Independent Review into the Delivery of Forensic Mental Health Services: Scottish Government response

Theme Four: Person-Centred Practices - Recommendations 22-42

Care and Treatment

Recommendation 22. There should be an equality of esteem between the professions in a high functioning forensic mental health service. This should be evidenced in practice and language used.

The Scottish Government agrees that the strength and success of forensic mental health services is in their multi-disciplinary nature and the value that each profession and role brings to the team. For our part, in working with partners to take forward these recommendations we will ensure that there is an equality of esteem in the way that we work with different professions.

Recommendation 23^*. The new Forensic Board should consider how best to fund social work posts embedded within the multi-disciplinary teams (MDTs) in forensic mental health services, in order to maximise interdisciplinary working.

The Scottish Government recognises the vital role Mental Health Officers (MHO) play in providing forensic mental health services and in supporting patients' treatment and recovery. As a range of MHO delivery models currently exist, we will work with territorial Health Boards, Integrated Joint Boards, Local Authorities and social work professional bodies to explore the relationship between funding posts and interdisciplinary working.

Recommendation 24. People should be supported to participate as much as possible in decision-making about their care and treatment. Staff should proactively involve people in both formal and informal conversations about their care. Staff must communicate in a style that best enables people to understand what is happening and to voice their opinions.

Recommendation 25. Staff should proactively inform people about their right to request a copy of information held about them. People need to be supported to make such requests if desired and to express their wishes about what information they receive and how this is communicated to them.

Recommendation 26. General information and advice for people within the forensic mental health system should always be provided in accessible formats, including Plain English and Easy Read versions. Staff should ensure that any additional information required to ensure a person's understanding and ability to participate in decisions about their own care and treatment plans are converted to such formats as required.

The Scottish Government notes that mental health legislation sets out that service providers must offer information and support. This is to enable patients and their carers to take part in decisions about care and treatment and consider the views of the patients, family members and carers when agreeing a care plan.

It is fundamental to person centred care for people to be supported to participate as much as possible in decision-making about their care and treatment. This includes accessible information both about individual care and general information and advice.

We will write to Health Boards to ascertain how they ensure that people using forensic mental health services are supported to participate.

Recommendation 27. Each unit within the forensic mental health system must appoint a named staff member as a Carer's Contact. This person must have received training in carer's rights and have sufficient knowledge to answer a carer's initial questions and signpost them to further information and support services.

The Scottish Government agrees that a named staff member in each unit within the forensic mental health system is beneficial as an addition to the contact that carers have with the clinical team.

Recommendation 28^*. The new Forensic Board should be funded to establish an advocacy service for forensic carers. This service will provide expert support to help carers navigate the forensic mental health system, represent their views and find satisfactory resolution to complaints.

Recommendation 29^*. The new Forensic Board should work in collaboration with existing carer organisations and advocacy services to develop a) information targeted at new forensic carers, and b) information and training for organisations supporting forensic carers.

The Scottish Government agrees that information and support for carers should be improved. We will work with Health Boards, Health and Social Care Partnerships and Local Authorities to engage existing carer organisations and advocacy in improving support for carers.

Recommendation 30^*. Until such times as the new Forensic Board is formed, individual Health Boards should put in place a system to reimburse travel expenses of those family members (or other carers) who have to travel to visit a person receiving forensic mental health services out of area. Once established, the new Forensic Board should continue to ensure financial support is in place.

The Scottish Government will explore with Health Boards, Health and Social Care Partnerships, Local Authorities and carer organisations to establish what support can be available to carers and families visiting a person receiving forensic mental health services out of area.

Recommendation 31. Where a person receiving forensic mental health services has indicated their consent, family members (or other carers) should be actively supported to take part in the Care Programme Approach process and their opinion recognised as that of an expert by experience. As part of this, their availability should be taken into account when scheduling these meetings.

Recommendation 32. Where a person receiving forensic mental health services has indicated their consent, family members (or other carers) should be proactively informed by the clinical team whenever a change is made to the person's care and treatment.

Recommendation 33^*. The new Forensic Board and people receiving forensic mental health services and their family members (or other carers) should co-design informal and formal feedback processes that address the specific vulnerabilities of these groups in the forensic system.

