Download Consultation on Mental Health in Scotland – A 10

Consultation on Mental Health in Scotland – A 10 Year Vision
September 2016
The new Mental Health Strategy will be published in late 2016. It follows a four-year
strategy that ran from 2012 to 2015. The new Strategy will cover a 10 year period.
The Scottish Government sought views on their proposed framework and priorities to
transform mental health in Scotland.
For more information about the consultation, see https://consult.scotland.gov.uk/mentalhealth-unit/mental-health-in-scotland-a-10-year-vision
1. The table in Annex A sets out 8 priorities for a new Mental Health Strategy that we
think will transform mental health in Scotland over 10 years. Are these the most
important priorities?
Yes / No / Don’t know
If no, what priorities do you think will deliver this transformation?
Scottish Care recognises the importance of the areas identifies as priorities for the new
Mental Health Strategy.
We are particularly pleased to see human rights being given prominence in the new
Strategy, given this is the direction of health and social care policy in Scotland. The
development of the new National Care Standards seeks to embed a human rights based
approach in care service delivery and regulation, as well as commissioning and assessment
processes. The new standards will prioritise personal choice, control, equality and
inclusiveness in all aspects of an individual’s life and care journey.
What’s more, the independent social care sector (who Scottish Care represents) increasingly
values human rights approaches to the provision of high quality, personalised care. This is
evidenced through the creation, in 2015 and 2016, of Scottish Care’s Human Rights
Conventions for both Care Homes and Care at Home and Housing Support services. These
Conventions were developed in partnership with those who access care services and detail
what is important to them in the delivery of their care and support. Since the launch of
these Conventions, a large number of services and organisations have endorsed them and
indicated their commitment to upholding these rights, raising awareness of them and
strengthening accountability in relation to the protection and promotion of human rights in
care.
Given these developments in health and social care and the increased awareness and
embedding of human rights, it is positive to see the priority areas for the Mental Health
Strategy equally reflecting this. It is only if different areas of policy and practice are
complementary and coherent in their articulation of priorities and approaches that we will
see whole systems culture change and reformed practice towards the principles of human
rights and improved support for all.
However, Scottish Care is disappointed to see little mention of older people’s mental health
needs, particularly those receiving social care, reflected in the priority areas and believes
this needs to be remedied.
Scotland’s population projections indicate that the number of people aged 75 and over will
increase by 28 per cent from 420,000 in 2012 to 530,000 in 2022 and then continue rising
steadily until it reaches 780,000 in 2037 – an increase of 86 per cent in just a quarter of a
century and 360,000 more than today. Inevitably, this will mean a higher proportion of
those with mental health needs being over the age of 65 and also a higher proportion of
these individuals requiring the support of elderly care services.
There are approximately 33,000 older people living in care homes in Scotland any night of
the year, and nearly 1,000 other individuals living in care home services for adults with
mental health issues. Additionally, 61,500 individuals receive support through home care
services, over 50,000 of whom are over the age of 65. Given these figures, it is crucial that
we ensure high quality mental health care and support is built into the provision of these
services, which nearly 100,000 people across Scotland access. To fail to adequately
recognise, plan for and seek to improve the mental health needs and supports for this
population through the Strategy would amount to an equalities issue.
Therefore more direction must be given on how we identify the current gaps in support for
older people with mental health conditions including social care gaps, how we address these
and how we support and train staff in care services to deliver positive outcomes for
individuals with mental health conditions, and to promote their own positive mental health.
Scottish Care has identified six areas where we believe more specific attention needs to be
paid to mental health priorities for both older people and individuals receiving and working
in social care services:
1. Recognising mental health conditions in older people as wider than
dementia. Whilst dementia is an undoubtedly crucial element of mental
health that requires specific planning, it is important to recognise that the
spectrum of mental health conditions that an older person may be living with
is much wider and these conditions may even be undiagnosed. By narrowing
our lens to dementia support only, we risk failing to improve the availability,
appropriateness and quality of support for older people living with other
conditions, including but not limited to depression, anxiety, eating disorders,
bipolar disorder, schizophrenia. The fact that people are living longer does
not diminish the range of conditions they may be living with nor the
requirement for tailored, effective support to be available to those over 65.
