Ways of Working - Key Themes
The Quality Strategy
In addition to specific commitments to particular action, we will also be working on a range of themes in respect of the improvement of mental health services and mental health improvement. These are set in the context of the Quality Strategy22 and focus on working with people and communities to produce better outcomes.
This Mental Health Strategy fully supports and adopts the 3 Quality Ambitions for Scotland that health and care must be:
Person centred - which is;
Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.
Safe - which is;
There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.
Effective - which is;
The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit and wasteful or harmful variation will be eradicated.
These are not new ideas to mental health, but inform the continuous improvement approach, which aims at delivery of and for consistent and reliable services everywhere. Much of the work that has already taken place in mental health in Scotland exemplifies the objectives and ambition of the Quality Strategy, notably the work in support of the Person Centred ambition. A key element of that work is in enabling people to become more involved and active in their own health and wellbeing - which is a key theme of our work on mental health.
Using a person centred approach to partnership working requires change in how the NHS and its partners develop and deliver services, and approaches to do more to give people greater control and engagement. Similarly, the work to understand how people experience and understand their health and are actively involved in their healthcare experience and decision making, directly links to the work that has begun with service users and their carers in mental health.
We will continue to develop a person-centred approach in mental health and ensure that the learning that has taken place in mental health at a local and national level is fed into the Quality Strategy Person Centred strand of work, and learn from how it develops in other areas of health and care. There are particular references to work on patient safety in mental health and to clinical effectiveness in the sections below, notably in respect of the access target for specialist CAMHS services and psychological therapies.
Seven Themes for Mental Health
Seven key themes emerged from the consultation on the mental health strategy. None of these ideas are new, but they will have increased emphasis across the mental health and mental health improvement agenda and some have explicit linkages with particular parts of the work programme. The themes are fully consistent with and exemplify the Quality Ambitions and have general application across the mental health work programme for promotion, prevention, treatment, care and recovery.
The themes are:
1. Working more effectively with families and carers
Families and carers can have an important role in providing support to those with mental illness, but can often feel excluded from making the contribution they would like to because of how services are structured or delivered:
The work from Healthcare Improvement Scotland on learning from suicides shows that better work with families can contribute both to safety and to better outcomes23;
Caring Together: The Carers Strategy for Scotland 2010-201524 sets out the action that is being taken with partners to provide better support to family members and carers to enable them to offer care and support without coming to harm themselves.
Commitment 2: We will increase the involvement of families and carers in policy development and service delivery. We will discuss how best to do that with VOX and other organisations that involve and represent service users, families and carers.
2. Embedding more peer to peer work and support
The work that was taken forward under Delivering for Mental Health to establish the first paid peer support workers was successful in creating the role within Scotland. There is a demand to make greater use of the approach, but people need to understand the role and benefits better:
The Scottish Recovery Network (SRN), working with the Scottish Qualifications Authority, have developed a nationally accredited Professional Development Award to assure that the role is of an appropriate quality to add value based on lived experience25;
SRN are developing a values framework with peer workers to help define and assure the role and have additionally developed the Experts by Experience Implementation Guidelines to help ensure considered role development26;
There is a broader demand for greater use of formal and informal peer support approaches, in addition to the peer support worker role within care teams, and we will seek to build this in to our work more generally.
Commitment 3: We will commission a short review of work to date in Scotland on peer support as a basis for learning lessons and extending the use of the model more widely.
3. Increasing the support for self management and self help approaches
The evidence base for people taking a leading role in managing their own illness over time and the wider benefits to them that this approach offers is well established. As outlined earlier, mental illnesses are amongst the most severe long term conditions:
NHS 24 has developed, piloted and now delivers the Living Life Guided Self Help Service, under which self-help coaches guide individuals over the phone through a series of self-help workbooks to help them understand some of the reasons why they are feeling low, depressed or anxious27;
NHS Health Scotland managed the Steps for Stress28 resources which contain practical ways for people to start to deal with stress. This complements Well Scotland29, the national health improvement website;
NHS Boards continue to develop and deliver self-help services locally, generally for people with common mental health problems, with many of these services being available through primary care, including the provision of self-help materials, access to computerised cognitive behavioural therapy and guided self-help.
This work links directly to the action and commitments on social prescribing which are set out later.
4. Extending the anti-stigma agenda forward to include further work on discrimination
There is a need to build on this success by developing the work further to focus on the experience of discrimination and exclusion that many people with mental illness experience;
There is also the need to focus attention more directly on stigma and discrimination in health and social care services, which is where service users often tell us they feel the most discriminated against.
Commitment 4: We will work with the management group for see me and the Scottish Association for Mental Health, who host see me, and other partners to develop the strategic direction for see me for the period from 2013 onwards.
5. Focusing on the rights of those with mental illness
The Mental Health (Care and Treatment) (Scotland) Act 200332, established core principles to apply to mental health services in Scotland and that approach has firmly embedded rights at the heart of practice within services:
The principles of the Act underpin many of the values of inclusion, reciprocity and dignity which are key to effective, person centred mental health services;
The Dementia Standards33 built on this approach to establish a framework for care and treatment standards for those with dementia and their carers; the standards apply irrespective of who delivers care or treatment, or where care or treatment are delivered and create a common understanding of how the quality of care and treatment should be assessed.
The Scottish Human Rights Commission has established a framework for embedding rights within care and treatment settings and services.
Commitment 5: We will work with the Scottish Human Rights Commission and the Mental Welfare Commission to develop and increase the focus on rights as a key component of mental health care in Scotland.
6. Developing the outcomes approach to include, personal, social and clinical outcomes
The Scottish Recovery Network34 was established in 2004 to take forward the recovery model in Scotland; recovery is the idea that individuals and services should look beyond purely clinical outcomes to see the whole person and their social and personal outcomes as equally valid:
In Delivering for Mental Health we set out plans to establish the Scottish Recovery Indicator as an approach to refocus services on the wider range of outcome and objectives; the SRI was launched and used, and has now been refined and re-launched in a more usable format as SRI 235;
In the work on access to psychological therapies we are working with NHS Boards to embed the capacity, not just to collect clinical outcomes but to be able to report on them, and do so in a way which encourages monitoring and improvement from the level of individual patients right through to how clinical teams are performing;
Our adult mental health benchmarking indicators and toolkit36 provide a platform from which service activity and outcomes can be compared between NHS Boards. As further indicators, including outcomes indicators, are developed they will be added to the benchmarking toolkit;
To promote outcomes-focused planning for mental health we have developed the Mental Health Improvement Outcomes Framework37;
Scotland is one of several nations engaged with the International Initiative in Mental Health Leadership38 in developing a set of mental health outcome indicators which are considered to be of importance, valid, and feasible, in today's mental health systems. This work will ensure that Scotland remains at the forefront of outcomes measurement in mental health.
7. Ensuring that we use new technology effectively as a mechanism for providing information and delivering evidence based services
Many people already look to the internet and other new media approaches for help when they are in distress and this trend is likely to increase over time. The NHS in Scotland already offers a range of services through new technologies:
Since 2008 NHS 24 has offered telephone based Cognitive Behavioural Therapy and Guided Self-Help as a response to depression39;
Other NHS Boards provide services such as Living Life to the Full Online, Beating the Blues and Moodgym;
NHS 24 hosts the NHS Inform service which includes information on mental health and wellbeing.40
Commitment 6: During the period of the Mental Health Strategy we will develop a Scotland-wide approach to improving mental health through new technology in collaboration with NHS 24.