Download Mental Health: A 10 year vision

Health and Social Care Alliance Scotland (the ALLIANCE)
Response: Mental Health – a 10 year vision
16 September 2016
The Health and Social Care Alliance Scotland (the ALLIANCE) is the national third
sector intermediary for a range of health and social care organisations. It brings
together over 1,500 members, including a large network of national and local third
sector organisations, associates in the statutory and private sectors and individuals.
The ALLIANCE’s vision is for a Scotland where people of all ages who are disabled or
living with long term conditions, and unpaid carers, have a strong voice and enjoy their
right to live well, as equal and active citizens, free from discrimination, with support and
services that put them at the centre.
On 5 August 2016, the ALLIANCE convened a group of members and third sector
partners to share views ahead of the Scottish Parliament’s call for evidence on mental
health, which also asks for views on the future of mental health in Scotland. The
response below is largely drawn from this discussion, our work with members and
partners over a number of years on mental health, including in the development of the
Mental Health (Scotland) Act 20151, and our various projects, programmes and
research2.
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?
No. The ALLIANCE believes that a more transformational strategy is possible than is
set out in the current vision paper3. We add our support to the recent call from the
1
http://www.legislation.gov.uk/asp/2015/9/contents/enacted
http://www.alliance-scotland.org.uk/what-we-do/our-work/
3
http://www.gov.scot/Resource/0050/00503669.pdf
2
Scottish Mental Health Partnership4 for a high level Commission of enquiry to lead and
inform the transformation required. Such a Commission could focus its deliberations in
a number of areas but this would, in our view, require significant reflection on the range
of outputs from the previous strategy, including:
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Integrating human rights based approaches to health and social care in the
mainstream of support and services
Prevention, early intervention and recovery being core to the development of future
strategy and guiding the mental health support and services of the future (including
evidence-based approaches to supporting recovery)
Clear measures to combat isolation, exclusion, stigma and discrimination
Cross-sectoral, coordinated approaches that are focused on the whole person and
incorporate employment, housing and education, as well as mental health care,
treatment and support.
These are measures which should be strongly informed and influenced by people with
lived experience of mental health problems and unpaid carers. Our members tell us
that, to date, the development of the vision for the new mental health strategy has not
strongly reflected previous discussions between people and the Scottish Government.
The ALLIANCE has written to the Scottish Government calling for a coproduction
approach to be taken to any new strategy.
“In discussions about the development of the strategy, however, a number of third
sector organisations and ALLIANCE members have raised concerns about the scope of
the draft vision, the nature of consultation in advance of publication and its potential
scope and impact, and these concerns, we understand, are shared by the Scottish
Mental Health Partnership.
The ALLIANCE is keen to ensure that a co-produced strategy is developed, building on
the successes of the previous Mental Health Strategy with input from people who have
lived experience of mental health conditions, unpaid carers and the organisations who
work with them from across Scotland.”
Letter from Ian Welsh, CEO of the Health and Social Care Alliance Scotland (the
ALLIANCE) to Maureen Watt MSP, Minister for Mental Health, 9 August 2016.
4
http://www.rcpsych.ac.uk/pdf/Why%20Mental%20Health%20Matters%20to%20Scotland.pdf
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?
We are concerned that the new draft vision does not adequately reflect the range of far
reaching research and recommendations made in reports commissioned under the
commitments of the previous 2012-15 Mental Health Strategy.
For example, in relation to Commitment 1 of the 2012-15 Strategy, the Mental Health
Foundation and Voices of eXperience (VOX) have published A Review of Mental Health
Services in Scotland5, providing a snapshot of experiences and views on future
development and reflection on the successes and challenges of the mental health
system in Scotland. Our concern is that the detailed information provided in this report
has not subsequently influenced the development of the new vision.
Human Rights
Human rights are already inherent in the ambition for mental health6, and health and
social care more widely. However, for many people – including people affected by
mental health problems – the right to the highest attainable standard of health remains
unrealised7. People with mental health problems can die 20 years younger, are poorer
on average and have fewer opportunities in life than the general population.
We urge the Scottish Government to make a clear commitment to enact the
recommendations outlined in the Mental Welfare Commission and the Scottish Human
Rights Commission report on progress towards increasing and developing the focus on
rights as a key component of mental health care in Scotland8 (Commitment 5 of the
previous strategy).
This report contained the following recommendations for the Scottish Government to
take forward in relation to human rights and mental health:
5
https://www.mentalhealth.org.uk/sites/default/files/Commitment%20One%20Report%2C%20January%202016.p
df
6
See, for example, the Rights for Life initiative (https://rightsforlife.org), the work of SAMH
(https://www.samh.org.uk/our-work/public-affairs/human-rights) and See Me
(https://www.seemescotland.org/our-movement-for-change/change-networks/human-rights)
7
http://www.scottishhumanrights.com/application/resources/documents/SNAP/GettingitRightAnOverviewofHum
anRightsinScotland2012.pdf
8
http://www.mwcscot.org.uk/media/240757/human_rights_in_mental_health_care_in_scotland.pdf
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The next mental health strategy should be explicitly build around a human rights
based approach, utilising a human rights framework to shape its aims and
mainstream human rights across its commitments.
