health difficulties can face an increased risk of experiencing vicarious trauma, moral injury and compassion fatigue.

The National Trauma Transformation Programme (NTTP) was established in 2018 to support a trauma-informed workforce and services across Scotland. Its aim is that services and care are delivered in ways that prevent further harm or re-traumatisation for children, young people and adults affected by trauma and adversity, and that support everyone’s unique journey of recovery.

The key components of the National Trauma Transformation Programme are:

• A Knowledge and Skills Framework for Psychological Trauma, which sets out the level of knowledge and skills that anyone in the workforce needs, depending on their role, to be able to recognise and respond to trauma appropriately.
• A Transforming Psychological Trauma Training Plan, which should be read alongside the Knowledge and Skills Framework, provides essential guidance and planning tools.
• Evidence-based trauma training resources and tools, guidance and support for implementation, including animations, e-learning modules, skills based training and resources to support staff wellbeing. An overview of these resources can be found on the NHS Education for Scotland site.
• A series of companion documents has been developed to support people, strengthen their understanding of how taking a trauma-informed approach can support both improved outcomes for the people they support and staff wellbeing and safety. Some examples include a trauma-informed practice and domestic abuse companion document, and a care experience and trauma-informed practice companion document.
• A Roadmap for Creating Trauma-Informed and Responsive Change: Guidance for Organisations, Systems and Workforces in Scotland was published in November 2023. This resource is designed to help services and organisations identify and reflect on progress, strengths and opportunities for embedding a trauma-informed and trauma- responsive approach across policy and practice.
• Transforming Psychological Trauma Implementation Coordinators (TPTICs), based in each health board, provide trauma expertise to organisations and Trauma Champions in their local area to support training, coaching, implementation and collaborations with people with lived experience of trauma. To find out who your local TPTIC is please contact Psychology@nes.scot.nhs.uk.
• A Local Trauma Champions Network, consisting of senior leaders from Local Authorities, Health and Social Care Partnerships, Health Boards, and key community planning partners is responsible for overseeing, encouraging and raising awareness of trauma-informed and trauma responsive practice across all services in their area. To find out who your local Trauma Champion is please contact trauma@improvementservice.org.uk. More information can be found on the National Trauma Transformation Programme website.

1.3 Suicide prevention and self-harm learning resources

1.3.1 Time Space Compassion

When we seek to support people experiencing distress, crisis, and suicidality, it’s key that we:

• offer them time to talk and feel listened to,
• give them space to make sense of what’s going on for them, and
• show compassion in how we respond and what we do next.

The Time Space Compassion principles and approach brings together lived and living experience, practice, evidence and expertise in the form of:

• a set of principles that you can use to guide your work and stay focused on what it means to provide a human and compassionate response
• an approach and resources that you can use on your own and with others, to reflect, learn and take actions that grow our collective ability to do this well
• ways to build and share what already works with others who share a commitment to improvement and positive change.

Time Space Compassion is an important part of the culture we are building around suicide prevention in Scotland.

You can find out more by:

• exploring the activities and resources covered by the introductory guide to Time Space Compassion along with the easy read guide
• reading examples of Time Space Compassion in practice, through this practice story collection and the Suicide Prevention Scotland’s Medium pages
• listening to the Time Space Compassion podcasts, with contributions from people with lived and living experience and practice expertise.

1.3.2 Suicide Prevention Learning Resources

NHS Education for Scotland (NES) and Public Health Scotland (PHS) have a comprehensive suite of learning resources on suicide prevention. A briefing paper attached at Appendix 1 provides descriptions of those resources and the relevant links.

These resources are part of the The Knowledge and Skills framework which adopts a public health approach to mental health improvement and suicide prevention that develops workforce capacity to improve mental health, respond to self-harm and prevent suicide across the lifespan.

1.3.3 Self-harm training

NHS Education Scotland’s Learning Byte 4: supporting people at risk of self harm is available on TURAS.

The learning covers: reasons why people self-harm, understanding self-harm as communication of distress, some common misconceptions surrounding self-harm, impact of thoughts, feelings and emotions on self-harm, adopting a sensitive, compassionate and non-judgemental approach when talking about self-harm, risk and protective factors associated with self-harm, ways you can positively respond to and talk about self-harm.

