Psychological therapies and interventions specification: consultation analysis

2 Consultation methodology

Introduction

The consultation ran for 13 weeks from 14 December 2022 to 17 March 2023 on the Scottish Government Citizen Space website. Five remote and in-person engagement events aimed at a variety of audiences supplemented the online consultation.

Public consultation

The consultation received 95 responses (all validated), Table 2.1. A larger proportion of consultation responses were from individuals (58%), with the remainder from organisations (42%).

The majority of consultation responses were submitted through Citizen Space (95%), with the remainder submitted to the Scottish Government directly by email (5%).

Organisations

Organisations were then grouped under three broad categories, Table 2.2, including:

• public sector organisations, such as Health Boards and local authorities, which make up the largest organisation category (48%)
• membership and/or professional bodies, such as British Psychological Society and Royal College of General Practitioners Scotland, which represent 30% of all organisation respondents
• the third sector, such as Age Scotland and People First Scotland, which comprises almost one-quarter of all organisation respondents (23%)

It should be noted that although organisations are placed under one category, it is recognised that there may be some crossover (for example, a third sector membership organisation).

N=40

Note: No private sector organisation respondents were identified

Percentages may not total 100% due to rounding

Organisations were then coded thematically, Table 2.3. As above, it is recognised that there may be some crossover. Mental health (33%) and Health Boards, Health and Social Care Partnerships (HSCPs) and services (30%) make up almost two-thirds of all organisation respondents.

N=40

A total of 26 organisations or 65% of all organisation respondents support marginalised, socially excluded, or disadvantaged groups or people who share protected characteristics, Table 2.4. This includes a mix of organisations who provide support and services (or their members do):

• to all people in Scotland or those living within a specific geographic area. This includes population level interventions (for example, an NHS Board, HSCP or local authority), or services that are available or open to large parts of the population. By their very nature, these organisations will support people who share protected characteristics as defined in the Equality Act (2010). Equalities is, however, not the primary remit or purpose of these organisations, rather it may be one of a number of strategic priorities or things that they do

• some organisations provide services to marginalised, socially excluded or disadvantaged groups. This may also include engagement with people who share protected characteristics. The focus of these organisations is not at a population level, rather they have a specific focus on one or more groups of people with, for example, a shared experience or issue or background. Some examples include organisations who support people with mental health issues, carers, and people with substance use issues

• some organisation respondents have a sole or primary focus on a people with protected characteristics

Note: These organisations were coded by EKOS to a specific protected characteristic

Individuals

Individual respondents were asked to provide details from an equality, diversity, and inclusion perspective. Key points to note from the tables presented in Appendix A include that:

• females are over-represented in the profile of individual respondents (74%) compared to the population as a whole
• individuals aged 25 to 49 years or 50 to 64 years make up the vast majority of responses (93%)
• 83% of individual respondents describe themselves as heterosexual/ straight
• 4% of individual respondents consider themselves to be trans or have a trans history
• 78% of individual respondents are from a Scottish or other British ethnic group, predominantly Scottish (55%)
• almost three-quarters of individual respondents (72%) do not belong to any religion, religious denomination, or body

Engagement events

The Scottish Government and key partners organised five engagement events between 21 February and 16 March 2023, Table 2.5.

The events were advertised in a variety of ways, including the Scottish Government and partners promoted and circulated information through existing channels and networks. The events were also used to signpost attendees to prepare and submit a consultation response through Citizen Space.

A summary of the main points raised during these events is presented in Appendix B. The points raised at the events largely chime with themes that emerged from the public consultation.

Source: The Scottish Government

Analysis

All responses were moderated by Scottish Government officials in the Mental Health Directorate to ensure that they were valid and appropriate. EKOS exported consultation responses from Citizen Space into Microsoft Excel for data cleaning, review, and analysis. Where submissions were submitted in another format, Scottish Government officials emailed these documents for EKOS to manually input into Microsoft Excel.

The consultation document was structured to allow respondents to answer questions independently in recognition that respondents might want to respond to one or some of the proposals without wishing to express views on the others.

