The following information is provided to the Joint Delivery Board on work being progressed across the children and young people and mental health policy landscape in order to provide context and support connectivity. This bulletin will continue to be developed and may highlight further areas of policy work at future meetings.
Mental health in primary care
Health and Social Care Partnerships (HSCPs)have been submitting local plans for Primary care mental health developments to the now established National Oversight Group. The first five plans were considered at the group meeting on 27 April and a further 20 plans will be considered at the next meeting on 22 June.
So far the plans are of variable quality and the team will be working with local systems to bring some of the less detailed plans up to the very high standard submitted by some HSCPs.
One of the assessment criteria for the plans is the extent to which they describe how children and young people will be able to access these primary care services. One of the principles is that in common with other of Primary Care services they are not age or care group specific.
As plans are passed by the group they will be recommended for ministerial approval and funding released to begin implementation. A measurement and evaluation framework is in development to help assess progress beyond the expansion of posts within these teams.
Quality and Safety Board
The Quality and Safety Board 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 CAMHS service specification. The aim of these standards is to improve the quality and safety of mental health services and to ensure that individuals, their families and carers know what they can expect from mental health services, ensuring a person-centred approach is at the heart of the approach. The standards should provide an opportunity to build a collective understanding of performance and enable effective benchmarking to drive improvements in quality of care. In addition, they should reduce scope of unwanted variation of quality of care and therefore reduce inequalities in experiences and outcomes. The standards should provide a basis for continual improvement though enabling greater scrutiny and assurance of services against the standards.
The Quality and Safety Board are also supporting the delivery of two of David Strang’s recommendations from his Independent Review of Mental Health Services in Tayside. These are:
- recommendation 12: Conduct a national review of the assurance and scrutiny of mental health services across Scotland, including the powers of Healthcare Improvement Scotland and the Mental Welfare Commission for Scotland
- recommendation 32: A national review of the guidelines for responding to substance misuse on inpatient wards is required
Perinatal and Infant Mental Health Programme Board
The Perinatal and Infant Mental Health Programme Board is taking a strategic oversight of the commitment to improve perinatal and infant mental health services across Scotland. This includes the development and implementation of community and inpatient statutory services, third sector provision, workforce/training development and awareness raising/stigma reduction. The priorities for each year are laid out in the annual Delivery Plan and the plan for 2021 to 2022 is available on our website.
Current priorities for the Perinatal and Infant Mental Health Programme Board include the ongoing provision of statutory services (including regional working and development of a service specification for perinatal mental health services), work on requirements around additional perinatal mental health inpatient provision and forward planning for the conclusion of the Programme Board in March 2023.
Mental Health in Schools Working Group
The Mental Health in Schools Working Group continue to work together to embed the new online professional resource which was published in June 2021. The free online professional learning resource supports school staff to understand and recognise the range of mental health and wellbeing concerns that children and young people may experience. The resource complements the Whole School Approach Framework for schools to support children and young people’s mental health and wellbeing.
Keeping The Promise
The Scottish Government is committed to Keeping The Promise by 2030, working in partnership with Local Government, The Promise Scotland, the third sector, health boards and importantly the care community to do so.
In March of this year, we published the Scottish Government’s Promise Implementation Plan that sets out how we will work across Government to Keep the Promise we have made to Scotland’s children and young people who are care experienced. The Plan has over 80 actions across nearly all Ministerial portfolios that we will take to Keep The Promise. The Plan is presented in two clear parts: Part One sets out the vision for what the future will look like and how as Scottish Government we will achieve this. Part Two sets out the actions and commitments we will take.