The Self-Harm Network Scotland also provides public and professional training to raise awareness, improve understanding and reduce stigma of self-harm. There are a range of different training opportunities that will enable you to choose the best option for you, your organisation and your training needs. All of the training is free and more information can be found at: Training - Self-Harm Network Scotland Penumbra (selfharmnetworkscotland.org.uk)

1.3.4 National Confidential Inquiry into Suicide and Safety in Mental Health

The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) produces free evidence based reports, videos, learning resources, quality statements and improvement toolkits, designed to support safer services, including primary care services. Of particular relevance to primary care are their resources on self harm and safer services, sharing the evidence base safe practices around personalised risk management, family involvement, guidance on depression and early follow up on discharge.

1.3.5 Creating Hope for Peer Support

Scottish Recovery Network, through their work with Suicide Prevention Scotland, have produced learning resources to support community based peer support, including services working with and as a part of community settings.

1.3.6 Recognising & Responding to Distress e-learning module

This is a standalone e-learning module, designed and developed by the University of Glasgow and funded by the Scottish Government as part of the wider Distress Brief Intervention programme. The module enables and empowers organisations to provide a compassionate effective response to people who they encounter in distress. Please note, this module is for organisations which are not part of the core DBI programme, i.e. they can provide support to people in distress, but they cannot make referrals to DBI Level 2.

Interested organisations can contact the University of Glasgow via the email shw-rr2d@glasgow.ac.uk to request access to the module.

1.4 Digital

1.4.1 Near Me e-learning modules

Near Me is a web-based system which is a safe and secure video consulting service powered by the Attend Anywhere platform, offering video call access to their services.

To access the eLearning modules you will need to have a Turas account. Anyone who works or volunteers in or with the public sector in Scotland (including third/voluntary sector or if you work in care homes, care at home or day care) can sign up for a Turas account.

New to Near Me video calls aims to equip service providers with the capability to carry out a Near Me consultation with confidence.

Near Me: video consultation skills eLearning aims to leave service providers aware of, and confident in applying, the different skills required for video consulting, compared to in-person or telephone consultations.

1.4.2 Thriving in a Digital Age Pathways

The Thriving in a Digital Age Pathways are intended to build understanding of the role of digital in health and social care. By working through the pathways you will be challenged to think about what you know and your understanding of working with a digital mindset.

There are four cumulative pathways; Explore, Embed, Drive and Shape. Each pathway contains five steps for you to work through. Each step consists of links to a resource (something to read, watch, or listen to) and accompanying activities to help you reflect on what you have learnt, and consider how you can apply the learning in your own organisation. The themes chosen are developed over the course of the pathways, with each building on ideas introduced in the pathway before.

1.4.3 Digital and Data Capability Framework

The Digital and Data Capability Framework has been developed by NHS Education for Scotland on behalf of Scottish Government and COSLA, and is designed to support the development of digital capabilities for everyone working in health and social care in Scotland.

The framework applies to the entire health and social care workforce in Scotland – NHS, Local Authorities, Health and Social Care Partnerships, Social Work, Social Care, Care and Support Providers, Housing, Third and Independent Sectors – including managers, leaders and those in strategic positions.

Hosted on the Turas platform, the framework identifies the digital skills, knowledge and behaviours everyone needs do their jobs and deliver safe and good quality care and support.

The framework complements existing organisational and professional learning and development frameworks and should be used to improve individual, team and service digital capability and identify any specific learning needs.

1.5 Children and Young People

1.5.1 Children and Young People’s Mental Health and Wellbeing professional learning resource

The Scottish Government commissioned Mental Health Foundation Scotland, Digital Bricks Learning and Children’s Health Scotland to develop a mental health professional learning resource, supported by the Mental Health in Schools Working Group. The resource is for all school staff to support the wellbeing of children and young people. Although aimed at school staff, it is open access and available to anyone who may find it of benefit.

The resource takes a whole school approach, centred around prevention and early intervention to promote positive mental health and wellbeing for everyone in the school community. It aims to provide school staff with knowledge and understanding of mental health and wellbeing in schools and a range of opportunities to learn about experiences and advice from practitioners and young people.

1.5.2 Children and Young People aged 0-5 years resource to support mental health and wellbeing

A 0-5 years resource has been developed for people who work with babies, infants and young children which highlights learning materials including best practice guidance, online modules, websites, animations etc to support learning around infants’, children’s and families’ mental health and wellbeing.

1.6 Open Badges

Open Badges are digital certificates recognising learning and achievement. If you can demonstrate that you’ve learned from materials produced by the Scottish Social Services Council (SSSC) you can earn an Open Badge.

Open Badges are a straightforward way to collect, manage and share evidence of learning in today’s digital world. You can collect them to evidence your learning and share them in places that matter to you. When you share your badge with someone, they will be able to see criteria against which the badge was issues and any evidence that you provided to prove you met that criteria.

