Response 32709312

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About You

1. What is your name?

Name
Joe Liardet

3. Are you responding as an individual or an organisation?

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4. What is your organisation?

Organisation
British Psychological Society

5. The Scottish Government would like your permission to publish your consultation response. Please indicate your publishing preference:

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Questions

1. Our framework 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?

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Yes
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If no, what priorities do you think will deliver this transformation?
The Society is broadly in favour of the priorities set out in the draft strategy but supports a more ambitious 10-year vision for Scotland, along with a widening of the identified priorities. Thus, it would like to see a strategy which has the goal of good mental health for all at its heart. This should include a public health campaign which: • Gives the message that mental health is everyone’s business (individuals, families, schools, employers, communities, etc). • Promotes an assets-based approach to build personal resilience, connectedness and social capital. • Advocates a biopsychosocial model of mental health and recognises the links between socioeconomic deprivation and poor mental health. • Ensures a fully integrated, whole system approach, with all agencies (health, social work, welfare, education, child protection, justice, asylum/refuge, etc) contributing to the agenda. • Pays attention to psychological and social factors in all areas of physical and mental healthcare. • recognises the impact of adverse childhood experiences on subsequent mental health • Views psychological treatment at least as important as medical treatment in mental health care. • Strives for quality and effectiveness in the provision of psychological therapies. • Addresses inequalities across the country and between care groups in access to and up-take of mental health services and, specifically, psychological therapies (e.g. poor uptake by older people/people with a learning disability compared to the general adult population). In relation to priorities, the Society is strongly supportive of having ‘prevention’ as the key priority but considers that this should go beyond the current focus on pregnant and new mothers, infants, children and young people. In particular, it would like the following to be included: • The mental health of people with physical health problems (e.g. traumatic brain injury, sports injury, long-term conditions) and their families/carers (to help prevent mental health problems and to improve response to treatment/recovery from illness). • The mental health of those who present with medically unexplained symptoms (to prevent unnecessary, often costly, medical investigations and procedures, and, to prevent the development of more serious mental health problems), • Adult survivors of trauma (to help prevent revictimisation, parenting difficulties, exacerbation of existing mental health problems, etc). • People in inpatient services (to help prevent re-admission e.g. people with dementia). • Women planning pregnancy who are already identified as being vulnerable to mental health problems. In addition, the Society would like the strategy to incorporate a commitment to a wholesale review of both mental health and capacity legislation, applying the principle that the deprivation of liberty and loss of freedom for the purpose of mental health treatment under civil law should be based on capacity.

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?
Additional actions recommended: Priority 1: • screening of expectant mothers for early identification of mental health problems/vulnerability • all systems support for vulnerable families • Case worker/named nurse allocated to work with vulnerable women from pre-pregnancy and beyond birth. Priority 2: • Roll-out parenting programmes to a broader range of vulnerable families.The BPS recommends that the term conduct disorder is not used as it does not fit with current models of understanding the relationship between children’s emotional needs and their behaviour and associated interventions. Terms such as ‘severe emotional and behavioural difficulties’ or ‘serious attachment problems’ are preferred. • Identify and treat children and young people with complex mental health problems beyond psychosis, e.g. co-morbidities. • Roll-out programmes in schools to promote well-being and help children and young people build resilience, connectedness and social capital.. • Develop seamless pathways between schools, educational psychology and child and young people’s mental health services. • Address the lack of specialist mental health provision for children and young people in inpatient services, including forensic institutions. Priority 3: • Support the integration of mental and physical health at primary care level to reduce stigma, foster community supports, build assets and contribute to the prevention of mental health problems (see Dale and Lee, 2015). • Develop a role for community practitioner psychologists (as currently employed in NHS England) to provide expertise in the application of relevant research findings to develop behaviour change programmes. • Test models involving practitioner psychologists working alongside General Practitioners. • Promote Routing Sensitive Enquiry (re trauma) in primary care. Priority 4: • Extend support for people with mental health challenges to include engagement in meaningful activities beyond employment. • Ensure that link workers (which the BPS supports) are not used as a substitute for trained mental health workers. Priority 5: • Ensure the provision of high quality psychological therapy by adhering to the guidance contained in ‘The Matrix’ (NHS Education for Scotland, 2015), ie evidence-based therapies, delivered by staff who are properly trained and appropriately supervised. • Improve consistency of access to psychological therapies, at all levels of intensity, across the country and across care groups. • Address gaps in the provision of psychological therapy, e.g. inpatients, prisoners, people with personality disorder. • Introduce a minimum dataset in relation to the assessment of mental health problems and the provision of psychological therapies. Priority 6: • Promote alternatives to medication for people with dementia. • Promote integrated approaches to behaviour change, e.g. smoking, alcohol and exercise, with the application of health psychology models. Priority 7: • Extend the “focus on improving mental health services” for people living with other long term conditions to include attention to cognitive functioning and psychological well-being, more broadly. • As above, promote integrated approaches to behaviour change, eg smoking, alcohol and exercise, with the application of health psychology models. Priority 8: • Consider the rights of people with prolonged disorders of consciousness (currently there is poor guidance on their care in Scotland) and their families. • Extend the review of deaths of patients in hospital to consider other aspects of harm e.g. restraint, near misses. Promote robust and transparent approaches to investigation, e.g. involve a broad range of investigators from a range of disciplines and backgrounds, to avoid clinicians being investigated by close colleagues. • Introduce a capacity based approach to the restriction of liberty and loss of freedoms in all areas of mental health care, to modernise existing mental health and capacity legislation, accepting that this will be a lengthy and time-consuming piece of work. • Given that any review of existing legislation is likely to take several years, the BPS urges the Scottish Government to extend the powers to assess capacity and authorise psychological treatment for people deemed to lack capacity, to practitioner psychologists, under Section 47 of the Adults with Incapacity (Scotland) Act 2000. This would bring immediate benefit to patients and carers.

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?
For psychological and social factors to be considered in all healthcare encounters and taken into account in all mental health treatment planning with individuals and their families/carers. For psychological interventions to be considered at least as important as medical treatment in mental health care. Access to high quality psychological interventions (in line with guidance in The Matrix (op cit)) within an appropriate timescale for all those who need them. For an effective focus on prevention, which ensures that: • people develop resilience and personal supports • services are accessed only by those who really needs them • The majority of people have their needs met adequately in primary care. • people’s needs are addressed sufficiently early to prevent problems worsening • people are matched to the most appropriate level of care as early as possible Participation of service users and carers in the planning, development and review of all mental health services and physical health services providing mental health care. For mental health services to be able to access support for clients from all relevant agencies, e.g. social work, housing, welfare, employment, etc. Smoother transitions between services (e.g. child to adult services), no gaps in provision and easy accessibility for all care groups and all populations regardless of socioeconomic status or ethnic group. For services to be supported by adequate IT systems to allow for continual, robust evaluation of outcomes and public scrutiny.