This is a cross Portfolio Plan the covers the activities of 26 Directorates across Government and brings our action together in line with the structure set out by The Promise
The Promise Implementation Plan sets out a number of key commitments that we will take forward to Keep The Promise and help provide children and families with the strong foundations they need to thrive. We will:
- introduce a new Whole Family Wellbeing Funding of at least £500m over the course of this Parliament, enabling the building of universal, holistic support services, available to children across Scotland
- introduce a new Care Experience Grant, providing a £200 annual payment over 10 years to young people with care experience between the age of 16 and 26
- set a Recommended National Allowance for foster and kinship allowances
- end the placement of 16 and 17 year olds in young offenders institutions without delay. We will fund care-based alternatives to custody and consult on new legislation in Spring 2022
- strive to ensure that Scotland becomes a nation that does not unnecessarily restrain its children. We will consult on the appropriate legal underpinning to ensure children’s rights are protected in care settings in March 2022
- agree with The Promise Scotland for them to develop a blueprint for the creation and control of, and access to, information about care experienced people which will empower people to decide who and when key information about them is made available
- agree with The Promise Scotland for them to scope the need for a national lifelong advocacy service for care-experienced people and their families
- work closely with The Promise Scotland to undertake a redesign of the Children's Hearings System. Sheriff Mackie’s Working Group has already started its work
- introduce a Promise Bill to make any further legislative changes required to Keep The Promise, including in relation to the Children’s Hearings Systems redesign, by the end of this Parliamentary session
Further information can be found on The Promise website..
Holistic Family Support
The Scottish Government remains committed to investing at least £500m over the life of this Parliament in Whole Family Wellbeing Funding (WFWF). This funding will support the whole system change necessary at a local and national level to transform the delivery of holistic family support to ensure families get the support they need, when they need it whilst driving our commitment to #keepthepromise. We will publish our spending plans for 2022 to 2023 in due course.
Tackling Child Poverty Delivery Plan
The Scottish Government published ‘Best Start, Bright Futures’ - the second Tackling Child Poverty Delivery Plan for the period 2022 to 2026 - at the end of March 2022. The Plan outlines transformational action to deliver on Scotland’s National Mission to tackle child poverty.
The Plan sets out action to put cash in the pockets of families. This includes action which took effect from 1 April 2022, with the doubling of the Scottish Child Payment to £20 per week for eligible children under the age of six and the increase in the value of a further 8 Scottish social security benefits 6%.
The plan commits to working in partnership with local authorities to mitigate the benefit cap, as fully as we can within the limits of devolved powers, backed by up to £10 million of investment each year. Additionally, the Scottish Child Payment will be further increased to £25 per eligible child, per week, by the end of 2022 when the benefit is expanded to eligible children under the age of 16.
The Plan also sets out the action we will take to drive progress in the medium to longer term to enable thousands of families to break the cycle of poverty. This includes significantly strengthening our employment services to support parents to enter, sustain and progress in work, backed by up to £81 million in 2022 to 2023, and further strengthening our support to parents through a new £15 million Parental Transition Fund to tackle financial barriers parents face in entering the labour market.
In addition to our support for parents to increase their earnings from social security and employment, the plan also sets out our wider commitment to reshape a holistic package of support around families, improve access to mental health services, tackle fuel poverty and increase access to affordable housing for families who need it most.
The wide ranging action set out in the Plan will help to drive progress toward the interim child poverty targets set for 2023 to 2024, to lift more children out of poverty and to provide much needed support for families facing the cost of living crisis.
The COVID-19 Children and Families Collective Leadership Group
The COVID-19 Children and Families Collective Leadership Group (CLG) has been taking immediate action throughout the pandemic to support children and families in vulnerable situations based on the data and intelligence that it receives and engagement work with children, young people and families. CLG will continue to receive regular updates on data trends, identify areas of concern, undertake deep-dive work to establish immediate actions to be taken; and monitor the impact of the response.
As the emphasis now shifts from crisis response to intermediate and longer-term recovery, CLG will focus on providing support for Covid recovery and renewal. CLG’s priorities for this year include maintaining momentum on work to Keep The Promise and the development of a Children, Young People and Families Outcomes Framework.
The Children, Young People and Families Outcomes Framework will be aligned to the National Performance Framework and provide a set of wellbeing outcomes, based on what matters to children and families, and a means of measuring progress against these in a meaningful and transparent way. It will provide a way of connecting what is done at national and local level, with the difference it is making to the lives of children and families in Scotland.
