Mental health - distress framework for collaboration: multi-agency partnership approach

4. The Strategic Landscape

In this section we have set out the strategic context for delivery of the framework.

The strategies included below, especially those concerning the social determinants of mental health, are not exhaustive. Health Boards and local partners should consider any additional national or local strategies which support the delivery of this framework.

The UN Sustainable Development Goals

The UN Sustainable Development Goals (SDG) are an urgent and universal call to action to create a better world by 2030. The SDGs apply to every country in the world including Scotland and are the responsibility of governments, businesses, civil society and citizens to deliver. Goal 3 aims to ‘ensure healthy lives and promote wellbeing for all at all ages’ with a specific target (3.4) to ‘reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and wellbeing’ by 2030.

The National Performance Framework

The National Performance Framework (NPF) is developed and published by the Scottish Government and is Scotland’s way to localise the SDGs. It currently sets out 11 National Outcomes with associated indicators which are tracked and publicly reported on. The NPF is for all of Scotland and sets out a vision for collective wellbeing. While we anticipate that this work will contribute to a variety of the National Outcomes, it will have a particular focus on:

• we are healthy and active.
• we respect, protect and fulfil human rights and live free from discrimination.
• we live in communities that are inclusive, empowered, resilient and safe.

Mental Health and Wellbeing Strategy

The Scottish Government and COSLA’s joint Mental Health and Wellbeing Strategy, builds on the work of the previous 10-year Strategy through a wider scope and an increased focus on wellbeing and prevention. The Strategy describes what a highly effective and well-functioning, whole-system mental health landscape should look like, with the right support available, in the right place, at the right times, whenever anyone asks for help.

People's needs for mental health care vary enormously. Some people may be able to manage their mental health conditions and emotional distress themselves, especially with support from family members, peer support groups, faith-based organisations, or community providers. Many others will need formal interventions to support their mental health conditions, typically offered through a range of daytime services. In most areas, mental health support is also accessible at out-of-hours primary care centres or via NHS 24.

We know that the current system is not delivering as we would wish despite the efforts of thousands of dedicated and skilled people across Scotland. One of the reasons for publishing a new Strategy was to lay out what we think 'good' looks like and move forward with all partners towards that vision. However, the Strategy acknowledges that there are many challenges to delivering sustainable mental health supports and services in Scotland. The Strategy’s Delivery Plan and Mental Health & Wellbeing Workforce Action Plan set out the specific actions that will be taken through a cross-Scotland partnership approach to:

• promote positive mental health and wellbeing for the whole population, improving understanding and tackling stigma, inequality and discrimination;
• prevent mental health issues occurring or escalating and tackle underlying causes, adversities and inequalities wherever possible; and
• provide mental health and wellbeing support and care, ensuring people and communities can access the right information, skills, services and opportunities in the right place at the right time, using a person-centred approach.

Self-Harm Strategy and Action Plan 2023 – 2027

Scotland’s first dedicated self-harm strategy and action plan aims for anyone affected by self-harm to receive compassionate, recovery-focused support without fear of stigma or discrimination. It is jointly owned by Scottish Government and COSLA. The approach in this strategy and action plan retains an important connection to the joint work on suicide prevention through the Suicide Prevention Strategy (see below) and to improving population level mental health and prevention through the Mental Health and Wellbeing Strategy and its Delivery Plan.

Priority 2 of the strategy is to continue to build person-centred support and services across Scotland to meet the needs of people affected by self-harm.

Creating Hope Together: Suicide Prevention Strategy 2022 – 2032

Creating Hope Together and accompanying Action Plan were published jointly with COSLA and set out a clear plan to reduce suicides in Scotland and address the inequalities which lead to suicide. The Delivery Plan 2024-2026 sets out the actions for delivery over the remainder of the current Creating Hope Together action plan

The shared aim though this work is for any child, young person or adult who has thoughts of taking their own life, or are affected by suicide, to get the help they need and feel a sense of hope.

To achieve this, all sectors must come together in partnership, and we must support our communities so they become safe, compassionate, inclusive, and free of stigma.