The SSSC and dozens of other social service organisations issue Open Badges to recognise continuous and informal learning that would otherwise go unrecorded.

You don’t need to be registered with the SSSC. Most of the badges are available to anyone. Watch Getting started with Open Badges badge for more information.

Some badges you may be interested in:

Personal Outcomes Planning

Understanding Personal Outcomes

Supporting Unpaid Carers

RNIB Top Tips Guides; Learning Disability and Sight Loss

RNIB; See differently, Technology to support people with sight loss and dementia

Where to go for Self-directed Support information

Palliative and End of Life Care: Care Planning and delivery (Informed level) Palliative and End of Life Care: Communication and conversations (Informed level)

1.7 Public Health Scotland Learning Zone

The Public Health Scotland Learning Zone allows access to a range of learning resources, and aim to provide all learners from across the public, private, and third sectors with the knowledge and skills to work together to create a Scotland where everybody thrives.

1.8 Equality, Diversity and Human Rights essential learning

This eLearning module is an introduction to equality, diversity and human rights for health and social care workers in Scotland. It has been developed to meet the essential learning needs of the health and social care workforce in Scotland. By the end of the module, you will be able to:

• State the non-discrimination, equality and human rights responsibilities you and your organisation have.
• Identify discrimination, harassment, and inappropriate behaviour where you work.
• Identify actions you can take to challenge and prevent inappropriate behaviour.
• Identify the meaning of key words and why language is important.

1.9 Cultural Humility

This eLearning module has been designed to support the development of positive cultural humility values, attitudes and behaviours in the health and social care workforce in Scotland. This is an important introductory learning resource for building a culturally humble workforce.

Cultural humility is the practice of self-reflection used to consider how our backgrounds and the backgrounds of others can impact our relationships. Being culturally humble means being aware of social power imbalances, biases, and respecting other’s values. This resource helps us to begin the journey of developing a cultural humility mindset through being open to what we haven’t learned yet, embracing continuous learning, and promoting equity and inclusion across health and social care.

The module explores experiences related to race, ethnicity, language, age, gender, religion, values, and beliefs which have been shared by health and social care professionals working in Scotland.

By the end of this resource, you will be able to:

• understand the concepts that underpin cultural humility
• identify the key behaviours for developing an inclusive workplace
• apply a reflective approach aimed at transforming practice in health and social care.

The module also includes a resource pack of further activities which can be used to guide further learning within your team.

Cultural humility acknowledges that nobody can ever fully understand or master every aspect of a culture, and it encourages a lifelong commitment to understanding and respecting others’ experiences, values, and worldviews.

1.10 Substance and Alcohol Use Support Resources

In order to access the learning, you will need to create an account or log into NHS Education for Scotland TURAS

1.10.1 Substance use and mental health training

Substance use and mental health training is available on Turas from NES, with specific modules which link to:

• Medication Assisted Treatment (MAT) Standards 6,9 and 10. All are related to psychological interventions.
• MAT Standards 4,6,8,9 and 10. All related to addressing stigma.

1.10.2 Scottish Families Affected by Alcohol & Drugs

The Scottish Families Affected by Alcohol & Drugs have developed information sheets which can be printed and posted out to people and include:

• Coping skills – Managing Emotions.
• Coping Skills – Ways of Responding.
• Understanding Substance Use – How do People Change?
• Why Families Need Support

1.11 The Mental Health and Money Toolkit

The Mental Health and Money Toolkit is a resource to help people understand, manage and improve their mental and financial health. It can be used to help guide conversations with relevant healthcare workers about a person’s mental health and money. It can also be taken to any money or debt advice appointments.

1.12 Domestic Abuse Awareness Raising Tool

The Domestic Abuse Awareness Raising Tool is an online training resource for professionals. It provides an awareness-raising introduction to domestic abuse and coercive control. The tool provides an overview of the main considerations when responding to domestic abuse; however, it does not replace specialist domestic abuse training. A map to local support services is available at the end.

1.13 Sensory e-learning modules

In order to access the learning, you will need to create an account or log into NHS Education for Scotland TURAS and search for ‘sight loss’, ‘hearing loss’, ‘deafblind’ and; BSL and Tactile BSL’.

1.14 Autism Learning and Research

1.14.1 A utism training for General Practitioners; Peer to Peer Learning

The National Autism Implementation Team (NAIT) have co-produced a resource from NHS England, which may be relevant for all health professionals and particularly staff working in primary care.