CLG’s last meeting on 12 May covered the following items:
- a “Lessons Learned” session arising from the work undertaken to date on supporting Ukrainian refugees
- CoSLA presented a report highlighting the work taking place across local government and related services to Keep The Promise:
- issues and recommendations resulting from a review of the 30 Children’s Services Plans (CSPs) published in 2020/21 and strategic engagement with the CSP Strategic Leads Network and other stakeholders
Further information on the Collective Leadership Group can be accessed on our website.
Digital Mental Health Programme Board
The Digital Board is progressing several workstreams:
- computerised CBT for young people experiencing anxiety is currently being rolled out through a Test of Change project in 5 Health Board areas. This looking at routes into treatment through schools, GPs and specialist mental health services
- support programme for parents and carers of child and teen suffering from anxiety and low mood have been made available through self-referral across all areas of Scotland
- work across CYP service continues across all areas of activity within the Digital Mental Health Programme
Wellbeing and prevention
Early intervention and prevention are key priorities for the Scottish Government in taking forward our approach to mental health and wellbeing. Our aim is to support people to positively engage with their mental health at an early stage, promoting and supporting the conditions for good mental health and wellbeing at a population level.
We are taking forward a range of key actions focused on prevention and early intervention by promoting and supporting the conditions for good mental health and wellbeing at population level and providing accessible signposting to help, advice and support. These programmes of work are focused on upstream support for mental health and wellbeing with the aim of reducing the need for clinical interventions by helping to address some of the social determinants of mental health.
Key actions include:
- the launch last month of Mind to Mind, a new site to support the mental wellbeing of the general population in Scotland by offering tips and advice from people with lived experience of mental health issues and associated professionals. The site focuses on five themes - anxiety and panic, sleep, stress, grief and loss and low mood – and signposts to a range of trustworthy resources
- an online platform for employers to support the promotion of mentally healthy workplaces, to be launched this Summer. This will provide an easy-to-access platform for employers with signposting to appropriate resources to help them support positive mental health and wellbeing at work
- support for grassroots community groups, through the Communities Mental Health and Wellbeing Fund, to deliver activities and programmes for adults facing social isolation, loneliness and mental health inequalities. £21 million was made available in 2021 to 2022 - involving over 1800 awards to community groups - and a further £15 million will be invested for a second year of the Fund in 2022 to 2023
Mental Health Strategy
We are committed to producing a new Mental Health and Wellbeing Strategy in 2022, building on the implementation of our Mental Health Covid Transition and Recovery Plan.
The new strategy will allow us to look ahead to make sure we are doing the right things to meet changing mental health needs over the coming years as we recover from the pandemic; and will set out a clear vision for future population mental health, wellbeing and care, and our priorities to help us get there.
The scope of the strategy will be wider than before, with an increasing focus on wellbeing and prevention. We will also consider how the strategy can take account of social factors and inequalities that may impact a person’s mental health and wellbeing.
We have already undertaken extensive engagement to help us shape thinking about the strategy. We will be launching a public consultation in the coming weeks and will take forward further engagement activity over the summer months, including with people with lived experience, to inform this important work. That will also involve learing from children and young people – the team leading on the Strategy are linking closely with those who led on engagement with children and young people as part of the Children and Young People’s Mental Health and Wellbeing Joint Delivery Board. The consultation will include questions on the scope of the strategy, the draft outcomes and what our overall vision should be. The consultation also contains questions about how we can support a sustainable workforce for mental health and wellbeing.
The National Care Service
The Independent Review into Adult Social Care (IRASC) recommended the establishment of a National Care Service, with Scottish Ministers being accountable for the delivery of consistent and high standards in health and social care services.
Last year the Scottish Government undertook a public consultation on its proposals for a National Care Service (NCS) to achieve changes to the system of community health and social care in Scotland; and published an independent analysis of the consultation responses. The feedback received has been used to shape and develop new legislation - the National Care Service (Scotland) Bill was introduced to the Scottish Parliament on 20 June 2022. The Bill provides the foundation for the NCS, and enables the fine detail of the new service to be co-designed with people who have direct experience of social care services. Plans have also been published to explain how that collaboration will work. In parallel with further consultation about mental health services, independent research will be commissioned by the Scottish Government to build the evidence base on the current delivery models of children’s services. This research project will consider the different models of delivery to develop an understanding of which delivery models can most effectively implement The Promise and support the improvement of outcomes for children and families.
