National Drugs Mission Implementation Group minutes: October 2021

Attendees and apologies

Group members

• Angela Constance MSP (Chair), Minister for Drugs Policy
• Kevin Stewart MSP, Minister for Mental Wellbeing and Social Care
• Maree Todd MSP, Minister for Public Health, Women’s Health and Sport
• Vared Hopkins, Dundee ADP Co-ordinator
• Dave Liddell, CEO Scottish Drugs Forum
• Jardine Simpson, CEO Scottish Recovery Consortium
• Sandra Holmes, Families Lived Experience Representative
• Rachel McGrath, Lived and Living Experience Representative
• Dr Catriona Morton, Royal College of GPs Deputy Chair
• Prof Marion Bain, Deputy Chief Medical Officer

Attendees

• Wendy Forrest, on behalf of Annemargaret Black
• Kelda Gaffney, on behalf of Gillian Ferguson
• Duncan McCormick, Medication Assisted Treatment Standards Implementation Support Group (MIST)
• Tracey Clusker, Medication Assisted Treatment Standards Implementation Support Group (MIST)
• Danielle Rowley, Samaritans
• Claire Pearce, NHS Tayside
• Thelma Bowers, North Ayrshire Council
• Jacqueline Kerr, Glasgow City Council

Apologies

• Keith Brown MSP, Cabinet Secretary for Justice
• Shona Robison MSP, Cabinet Secretary for Social Justice, Housing and Local Government
• Martin Coyle, Lived and Living Experience Representative
• Vicky Irons, Dundee Integration Joint Board Chief Officer
• Annemargaret Black, Stirling and Clackmannan Integration Joint Board Chief Officer
• Gillian Ferguson, Glasgow ADP Co-ordinator
• Justina Murray, CEO Scottish Families Affected by Alcohol and Drugs
• Michael Kehoe, Royal College of Psychiatrists Committee Member
• Prof Alex McMahon, Chief Nursing Officer

Observers

• Aime Jaffray, Drugs Policy Division
• Martin Shanahan, Drugs Policy Division
• Sharon Mooney, Drugs Policy Division
• Morris Fraser, Drugs Policy Division
• Diane McLafferty, Drugs Policy Division
• Orlando Heijmer-Mason, Drugs Policy Division
• Michael Kellet, Population Health Directorate
• Kim Gallacher, Mental Health Division
• Tony Rednall, Chief Nursing Officer Directorate

Items and actions

Welcome and introductions

The Chair welcomed members and attendees to the second meeting of the Implementation Group. Apologies received and nominated deputies were listed.

The minutes of the previous meeting were agreed.

Update on Medication Assisted Treatment (MAT) standards

Duncan McCormick presented an update on the adoption of the MAT standards. The key points were:

• Alcohol and Drug Partnerships (ADPs) have rated themselves against the MAT standards and the MAT Implementation Support Team (MIST) have been meeting with ADPs to develop practical support plans. This has allowed MIST to map expected improvements by April 2022
• there has been a focus on evidence to support ratings and improvements, including qualitative evidence from people who use the services
• the risks to delivery are workforce capacity, information governance, challenges to access in rural areas, whole systems change

In discussion, the following points were made:

• Vered Hopkins highlighted issues with recruitment and retention of staff, workforce development and career progression. She also commented that gendered differences should be considered in evidence collection. Action: Vered and Duncan to speak separately about gender issues
• Sandra Holmes explained that families still find it difficult to navigate treatment systems, and that she has experienced the sharp end of workforce challenges. She offered for Families Campaign for Change to give a presentation at the next Group meeting. Action: Secretariat to explore arranging a presentation by the Families Campaign for Change
• Catriona Morton welcomed the QI approach being taken and reflected that the journey of the person accessing treatment was important, specifically where that journey is deemed to have started. The early journey is key but is not always captured. She highlighted that strong engagement with GPs is crucial. Action: Catriona and Duncan to speak separately about engagement with GPs

Discussion on improving access to mental health services for those with alcohol and drug problems (paper one)

The Chair introduced Paper one on access to mental health services for those with alcohol and drug problems then opened up to discussion. Points discussed were:

• the Minister for Mental Wellbeing and Social Care reflected that culture change was key to this issue. He commented that we hear from people who are accessing services for their drug use but cannot access services for their mental health problems which makes their efforts with drugs services more difficult. Staff who work in drugs services feel stigmatised by their colleagues in mental health services
• the Minister for Public Health, Women’s Health and Sport commented that this is equally relevant for people with problematic alcohol use. She reflected that we need to treat a whole person holistically
• Jardine Simpson commented that people often feel passed between drugs and mental health services. He reflected that people who receive medication assisted treatment are sometimes prescribed psychoactive medications by their mental health professional, which is not helpful to them. There needs to be engagement with psychology and psychiatry professionals about how they can improve
• Vered Hopkins agreed that culture is key to this but commented that this has to go beyond the workforce to communities, as stigma is a barrier to treatment
• Thelma Bowers described success locally on integration. She highlighted that stigma and culture were key to integrated services, and that they had had success putting pathways and joint working arrangements in place. They have also employed five recovery workers with lived experience who have provided constructive challenge to culture and practice
• Wendy Forrest highlighted the importance on how this feels for the individual experiencing it. It is key we organise our services on the ground around these principles, and bring together the varied needs of this population (e.g. housing, employment)
• Dave Liddell commented that peer research shows that people have difficulty navigating systems, and are often pushed between services. We must take a no wrong door approach, but integrated approaches are not standard across the country. Suggests we could have Health Improvement Scotland to a future meeting to share their work on integration. Action: Secretariat to explore this with Health Improvement Scotland
• Sandra Holmes highlighted the burden placed on families and third sector organisations by the limited operating hours of substance use services. The Minister for Drugs Policy agreed that services should be available seven days a week
• Kevin Stewart highlighted that accountability was key
• Catriona Morton commented that in physical illness we understand multiple morbidity is the norm, and this is also true for mental health. Catriona also commented that there are various pathways into services and that it would be a useful exercise to map these. This would then allow us to assess whether we are responding effectively across the system. Action: secretariat to explore this

The Chair summed up discussion and action points. These included:

• a commitment by attendees to assist and learn from the Health Improvement Service pathway project
• a call for all health boards and organisations to make staff available for trauma-informed recovery training
• a call for organisations to ensure that they have robust non-fatal overdose pathways to ensure that people in crisis are helped into a recovery journey

AOB and date of next meeting

The Chair invited any other business, there was none.

The Chair concluded the meeting and advised that the next meeting will take place on 14 December at 11:15.