Scottish Care and independent sector social care providers are committed to
supporting the development and implementation of the next Dementia
Strategy, but the Mental Health Strategy offers a complementary yet unique
opportunity to better recognise the wide-ranging mental health needs of
older people.
2. Ensuring appropriate support for those living with enduring mental health
conditions who access social care services
One of the current shortcomings of mental health care and support is the
way in which both formal and informal support is available to individuals
when they start receiving social care services, particularly within a care home
setting. For instance, despite the overall success of the commitment to one
year post-diagnostic support for individuals with dementia, very few people
living in care homes have received this support or even had a formal
diagnosis. The current infrastructure and professional relationships between
care services, GP services, pharmacy services, Allied Health Professionals and
primary care mean, at best, multi-disciplinary support to individuals in care
homes settings is a postcode lottery. This has real implications for individuals
living with mental health conditions who are likely to require a range of
professional supports and particular expertise to enable them to live well in a
care home. Additionally, more effective planning needs to be in place to
ensure those who have moved into a care home setting can have
continuation of community support available to them before they entered
the care home. Finally, care home staff do a fantastic job in promoting
personalised care to deliver positive outcomes for residents, but there may
be additional support and training they need to ensure they fully understand
how best to support individuals living with different mental health
conditions. The integration of health and social care certainly presents
opportunities to improve shared learning, multi-disciplinary and cross-sector
working, better professional dialogue and person-centred rather than
location-centred care, but this will require culture change which could be
progressed more effectively by recognising it through the Strategy.
3. Awareness of the risk of developing mental health conditions in periods of
transition, change and trauma, particularly in older age
As well as the current challenges around effectively supporting older people
with enduring mental health conditions, it is important to recognise the
particular factors relating to older people and social care which may prompt
or exacerbate mental health conditions. For instance, older people are more
likely to experience bereavement through the loss of friends, spouses and
relations which can require mental health support. Additionally, individuals
who go through transitions such as moving into a care home or another care
setting may experience difficulties in adjusting to a loss of home or a
perceived loss of identity. It is therefore crucial that we recognise the risk
factors and pressure points for older people, where they may require
additional expert support in order to maintain or restore positive mental
health.
4. Transitions between adult services and older peoples services
As articulated in the above two points, there are risks to positive mental
health associated with transitional phases and it is recognised that transition
phases can lead to a breakdown in communication and quality of care and
support, leading to further uncertainty and anxiety for individuals at the
centre of that support. In addition to the issues associated with transitions in
care settings, there are also challenges where individuals cease to be part of
adult services and move to older people’s services. Scottish Care believes
that, as a society, we still have an inherent inequity in older people’s care and
support compared to other types of care and support and unfortunately,
discriminatory practice can still prevail. For instance, we are much more
likely to support a younger person in an assets-based, outcomes-focused way
which enables them to achieve their goals and ambitions than we are for
older people, who are more likely to be identified by their conditions and
disabilities rather than their many abilities. Whilst positive progress is being
made around outcomes and personalisation, and human rights-based
approaches can support this, there remain challenges for how we support
older people with mental health needs to live well and what resources
(including funding) are available within older people’s services to do this
effectively. Attention must therefore be paid to how we support people
with mental health needs through care transitions effectively so that they do
not experience a diminishing of quality support based on their age or
location.