In the Programme for Government 2021 to 2022, and the Green Party Agreement, we have committed to deliver a longer term workforce plan in the first half of this Parliament. We want to ensure that commitments in the forthcoming Mental Health and Wellbeing Strategy are underpinned by a resilient and sustainable workforce, that feel valued and supported to promote better mental health and wellbeing outcomes.
We are currently consulting on our strategic approach to workforce planning for mental health and wellbeing, and well as a series of immediate short term actions aimed at growing the mental health workforce. These will be included in the forthcoming Mental Health and Wellbeing Strategy, which is due to be published by the end of 2022.
We are committed to working with Health Boards to deliver real transformation in mental health services and improve the mental health and wellbeing of Scotland.
Following the publication of the Mental Health and Wellbeing Strategy, we will be working closely with partners to identify short, medium and long term actions for Mental Health Workforce Plan, to be published in 2023.
The Plan will build on the recently published National Health and Social Care Workforce Strategy, which sets out a new framework to shape Scotland’s health and social care workforce over the next decade, placing training, wellbeing, job satisfaction and the principles of Fair Work at its heart. It will look at the whole workforce journey and how we can plan for, attract, train, employ and nurture our mental health workforce.
Self harm strategy
The Scottish Government is determined to improve our responses for people who self-harm, and has committed to developing a self-harm strategy which will be separate from (but linked to) our suicide prevention strategy. The views of people with lived experience of self-harm – and their families – will be at the heart of developing the strategy, and it will be informed by insights from services that already provide compassionate support to people who self-harm.
Although this is our first standalone self-harm strategy, we have some good work to build on, including engagement undertaken by Samaritans around their Hidden Too Long - uncovering self-harm in Scotland report. However, many aspects of self-harm are hidden and not well understood and we will build our approach in an iterative way. The initial phase of the strategy will be exploratory, where we will listen to the views of people with direct experience of self-harm and organisations that support them. This will help us understand the changes that are needed, and how we go about delivering them and will be the foundation of the strategy. We know how important it is to get this exploratory phase right, and so will be working alongside people with lived experience to design the programme of engagement.
Progress to date:
- we have now set up a small ‘self-harm strategy design group’ which brings together ‘experts by experience’ and some services which support people who self-harm (Penumbra, Samaritans, Childline, Parentline, SeeMe) to help us plan a programme of engagement which will inform what the strategy and action plan could look like. This will include gathering insights from a wider range of services, including those working with children and young people and their families
- we have also held a self-harm data and evidence workshop bringing together a wide range of academics, analysts and practitioners. This was very positive and as a group we are continuing our conversations about how data and evidence can inform and support the development of the strategy
- given the exploratory nature of the work, we are not yet able to put firm timelines around the development of the strategy but will keep the Joint Delivery Board updated as the work develops
We have also provided funding to Penumbra to pilot new self-harm services in three local areas, which will test out a range of approaches, including some work with children under 16, and to develop an online national support portal and learning from this work will also inform the development of the strategy and action plan. Further information about the new pilot services will follow shortly.
National Suicide Prevention Action Plan – Every Life Matters
The current national action plan began in 2018 and has been extended until September 2022. The Action Plan contains ten actions; four additional actions were recommended by the National Suicide Prevention Leadership Group (NSPLG) in its July 2020 COVID Statement. There are identified delivery leads for the actions and NSPLG sponsors for each action. Progress against each action is contained in the table below. While work continues to implement the current action plan, engagement has begun to develop the next suicide prevention strategy (due for publication in September 2022). Links with the work of the JDB have been made with relevant delivery leads attending the task and finish groups to ensure the alignment with the suicide prevention work. See Annex A for updates to the action plan.
The Scottish Government will set up and fund a National Suicide Prevention Leadership Group (the NSPLG) by September 2018, reporting to Scottish Ministers – and also to COSLA on issues that sit within the competence of local government and integration authorities. This group will make recommendations on supporting the development and delivery of local prevention action plans backed by £3 million funding over the course of the current Parliament. NSPLG in place since 2018.