Measures to combat stigma and discrimination and improving the awareness of the
rights of people with mental health problems.
Development of policies, practices, procedures and priorities employing integrated
human rights and equality impact assessments.
A review and consolidation of existing training initiatives across the mental health
workforce against the human rights framework.
Promotion of the wider use of advance statements.
National action to focus on strengthening existing forms of supported decision
making.
Children and Adolescent Mental Health Services (CAMHS)
Around Scotland there is a disparity between the ages of eligibility for CAMHS, with
some areas (e.g. NHS Borders) allowing eligibility until age 18 and others (e.g. NHS
Lanarkshire) capping access at age 16 (if referred before 16th birthday). This means
that there are more cases relevant to the CAMHS waiting time target in some areas of
the country than others and, consequently, a disparity between the figures.
At the same time, young people report that education staff do not appear confident
enough to deal with mental health issues or make referrals to CAMHS for the children
and young people they work with. This was reflected in focus group discussions
undertaken as part of the Scottish Youth Parliament’s “Our Generation’s Epidemic”
report9, particularly in relation to talking to teachers about mental health.
ALLIANCE members and partners have expressed concern that as long as CAMHS
targets are the key measurements for these services this will continue to drive
investment, energy, resources and strategic decision making within Health Boards.
Whilst the targets are useful for measuring access to services – a key component of the
right to health – prioritising them can lead to young people not receiving support at a
much earlier stage and preventative action not being taken. This has the unintended
consequence of resulting in people requiring to be in a more severe condition in order to
get support.
9
http://www.syp.org.uk/our_generation_s_epidemic
Other priorities for improvement:
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Moving beyond a medical model of support to a broader approach which
encompasses rights-based10 community and guided support to the right types of
help to meet personal circumstances.
Improved communication about the eligibility for CAMHS and progress of a referral
to CAMHS.
The current target is a measure of whether someone receives access to a service –
not whether they get any benefit from doing so. Improved monitoring and evaluation
of people’s personal outcomes is critical to determining the effectiveness of a
service.
Greater recognition of recovery approaches. SRI 2, developed by Scottish Recovery
Network to provide services with a practical tool to review, develop and improve how
they support recovery11 has rarely been used in CAMHS services. There have been
400 SRI 2 completions to date most of which are by NHS services but only two
completions are by CAMHS services12.
Improved links between the education system and CAMHS – with integration of
mental health support into schools a priority. These services, in some areas, have
been withdrawn due to a lack of local resources, despite evidence showing that
raising awareness and removing stigma influences outcomes.
Mental Health Key Performance Indicators
The Scottish Government is also currently establishing a suite of specialist mental
health key performance indicators (KPIs). We believe that these indicators need to link
more closely with existing indicators to help drive change and transformation in line with
the Scottish Government’s policy agenda and captured in the National Health and
Wellbeing Outcomes. This should be a priority area for the new strategy.
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?
Adopting a Human Rights-Based Approach in Scotland
We believe that adopting a rights-based approach to mental health and wellbeing will
help the Scottish Government achieve its aim to transform mental health in Scotland.
10
http://www.mwcscot.org.uk/media/240757/human_rights_in_mental_health_care_in_scotland.pdf
http://www.sri2.net
12
http://www.sri2.net/images/files/Guidance/Documents/SRI2_Report_Final_Web.pdf
11
Taking a human rights-based approach to mental health and wellbeing, in a gradual and
considered way, is about taking rights beyond the ‘floor’ of what is acceptable.
Human rights are often associated with courts, lawyers and legal action. However they
are also standards to help shape policy, programmes and practical interventions.
Rights and the human rights-based approach can be embedded at all stages, including
legislation and policy; budgeting; implementation; monitoring, evaluation and review.
The rights-based approach adds to Scotland’s values based approaches by ensuring
we are accountable for our actions.
To make a real difference much more must be done to increase understanding of how
such approaches can be used in practice and translate the policy intentions “into more
consistent, positive outcomes to which individuals are entitled.”13 This does mean
making different decisions around how resources are allocated and used – especially in
times of austerity.
We recognise that in the current environment this is challenging. But the difficult
financial, and uncertain political, climate give greater impetus to the need to develop
new approaches on a fair, robust and legal basis. A human rights-based approach to
decision-making can be a very useful framework to inform difficult decisions and budget
prioritisation by giving a structure and tools against which to balance competing needs
and develop new and sustainable approaches to health and social care.
The rights-based ‘PANEL’ principles14 offer a way to put rights into practice. More
information on PANEL can be found in the Scottish National Action Plan Action Group
on Health and Social Care’s consultation response. This also contains
recommendations for priorities and early action on areas of concern for people with
lived experience of mental health problems, including participation in decision-making,
stigma and discrimination, and lack of accountability and information.