5. Capacity of care staff to effectively support people living with mental health
conditions
As the population ages and people access care and support services later due
to the success of community and informal support, care staff are increasingly
supporting individuals at advanced stages of life with more complex and
wide-ranging needs. This increasingly includes those living with mental
health conditions. Whether individuals are supported in their own homes or
in care home settings, care staff need to have the right values, skills, training,
awareness and support to enable them to delivery high quality, personalised
care that meets the needs and outcomes of the individuals they support. The
current funding, recruitment and retention challenges in the care sector
make this especially challenging but of even more critical importance,
particularly in relation to mental health whereby staff must have the time
and resources to deliver sensitive, appropriate support. This can range from
recognising subtle changes in an individual’s mood or health through to
supporting someone with behaviour that challenges. Often a care worker is
the key link to other individuals involved in a person’s life and care, and the
quality of relationships built mean they are often best placed to assess the
health and wellbeing of the person they support. If we don’t invest in
ensuring we understand what care staff need in order to deliver high quality
mental health care and support and build this into the Strategy, we will not
achieve positive outcomes for individuals.
6. Protecting and promoting the positive mental health of those working in
social care
A crucial element of the Mental Health Strategy is how we protect and
promote the wellbeing of the workforce, particularly those who support
others and whose own mental and physical health is often most
detrimentally impacted. To understand how best to do this, it is important
that we understand the factors and circumstances which can negatively
impact on a worker’s mental health. For those working in social care, these
elements are wide-ranging and include the impact of dealing with
challenging, stressful and emotionally charged situations on a daily basis, long
hours and poor pay, delivering palliative and end of life care to individuals
with whom relationships and bonds have been formed and subsequently
dealing with bereavement, and lone working practices for those in homecare
services. Scottish Care recognises the importance of physical, mental and
emotional wellbeing of care staff and has held events focused on this issue.
The feedback we often receive from front line care staff includes feelings of
exhaustion and being close to ‘breaking point’. If further steps are not taken
at a national level to embed a focus on workforce wellbeing, we risk a mental
health crisis in the social care sector and Scottish Care would therefore want
this to be better recognised in the Strategy.
2. The table in Annex A sets out a number of early actions that we think will support
improvements for mental health. Are there any other actions that you think we need to
take to improve mental health in Scotland?
It is positive to see some focus being given to the mental and physical health of workforce
through ‘All of Me’. However, steps should be taken to ensure that the workplaces this
programme supports includes social care workplaces, and that there is sufficient
understanding of the particular challenges for that employers and employees in this sector
in relation to mental health as outlined above.
Scottish Care would want to see more explicit actions relating to older people and social
care to ensure that real progress is made through the strategy in addressing their mental
health care and support provision challenges. Scottish Care would welcome further
engagement with the Scottish Government in order that we can support further exploration
of what these specific actions may be.
Scottish Care will be commencing a piece of work in early 2017 exploring the unmet mental
health needs of older people in receipt of social care services. This work will explore both
what these unmet needs are and what needs to be in place to address these gaps, whether
they relate to awareness and understanding, care and support availability and
appropriateness, or staff capacity, skill mix and training. We would be happy to share the
outcome of this work to inform the ongoing development and implementation of the
Strategy, but feel that actions specifically around older people and social care need to be
built into the initial Strategy to facilitate work, shared learning and improvement support in
these vital areas.
3. The table in Annex A sets out some of the results we expect to see. What do you want
mental health services in Scotland to look like in 10 years’ time?
There are a number of positive outcomes Scottish Care wants to see as a result of the new
Mental Health Strategy. These are:


Equity of access to mental health care and support, regardless of age or mental
health condition.
Recognition of the particular needs of older people living with mental health
conditions and an understanding of how best to support these individuals.


A skilled and valued care workforce who feel confident and competent in effectively
supporting people with a range of mental health conditions.
A culture within health and social care, and wider society, which promotes &
protects human rights and recognises mental health and wellbeing as a vital
component of overall health and wellbeing.
By ensuring the Strategy is as comprehensive and fit for purpose as it can be (including by
using responses to this consultation to refine and improve the Strategy) and by working in
partnership with a number of organisations, individuals and sectors throughout its 10 year
delivery, we are confident that these results can be achieved.
Becca Gatherum
Policy & Research Manager