Chamber and committees

Scottish Government submission of 8 July 2021

PE1871/B - Full review of mental health services

Improving access to specialist mental health services

Mental Health remains an absolute priority for the Scottish Government, and we are committed to ensuring that everyone who needs support can get access to services that are appropriate to their needs.

The effects of the Covid-19 pandemic have been wide-ranging – both in terms of effects on individuals and families, but also on our NHS, and we know that some individuals are waiting too long for treatment. However, we acknowledge that simply returning to where we started will not be enough. There were significant issues before the lockdown in terms of access to key services, and the impact of the pandemic is likely to lead to increasing and evolving demand for treatment.

Following close engagement with stakeholders, we published our Mental Health Transition and Recovery Plan in October 2020. This outlines our response to the mental health effects of the Covid-19 pandemic, and is backed by a £120 million Recovery and Renewal fund. The Recovery and Renewal Fund has brought the total anticipated spend on mental health in 2021/22 to in excess of £1.2 billion.

The Transition and Recovery Plan outlines how we will support NHS Boards and Integrated Joint Boards to move beyond the position at the start of the pandemic. As part of this programme of work, the Scottish Government has been engaging closely with NHS Boards to support them to address issues relating to access to services. This includes a tailored programme of enhanced improvement support for seven NHS Boards in which the waiting times for treatment are unacceptably long (Borders, Fife, Forth Valley, Highland, Lanarkshire, Lothian and Tayside). We are now working with Mental Health leads in these Boards to support the development and implementation of local recovery plans and to target investment to improve access to CAMHS and Psychological Therapies.

Over the next 6-12 months, we expect to extend our programme of enhanced improvement support to all Boards that need it. We will ask all Health Boards to provide trajectories to meet the 90% waiting times standard, and use these to monitor and drive improvements. In 12-18 months we would expect to see the new service delivery and reforms arising during Covid-19 embedded in mental health services as standard and starting to make a difference to performance.

Other work to improve access to mental health services and support

NHS Boards with larger populations have established specialist 24/7 Mental Health Assessment Units that are immediately available for mental health crises. There are now 13 of these centres across Scotland, which have received positive feedback from patients, clinicians and Police Scotland.

We have also provided £2.1 million to expand the NHS 24 Mental Health Hub that is now available to the public 24 hours a day, for 7 days a week, and £1.2 million to provide extra capacity for Computerised Cognitive Behavioural Therapy (cCBT).

Additionally, anyone who phones the NHS 24 Mental Health Hub in emotional distress from anywhere in Scotland, who does not need emergency clinical intervention and who is assessed as appropriate for referral, can now be referred to the Distress Brief Intervention (DBI) Programme for further support. A Third Sector provider of DBI will make contact with the person in distress within 24 hours and work with them over a two week period to help them manage their distress. More than £1 million has been invested towards the expansion of the Distress Brief Intervention programme since March 2020.

Primary Care & Infrastructure

We are working with the Redesign of Urgent Care Programme to improve the integration of physical and mental health within the urgent care setting. Our unscheduled care pathways must be easy to access, quick and responsive at the earliest possible point. We are therefore working with partners to ensure that people who present with unscheduled care needs find our various systems easy to access and are supported by a clearer referral pathway to the right intervention, support or treatment. The intention is to build on the progress already made toward providing an unscheduled care response, this will include:

• Embedding mental health unscheduled care pathways for adults, children and young people;
• Continuing to develop Mental Health Assessment Services,
• Establishing Multi-Disciplinary Team test sites to support those with Complex Psychosocial Needs;
• Continuing to develop approaches to support people in distress by continuing the national roll-out of Distress Brief Intervention, including an evaluation.
• Continuing to build mental health capacity within primary care settings with a view to implementing Primary Care Mental Health teams; and
• Further enhancing mental health service delivery through digital innovation.

Mental Health Care & Quality Standards

We are developing quality standards to support general adult secondary mental health services. This is part of a wider ambition to develop a suite of standards for mental health services, building on the work of the existing CAMHS service specification. The Scottish Government’s Quality and Safety Board for Mental Health Services agreed to prioritise the development of standards for general adult secondary mental health services as it will have an impact on the largest number of service users. This will allow us to address transitions between inpatient and community services which has been identified as a key area for improvement.

Suicide Prevention

Suicide prevention is a priority for the Scottish Government and we are committed to working with our National Suicide Prevention Leadership Group, COSLA, and partners on delivering the Suicide Prevention Action Plan: Every Life Matters. Many of the key deliverables of the Action Plan have been achieved to date, including the launch of Scotland’s social movement: ‘United to Prevent Suicide’ along with an initial public awareness campaign; production of learning resources to support suicide prevention; and guidance to encourage, inform, and support local suicide prevention approaches.

Pilot services to support those bereaved by suicide will go live this summer, as will the roll out of timely data on suicide deaths by Public Health Scotland, which will provide valuable intelligence to further inform local suicide prevention planning. Through our Action Plan we are working to introduce processes to review all deaths by suicide.

Prevention and early intervention

As well as concentrating on improving specialist services, there is a huge opportunity for the Recovery and Renewal Fund to make a transformational difference in terms of our focus on prevention and early intervention. We are currently considering a range of options for investment of the remainder of the £120 million fund which will focus on wider support for mental health and wellbeing, including Primary Care and Community Services.

Since January, we have provided additional funding to local authorities to deliver locally based mental health and wellbeing support. Over 100 new and enhanced supports and services have been established including primary school councillors in Stirling, family mediation in Dundee and self-harm support in South Ayrshire. Last year we provided £3.75 million to establish these services and have allocated a further £15 million this year to continue their operation. These services offer an alternative to CAMHS for children and young people, where appropriate, by providing support for emotional distress delivered in a community setting.