Community Links Practitioners
Primary care and community based approaches can offer guided support to get the right
type of help at the right time and help prevent the need for individuals to ever even
access the medical system. We welcome the Scottish Government’s recent
13
http://www.scottishhumanrights.com/application/resources/documents/SNAP/GettingitRightAnOverviewofHum
anRightsinScotland2012.pdf
14
http://www.scottishhumanrights.com/careaboutrights/whatisahumanrightsbasedapproach
commitment to extending this role15, which has the potential to transform current
practice around prevention and early intervention in mental health.
One example of this type of approach is the National Links Worker Programme16, a joint
project between the ALLIANCE and General Practitioners at The Deep End (GPs at the
Deep End). Delivery Partners include the Royal College of General Practitioners
(RCGP), and Scottish Association for Mental Health (SAMH). The programme aims to
mitigate the impact of the social determinants of health in people that live in areas of
high socioeconomic deprivation (top 15% SIMD), along with gathering and sharing
learning about the approach and supporting others who are interested in this way of
working.
The programme offers a new model of primary care, co-produced with GPs, and aligned
to the needs of socio-economically deprived communities. Key findings from this subproject of the main evaluation study includes the following:
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Community resources where the programme is active report a substantial increase
in referrals from primary care, and an increased relevance of these referrals with
regard to the services they offer.
Community Links Practitioners are valued as a vital resource that enables
coordinated approaches to working for the benefit of the most vulnerable people.
This is seen as a valuable asset that is otherwise missing for these people.
Community resource staff perceive Community Links Practitioners to be at the
centre of a potential network of resources, with a broad knowledge of the person,
available support, and close links with primary care practitioners.
The Links Worker Programme should be understood as an intervention that is being
targeted not simply at the individuals who access the services of a Community Links
Practitioner, but as a transformative intervention which acts as a catalyst to wider
changes in the primary care team. We believe that a links approach, adopted by GP
practices across Scotland, would transform primary care and support for people who
have mental health problems and we therefore encourage the Scottish Government to
further nurture these developments.
The Scottish National Party’s 2016 manifesto recognises that under a returned SNP Government:
“Scotland’s most deprived communities need additional support” and commits to “recruit at least 250
Community Link Workers to work in GP surgeries and direct people to local services and support.”
16
http://links.alliance-scotland.org.uk/
15
Social Security and Independent Advocacy
The Scottish Government is currently consulting on the development of social security
in Scotland, following the transfer of responsibility from the UK Government to the
Scottish Government for a number of social security benefits as a result of the Smith
Commission and then the Scotland Act 2016. The ALLIANCE believes that in ten years’
time, independent advocacy should be available across the country that is tailored to
the individual requirements of people who have experience of mental health problems
accessing the new social security agency.
The ALLIANCE and Scottish Independent Advocacy Alliance (SIAA) were funded by the
Scottish Government to deliver a one year pilot advocacy project in four areas of
Scotland (Dundee City, Forth Valley, Glasgow, Midlothian/City of Edinburgh) from May
2015 to October 2016. The project was specifically tailored to support people with
mental health problems, neurological conditions and learning disabilities. Over 900
people used the project, 74.1%, of the primary health conditions amongst people related
to their mental health17.
The project aimed to show the value of independent advocacy support during
assessment processes for Employment Support Allowance and Personal Independence
Payment. It has also created a significant amount of evidence on the experiences of
people with mental health problems accessing the current social security system and
recommendations for the future18. The ALLIANCE believes that independent advocacy
can:
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Provide an enhanced level of support for people during assessment processes.
Go some way to empowering people in an inherently unequal situation.
Act as a barrier to inappropriate conduct by assessors.
Enable a witness to inaccurate recording of findings in such processes.
Key tasks carried out by independent advocates in assessments centred on:
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Prompting clients at varying degrees of frequency.
Providing reassurance, verbally, non verbally or by their presence.
Calming clients down including prior to assessments and when there were delays.
On one occasion challenging assessors, on another challenging the behaviour and
decisions of assessment centre staff.
http://www.alliance-scotland.org.uk/what-we-do/our-work/policy/welfare-advocacy-support-project/
http://www.alliance-scotland.org.uk/download/library/lib_570dfed6e8a1a/
Many people who accessed the support were clear that they would not have gone to the
face to face assessment, or not have completed the face to face assessment, without
the support of an independent advocate. A detailed evaluation of the project was
undertaken19, which showed that significantly greater numbers of people who received
independent advocacy support had successful claims than the national average. The
largest impacts were seen on people’s understanding of the process, their ability to
communicate and preparation and there were also significant impacts on people’s
confidence about communicating.
The ALLIANCE is keen to ensure that the 10 year mental health vision explicitly
recognises the need to ensure that independent advocacy has a key role to play in
supporting people affected by mental health problems to navigate the social security
system as well as health and social care settings and wider.
For More Information
Contact:
Andrew Strong, Assistant Director (Policy and Communications)
E: [email protected]
T: 0141 404 0231
W: http://www.alliance-scotland.org.uk/
19
http://www.alliance-scotland.org.uk/download/library/lib_570dfed6e8a1a/