The analysis has sought to identify the most common themes and issues. It does not report on every single point raised in the consultation responses. The analysis has been structured in line with the themed sections of the consultation document.

Summary tables for all closed questions are presented in Appendix C with percentages referred to in the main report^[1]. This analysis excludes consultation respondents that did not provide a response (meaning blank responses).

For open-ended questions, the approach undertaken to help readers get a sense of the strength and frequency of themes and issues means that:

• most chapters in the report contain numbered themes (for example, Theme 1, Theme 2, Theme 3) - these have been set out in order of relative importance with Theme 1 being noted by the greatest number of consultation respondents
• points raised have been quantified in some way - for example, we use the terms ‘all’ (100% of respondents), ‘most’ (between 75% and 99% of respondents), ‘many’ (between 50% and 74% respondents), ‘some’ (between 10% and 49% respondents), and ‘few’ (less than 10% of respondents) to articulate the strength of opinion

The standard process is that equal weighting should be given to all responses. This includes the spectrum of views, from large organisations with a national or UK remit or membership, to individual viewpoints.

This analysis report includes quotes from respondents who gave permission for their response to be made public. This does not indicate that these comments will be acted upon or given greater weight than others.

All responses, where the respondent gave permission for their comments to be published, will be made available on the Scottish Government Citizen Space website.

Points to note

The following points should be noted, including that:

• respondents to any public consultation or engagement event are self-selecting, and the responses may not be representative of the population as a whole
• not all submissions were presented in line with the consultation questions
• there does not appear to have been a campaign response – albeit there are some consultation responses from individual respondents and health improvement organisations that use the same or similar wording in open-ended questions. In part this likely reflects membership bodies (and others) pushing the public consultation out to their members and/or wider networks
• while for most closed questions within the consultation a majority of respondents agreed or strongly agreed with the questions posed by the Scottish Government – there were several instances where a relatively high proportion of respondents neither agreed nor disagreed with particular questions

Key themes that emerged from the consultation

Several themes were raised to all consultation questions leading to considerable repetition of points and views. Rather than repeat these themes in detail in each chapter of the report, the themes have been summarised below.

The specification

• further clarity, detail, guidance and consultation was requested on how the specification would be operationalised, monitored, and audited – that is, what services they are intending to apply to, what needs to be in place to implement and measure the specification, and how the Scottish Government would ensure compliance and independent assessment

• there was a request for the outcomes within the specification to be clear, concise, appropriately described and defined, specific, measurable, and easily understood

• any terms used within the specification should also be defined, consistent and not interchangeable (for example, “care”, “support” and “treatment”)

Resources

• budgetary pressures and workforce challenges (for example, staff shortages, recruitment, retention, diversity, supervision, wellbeing, morale, burnout) mean that constrained resources may make it difficult for services to achieve the outcomes of the specification
• adequate and sustained financial resources and other support (for example, training and digital infrastructure/support) would be needed to build capacity and capability within the workforce
• some outcomes in the specification may also raise expectations of delivery of care which cannot currently be met. While the specification is aspirational it must also be achievable, and consideration could be given to where additional resource is required in order for the outcomes to be achieved

Services and service providers

• person-centred, collaborative care and holistic approaches are viewed as a key component of the delivery of high-quality psychological care
• inclusive information and communication was considered essential
• effective interfaces and improved information sharing, communication and collaborative working between services and professionals in the public and third sectors
• there could be more explicit reference to the role of primary care across the specification (for example, general practice and community pharmacy) as this is usually a person's first point of contact – this could include how the specification would interface with primary care, and how roles in primary care could complement psychological care services
• it was considered imperative that the specification seeks to understand the wider social determinants of health in seeking to reduce inequalities in mental health (for example, housing, income levels, education, access to transport) – but also recognise that these factors are complex and largely outside of the control or influence of psychological care, therapies and interventions

People with lived experience

• the specification needs to continue to foster a change in attitudes - people should be supported and empowered to be equal partners in their own psychological care

• the views, experiences, and priorities of people who use psychological care services, their families and carers, and the workforce should remain connected to service development and policy