The Vision for Justice in Scotland

The Vision for Justice in Scotland sets out the vision for the future justice system in Scotland, spanning the full journey of criminal, civil and administrative justice, with a focus on creating safer communities and shifting societal attitudes and circumstances which perpetuate crime and harm. This Strategy is underpinned by four core principles: equality and human rights; evidence based; embedded person centred and trauma informed practices; collaboration and partnership. It also outlines two transformational priorities: ‘Our services, third sector partners and legal profession must be person-centred and trauma-informed’ and ‘we must also strive to work across our public services to improve outcomes for individuals, focussing on prevention and early intervention’.

While the vision has a wider focus on the justice system as a whole; its core principles and overarching priorities speak to the ambitions of this Framework and align with its intended outcomes. It focuses on promoting person-centred justice services and highlights the importance of embedding trauma-informed practice. It seeks to ensure that justice services recognise the prevalence of trauma and adversity, realise where people are affected by trauma and respond in ways that reduce re-traumatisation.

It recognises that the population in contact with the criminal justice system is a vulnerable one in relation to health and wellbeing, with people often experiencing high levels of mental health problems. It also highlights the same key issues set out in the HMICS review: that justice agencies are commonly dealing with situations where the main issues are around mental health and distress, where no offence has been committed; and that the police service are dealing with increasing numbers of people in mental health distress. The vision underlines that we must work across all partners to improve the mental and physical health and wellbeing of those who come into contact with the justice system, which is the key focus of this Framework and the ongoing work around mental health and policing.

Alcohol and Drugs Strategy – Rights, Respect and Recovery

There is significant overlap between mental wellbeing and substance use. The current alcohol and drugs strategy, Rights Respect and Recovery (2018) is being delivered through a National Mission 2021 – 2026 to save and improve lives. The Mission recognises the need for multi-agency interventions to support those with dual diagnosis (mental health and substance use).

The Mission includes the development of a protocol which is being led by Healthcare Improvement Scotland with the aim to develop, test and support implementation of a good practice protocol for how mental health and substance use services should work together.

The Mission also includes the implementation of Medication Assisted Standards (MAT) and standard 9 aims to ensure that all people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery. Implementation of the MAT standards is being supported by a MAT Implementation Support Team (MIST) in Public Health Scotland who publish an annual Benchmarking Report. The Reports include data on how the various contact points for people with dual diagnosis have ensured mental health treatment is included in individual care plans.

The Mission also includes a National Collaborative of people with lived and living experience of substance use. The Collaborative has developed a Charter of Rights, which was launched by the First Minister in December 2024. The Charter will be accompanied by a National Specification for treatment and recovery services which will include alignment with mental health services.

Housing and Homelessness

Tackling homelessness is a priority for the Scottish Government, as set out in the joint Scottish Government/COSLA Ending Homelessness Together Action Plan. The actions set out in that plan recognise the importance of joint working across different policies, sectors and organisations, in line with the objectives of this document. Alongside a commitment to a No Wrong Door approach to delivering homelessness services, new legislative proposals are included in the Housing (Scotland) Bill, introduced to Parliament in March 2024, to better prevent homelessness.

Significantly, the proposed measures include new ‘Ask and Act’ duties on ‘relevant bodies’ named in the Bill, which includes the police service and Health Boards. The proposals are based on the principles of shared public responsibility, earlier intervention and more options through avoiding crisis, to prevent homelessness. The relevant bodies will ask about housing situations as part of their existing functions and act on this information within their existing powers.

While the intention is that relevant bodies do not just default to referring to local authority housing departments when somebody is threatened with homelessness (as opposed to already being homeless), these new duties have the potential to significantly strengthen partnerships both between different relevant bodies and with local authorities in helping to prevent homelessness and repeat homelessness. These new Ask and Act measures will also be accompanied by changes to existing homelessness legislation, so that local authorities act sooner to prevent homelessness.

While no timescale for implementation has been included in the legislation, if it is passed by the Scottish Parliament, these measures will require strong guidance and training, including on the sharing of information and collection of data, and the Scottish Government have committed to working with partners across the relevant bodies and with local authorities to ensure this is fit for purpose.