The Scottish Government agrees that it is important for patients, family members and carers to be involved in the care and treatment provided and support should be given to enable participation. Each forensic mental health services should therefore work to improve involvement and engagement of family members and carers in the care and treatment of patients. Further, using the work of the Forensic Carer Forum and Carers Coordinators group, both supported by the Forensic Network, examples of best practice should be highlighted, shared and built upon to improve engagement and participation of family members and carers.

Recommendation 34. The Scottish Government should re-inforce the use of its guidance on transferring Suspension of Detention plans (SUS) issued in 2018 with clinical teams and identify any ongoing barriers (clinical, administrative or cultural) prior to refreshing and reissuing to all clinical teams, as part of its ongoing update of the Memorandum of Procedure on Restricted Patients.

The Scottish Government is taking forward a programme of reviewing all of the processes and procedures for restricted patients. The Memorandum of Procedure will be revised as part of this programme. In the meantime we will re-issue the guidance on transferring suspension of detention plans and will ensure that consideration to transferring plans is given in all cases where Scottish Ministers' approval to transfer is required.

Recommendation 35. At pre-transfer Care Programme Approach meetings, it must be made clear to the person that the option to transfer existing SUS is available. Reasons for not carrying SUS forward should be clearly discussed with the person. Their own obligations for ensuring that their SUS is carried on as planned once transferred must also be clearly explained.

The Scottish Government agrees that clear information about suspension of detention plans (SUS) must be provided to the person and to receiving services at pre-transfer Care Programme Approach meetings, so that existing SUS plans can be continued wherever possible following transfer.

Social and Environmental Conditions

Recommendation 36. The poor state of repair of current inpatient environments, including outside space where it is provided, should be addressed by individual Health Boards to ensure they are therapeutic spaces which demonstrate a value being placed on the people detained there.

Recommendation 37. Evidence-based design of therapeutic environments should inform the planning stages of all renovations and new developments within the forensic estate.

Recommendation 38. Everyone subject to detention within the forensic inpatient services should have their own single room.

The Scottish Government agrees that the physical environment in which forensic mental health care is provided is important, both in terms of supporting recovery and the dignity of all who live, visit and work in these environments. This is particularly prevalent for those patients who receive long-term treatment within the forensic mental health care system.

Many inpatient services were built within the last twenty years but routine maintenance, redecoration and replacement of furnishings will become ever more important in the years to come, as these environments age. We will work with Health Boards, the Forensic Network and others to prioritise work to assess and improve physical environments in the forensic estate.

Recommendation 39^*. The new Forensic Board should, under the direction of the Nurse Director, establish multi-disciplinary 'Best Practice' standards to guide least restrictive practices. These must have the principle of person-centred practice at their core and should be applied consistently across all forensic inpatient settings.

The standards must include guidance around enabling people to: access privacy to support relationships with family and friends; access bedrooms;

access personal belongings; and, access technology – this should be accompanied by staff training to ensure they can confidently support a positive risk approach to technology.

The Scottish Government agrees that quality standards for forensic mental health services have an important role in ensuring consistency of care and least restrictive practice. In the Coronavirus (COVID-19): mental health - transition and recovery plan we committed to supporting the collaborative development, implementation and assessment of quality standards for mental health services.

Recommendation 40. The Scottish Government should respond timeously to the Technology and Communications Group's updated report, which the Review hopes will reflect an enabling, rather than a risk averse approach in its recommendations.

The Technology and Communications Group's updated report has been received by the Scottish Government and is currently under consideration. We will work with the Forensic Network and others to take forward its recommendations as appropriate.

Recommendation 41. The Scottish Government, together with forensic mental health services, should monitor the availability of placement providers to ensure there are sufficient available to support the rehabilitation of people in forensic inpatient services and to sustain them for people discharged back into the community.

Recommendation 42. The Scottish Government should re-engage with Allied Health Professionals to finalise their draft guidance aimed at supporting people with criminal convictions and mental health conditions into work, volunteering or education.

The Scottish Government agrees that placements, work, volunteering and education are essential elements of recovery and rehabilitation. We will engage with forensic mental health services and with Allied Health Professionals to take forward these recommendations to improve availability and facilitate guidance.

^* This recommendation refers to a new Forensic Board having responsibility. See response to recommendation 1