The learning can be access with the following OpenAthens link; password will be needed Resource (learninghub.nhs.uk).

1.14.2 National Autism Implementation Team

National Autism Implementation Team (NAIT) are a Scottish Government funded, practitioner researcher partnership based at Queen Margaret University.

1.15 Learning Disabilities and Autism Lived Experience Resources

People with learning disabilities and autistic people co-created a package of lived experience resources. The resources are for professionals throughout health and social care and are designed to support more accessible mental health and health supports and services for people with learning disabilities and autistic people. They are also designed to support professionals to improve their knowledge and understanding about what it is like to live with learning disabilities and/or autism.

1.15.1 Learning Disability Package

The learning disability package, which can be accessed here, consists of:

• Top Ten Tips Film
• E-poster
• Behind the scenes film showcasing the involvement of people with lived experience
• E-booklet around the top ten tips
• 3 things about me card

The 3 things about me card is a person-centred intervention tool created by people with lived experience to support communication and conversations and build relationships and trust between people with learning disabilities and autistic people and professionals. It is particularly helpful where sensitive and difficult conversations may take place.

1.15.2 Autism Package

The autistic drivers package, which can be accessed from the Different minds. One Scotland website, consists of an:

• 8 minute film and two E-posters designed for GP practice staff
• E-booklet including 5 films on being autism informed for mental health practitioners. The films include: masking, social interaction and communication, sensory differences, appointments and different identities and intersectionality.

1.16 ICD-11 Guidelines for Mental, Behavioural and Neurodevelopmental Disorders

The World Health Organisation (WHO) has developed specialist training for clinicians including 15 modules which cover specific areas of the International Classification of Diseases (ICD) -11 Mental, Behavioural and Neurodevelopmental Disorders. Each unit is designed to take approximately one to one and a half hours and focuses on a different disorder grouping.

The Royal College of Psychiatrists have produced a series of free webinars and the NHS a learning module which is specific to Scotland. You will need to login to your Turas account to view it. Turas is the NHS Scotland’s platform. If you do not have a Turas account you can sign up for one. It is free.

ICD-11 is the international standard for the collection and reporting of health information by WHO’s 194 Member States, which allows for comparison of health data worldwide.

A summary of the changes from ICD-10 to ICD-11 can be found on the NHS Education for Scotland website. The Scottish Government and NHS Education for Scotland have developed an animation which provides information for patients, families and carers on what ICD-11 is in an easy to understand and accessibly way, you may find it helpful to view this animation or to signpost patients to this.

1.17 Unpaid Carers

A carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support. When you work in a primary care role, it is highly likely you come into direct contact with unpaid carers. Unpaid carers have a unique role in the life of the person they care for. They have valuable knowledge to contribute to the care and support of the person they care for, and any decision will have an impact on them and on their caring role. If unpaid carers, the person they care for, and workers from health and social care work together as partners they increase the chances of achieving better outcomes for all involved.

Caring, particularly more intensive or stressful caring roles, can also impact on carers’ physical and mental health. Unpaid carers are also normally prioritised for free flu and Covid vaccination so recording someone’s carer status can be an important way to make sure they don’t miss out.

The introduction of the Carers Act established rights for all carers to support, information and advice; and to be listened to in decisions about the care and support of the person they are caring for, including a responsibility on health boards in relation to carer involvement in discharge planning. The Triangle of Care helps mental health services support carers in exercising these rights by providing the information, advice and support that carers require to continue in their roles as expert partners in care.

NHS Education for Scotland, has created Equal Partners in Care (EPiC), an educational resource designed to support learning that enables health and social care staff to identify, support and work with unpaid carers as equal partners.

EPiC is intended for all staff who come into direct contact with carers in their day-to-day jobs. It is also intended for anyone with a workforce education and learning role, and/or managers who support the workforce to improve outcomes for carers and the people they care for.

1.18 Future Care Planning Toolkit

Healthcare Improvement Scotland have developed a Future care planning toolkit (formally anticipatory care planning) which is a person-centred, proactive approach to help people consider what is important to them and plan for their future care.

Future care planning involves conversations between individuals, their families, carers, and professionals. It helps people communicate goals and preferences, and gives them opportunities to consider realistic options and plan for future changes in their health and care that can be recorded, shared and reviewed.

Future care planning is often discussed and delivered in Primary Care settings.

1.19 Caring for Smiles

Caring for Smiles is Scotland’s national oral health promotion, training and support programme for older people, particularly those living in care homes.