Local Area Action Plan Guidance published in April 2021. Work continues with local areas to support development of local suicide prevention action plans.
Scottish Government will fund the creation and implementation of refreshed mental health and suicide prevention training by May 2019. The NSPLG will support delivery across public and private sectors and, as a first step, will require that alongside the physical health training NHS staff receive, they will now receive mental health and suicide prevention training. New resources developed to fulfil the requirements at Informed and Skilled level within the Mental Health and Suicide Prevention Framework are available on TURAS.
Work continues on development of Enhanced and Specialist level learning opportunities.
The Scottish Government will work with the NSPLG and partners to encourage a coordinated approach to public awareness campaigns, which maximises impact.
The United to Prevent Suicide social movement launched with over 10,000 visits to the digital hub in September. Specific campaigns around men @_FCUnited was launched in September. A new campaign focussed on children and young people will be launched over summer 2022.
With the NSPLG, the Scottish Government will ensure that timely and effective support for those affected by suicide is available across Scotland by working to develop a Scottish Crisis Care Agreement.
A two-year pilot of bereavement support services in Ayrshire & Arran and Highland areas began in August 2021.
The NSPLG will use evidence on the effectiveness of differing models of crisis support to make recommendations to service providers and share best practice.
The ‘Time, Space, Compassion’ recommendations were published in October 2021 and are being taken forward by a dedicated Suicidal Crisis Support Action Group, led by Nigel Henderson, National Lead for this work.
The NSPLG will work with partners to develop and support the delivery of innovations in digital technology that improve suicide prevention. Phase 1 of a project with NHS Inform to create Safer Online Suicidal Journeys using vlogs created by those with lived experience was launched at the beginning of June.
A digital innovation scheme is also in development which will be aimed at young people.
The NSPLG will identify and facilitate preventative actions targeted at risk groups.
Reports on the specific needs of BAME and Veterans groups have been produced.
The NSPLG will ensure that all of the actions of the Suicide Prevention Action Plan consider the needs of children and young people.
Work focusses with each delivery lead to ensure the needs of children and young people are fed throughout their actions.
A Youth Advisory Group has now been launched and recruitment for members is underway. This will ensure the voices of children and young people are fed into the work of the other actions and the group will be integral to the new strategy.
More information about engaging children and young people in the development of the new strategy, and a guide to assist with facilitating these discussions can be found here.
The Scottish Government will work closely with partners to ensure that data, evidence and guidance is used to maximise impact. Improvement methodology will support localities to better understand and minimise unwarranted variation in practice and outcomes. The NSPLG and the delivery leads for each action are supported by an Academic Advisory Group and a Lived Experience Panel.
Work also continues to gather evidence of good practice from across local areas which will become part of the guidance described in action 1.
The Scottish Government will work with the NSPLG and partners to develop appropriate reviews into all deaths by suicide, and ensure that the lessons from reviews are shared with NSPLG and partners and acted on. Pilots of multi-agency reviews of all suicide deaths in Scotland are taking place in three areas across Scotland with a view to establishing a national process.
C1. Closer national and local monitoring of enhanced and real time suicide and self-harm data — to identify emerging trends and groups at risk for early preventative action.
More timely suicide deaths data from Police Scotland is now available through Public Health Scotland for local leads and appointed individuals. Work continues to establish ways of collecting self-harm data.
C2. Specific public suicide prevention campaigns, distinct from and in partnership with the umbrella ‘Clear Your Head’ mental health and wellbeing campaign — to encourage people at risk of suicide and in suicidal crisis to seek help without stigma and to encourage others to give it.
This has been picked up as part of the work of action 3.
C3. Enhanced focus on specifically suicidal crisis intervention — to ensure that those in suicidal crisis can access timely help and support, and meet any increase in numbers.
Will be aligned with the work from action 5.
C4. Restricting access to means of suicide — to reduce the availability to those in crisis of the most commonly used means of suicide.
Work to understand the most effective measures is being undertaken by the Academic Advisory Group.
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