Short Life Working Group On Prescription Medicine Dependence And Withdrawal: consultation

Mental Health

People experiencing mental ill health should expect high quality care, which can include the prescription of medication if they need it. The prescription of any medication is a clinical decision made in discussion with the patient, and within the context of their recovery. There is good evidence that health professionals assess and treat mental ill health appropriately. Prescriptions should be reviewed regularly to achieve the best possible health outcomes, and on-going support should be provided to patients who are prescribed medicines.

We have committed to delivering a tailored programme of work to help individual NHS Boards respond effectively to the anticipated increase in demand for mental health services in the months ahead. We have also committed to building on innovations and new service designs that have emerged, such as the establishment of Mental Health Assessment Centres and the expansion of digital services and online therapies where they best meet patient needs.

Protecting good mental health in Scotland is central to our long-term response to the pandemic and - as set out in our Mental Health Transition and Recovery plan - a key part of this is to ensure the continuity and the quality of mental health services, enhancing access where demand is high. We see reducing stigma as critical, which includes challenging any stigma around care and treatment for mental ill-health. Additional help and support is available as alternatives to prescribing drugs. Below are some examples of mental health support available in Scotland.

Frontline Support

• In response to the Covid-19 pandemic, the Scottish Government worked with Health Boards to establish Mental Health Assessment Services to alleviate pressure on Emergency Departments while ensuring that appropriate referral pathways are in place so that people receive the right support at the right time.
• There are now 13 of these services across Scotland, receiving positive feedback from patients, clinicians and other services. Work is underway to retain, develop and support Mental Health Assessment Services as part of a broader approach to helping people with mental health needs or in distress.

Digital Therapies

• Digital Therapy is now an integral part of service delivery across Scotland. Digital tools have also been a key part of our Covid-19 response, enabling services to continue despite physical restrictions.
• Since the beginning of the pandemic, £6 million of dedicated funding has expanded the NHS 24 Mental Health Hub to be available to the public 24 hours a day, for 7 days a week; provided extra capacity for Computerised Cognitive Behavioural Therapy (CCBT) and to roll out the Distress Brief Intervention (DBI) programme on a national basis.

Distress Brief Intervention (DBI)

• The DBI programme is an innovative way to support people who present to frontline services in distress but who don’t require an emergency clinical intervention.
• DBI consists of two parts, with Level One seeing trained front-line health, police, paramedic and primary care staff help ease any individual. They can - where assessed as appropriate - then ask the person if they would like further support and, if they agree, Level Two is then provided by commissioned and trained third sector staff who will provide community-based problem solving support, wellness and distress management planning, supported connections and signposting.
• The Scottish Government has committed to having the Distress Brief Intervention programme embedded in all NHS Boards by 2024.

Suicide Prevention

• In July 2020, the National Suicide Prevention Leadership Group made recommendations for a suicide prevention response to the pandemic, in addition to delivering the Suicide Prevention Action Plan (published in Summer 2018). Progress is now being made across all four recommendations.
• Any individual feeling suicidal is encouraged to contact their GP. Out of GP opening hours, telephone advice and support on healthcare can also be obtained from NHS 24 on the short code 111. Anyone in immediate danger or with the means to cause themselves any harm is urged to dial 999 and request an ambulance.
• Support is available from Breathing Space, who offer free and confidential advice for people over the age of 16 who are experiencing low mood, depression or anxiety, whatever the cause. Breathing Space is funded by the Scottish Government's Mental Health Division and the service is provided by NHS 24.

Mental Health and Substance Use

• In line with the National Alcohol and Drugs Strategy, work is underway to improve the integration between Mental Health and addiction services; working with Health Boards; Health and Social Care Partnerships; community partners, third sector organisations and those with lived experience to develop person centred approaches which can be used across health and social care settings.

Covid-19

• Much of the above is taking place in the context of the Mental Health Transition and Recovery Plan (published in October 2020) which outlines the Scottish Government’s response to the mental health impacts of Covid-19.
• The restart, recovery and continued improvement of statutory mental health services will be an important part of this work. Mental Health services are a priority within NHS remobilisation. We will therefore develop a longer term renewal programme for mental health services to support the Covid-19 recovery process.