Response 53211112

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About You

1. What is your name?

Name
Hilary Robertson

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

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4. What is your organisation?

Organisation
Human Development Scotland

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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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If no, what priorities do you think will deliver this transformation?
We welcome the strategy’s commitment to prevention and improving access to services, making them more efficient, effective and safe. Additional priorities we believe are required to achieve a transformation are: 1. Commitment to timely access. There is a clear relationship between how quickly a client can access services and their chances of recovery. We suggest NHS Scotland works towards a waiting time target of 28 days from referral request to first treatment. This is similar to the target in place in Wales. 2. An explicit commitment to greater data transparency and accountability. While many mental health statistics are published, basic information on aggregate levels of mental health spend are not readily available making it difficult to hold current and future ministers to account. Furthermore, published information on rates of recovery and improvement lag behind those published in England. 3. A commitment to research. Many talking therapies remain under-researched. Further research to evaluate the appropriateness of different modalities of therapies for different patient groups, and to improve understanding of education and training, is much needed.

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?
1. Commitment to a choice of therapy. There is robust evidence that choice is an independent predictor of treatment outcome. A 2014 meta-analysis of 32 clinical trials found that clients who shared in decision making or received a choice of treatment had lower drop-outs, greater treatment satisfaction and better treatment outcomes. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176894/ This is in line with data collected by the 'We Need To Talk' coalition in England in 2010 which found that: - 91% of people who had a full choice of therapy were likely to be happy with their treatment compared to 28% of those who wanted a choice but did not get it - 38% of people who had a full choice of therapy reported that therapy definitely helped them back to work compared to 8% who did not https://www.mind.org.uk/media/280583/We-Need-to-Talk-getting-the-right-therapy-at-the-right-time.pdf 2. Shorter waiting times Shorter waiting times are linked to improved patient outcomes. Evidence from Wales suggests that the less time someone has to wait for treatment, the greater the chances their mental health and wellbeing will improve. Of those seen in 28 days or less, more people saw improvement than those who did not, over 28 days, the figures reverse (Gofal (2014) People’s Experiences of Primary Mental Health Services in Wales – One Year On). In line with targets in place in Wales, we suggest that, over time, the current 18 week target be replaced with a far more stringent 28 day target. Furthermore, we suggest that the clock for the target starts ticking upon referral request, rather than actual referral, to prevent ‘gaming’ the target. 3. Less emphasis on computerised CBT (cCBT) We believe the consultation focuses unduly on the provision of Computerised CBT (cCBT). While cCBT does appear to work in certain experimental settings, its utility in actual clinical settings is open to question. One recent study in a real-world clinical setting in the UK found that cCBT provided no benefit over usual GP treatment http://www.bmj.com/content/351/bmj.h5627. Practice-based evidence suggests high levels of engagement and retention, improved wellbeing and good client satisfaction from face-to-face interventions. Systematic reviews have suggested that the acceptability of cCBT to patients is very low when compared with other treatments as indicated by far lower take-up rates. Many patients offered cCBT do not access the material, or they make minimal use of it. (http://www.ncbi.nlm.nih.gov/pubmed/18205964?access_num=18205964&link_type=MED&dopt=Abstract) Client preference for cCBT is very low. For example, out of one sample in Sweden, 65.1% of patients preferred face-to-face treatment, compared to only 2.6% who preferred treatment provided via the Internet (21.7% preferred both modalities to an equal extent)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925931/. A concern for voluntary sector services is having to pick up the high proportion of clients who drop out of cCBT. This needs to be monitored and addressed appropriately.

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?
A real transformation of mental health services over the next 10 years will require an unwavering commitment to aim for a maximum 28-day waiting time target for access to a qualified and accredited counsellor, psychotherapist or counselling psychologist who can deliver talking therapy, whether this be via primary care or appropriately accredited and licensed 3rd sector services. At one stroke this would put the ‘care’ back into the mental health/‘care’ professions, and signal acceptance that mental health support and help may not begin and end with the NHS. It would also take into account that physical and mental health are intertwined and mutually influential. Specific measures in relation to the strategy's priorities: Priority 2: Prevention and early intervention for infants, children and young people A 24-hour helpline, staffed by appropriately qualified professionals, for parents, relatives, carers and friends seeking information and practical, sometimes emergency, help for children and people in psychoses, altered mind states and/or emotional distress. Priority 3: Access to mental health support in primary care Access via primary care services (GP practices, integrated health care centres) to: • Information about the range of talking therapies and how they may be accessed • Assessment/exploratory interview with a qualified and accredited counsellor within 28 days of a referral request • Information about mental health services, including talking therapies*, easily available to GPs and primary care practitioners; GPs and primary care practitioners receiving training regarding the range of options in talking therapies and the choices available to people seeking support, insight and the means to improve their well-being. *including in regard to undertaking training and qualifications in counselling and psychotherapy Priority 4: Support for self-management. • Education for young people*, parents and older people regarding how to understand our own mental ill-health and to be able to take action to maintain or improve it. We should draw people’s attention to the fact that mental ill-health can be remedied more often than is supposed and that the concept of recovery is well supported. • A recognition of the importance of human relations in developing and supporting individual well-being and resilience and an awareness that our personality and personal qualities are influenced by our relationships, rather than being constant. This should include maintaining resilience, well-being and personal insight in staff and carers, both during training and throughout their careers. This is often done best in 3rd sector settings which allow people to 'step out' of their usual roles. Addressing staff well-being and resilience benefits the well-being of the wider population indirectly and so supports several of the strategy's priorities. • Properly-funded mandatory weekly personal, social health and economic (PSHE) lessons in schools delivered by well-trained staff: specifically mental health education tailored for girls and young men. Priority 5: Increase capacity and address waiting times issues in CAMHS and psychological therapies. 
 • Ensure access within 28 days to talking therapies provided by qualified and accredited counsellors and psychotherapists by people with substance abuse or addiction problems, and by offenders • A network of ‘safe haven’ residential crisis centres developed and staffed under the guidance of appropriate qualified professionals, where people in psychoses, altered mind states and/or emotional distress can find, generally, time-limited sanctuary. Access to such centres should be within 28 days of a referral request • Ensure integration of service provision, education and accuracy of information across community, primary, secondary and acute care settings. (Research references courtesy of the UKCP)