Scottish mental health law review: our response

A response to the independent review of mental health, capacity and adult support and protection legislation, chaired by Lord John Scott KC.

What are the opportunities for change?

The Review’s recommendations are already strongly aligned with existing commitments to advance human rights in Scotland and to change the way we provide for and meet the needs of our communities. Despite resource constraints, there are significant efforts already underway at national level to achieve many of the aspirations set out in the final report. The timing of the Review is beneficial and provides opportunities to support and deliver change, through influencing ongoing policy development, as well as considering new options for reform. We will ensure that the strategic links across all these areas of policy are made on an ongoing basis.

The Scottish Government is consulting on a new Human Rights Bill for Scotland. Proposals include the incorporation of economic, social and cultural rights - alongside specific protections for women, disabled people and people experiencing racism - and the introduction of a right to a healthy environment into Scots law, within the limits of devolved competence. That Bill proposes to build on the civil and political rights already protected through the Human Rights Act 1998 and the ECHR, as well as the children’s rights to be incorporated through the United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Bill.

The development of the National Care Service is also a bold commitment to make sure that everyone has access to high-quality community health, social work, and social care support when they need it. Crucially, the service is being co-designed with people who access community health, social work and social care support, their families, and carers as well as our workforce and third sector organisations. It provides significant scope for meaningful reform in the way people access their rights.

Our new Mental Health and Wellbeing Strategy sets out a long-term vision for change, building on the previous work to support recovery and renewal and strengthen mental health services, post-pandemic, through the actions set out in our Transition and Recovery Plan. The Strategy lays out our long-term approach to improving the mental health and wellbeing of everyone in Scotland. We will publish an initial Delivery Plan to complement the Strategy, which will be refreshed regularly.

Through our strategic approach to workforce planning, our aim is also to achieve a mental health and wellbeing workforce which is diverse, skilled, supported, and sustainable. This will ensure service delivery meets the mental health needs of the people of Scotland and supports the Strategy’s vision.

The Adult Support and Protection Improvement Plan continues to undertake activities focused on assurance, governance, data & information, legislation, policy and guidance, practice improvement and prevention to improve support and protection for adults at risk of harm. Work includes the development and roll out of a revised minimum data set to inform improvement at local and national level, undertaking evidence reviews on key processes, and development of online training and resources for practitioners.

As part of the Plan, the Scottish Government published a revised Code of Practice, along with guidance for General Practice and for Adult Protection Committees, in July 2022. These documents reflect changes in legislation and practice and provide enhanced information to aid practitioners in supporting and protecting adults at risk of harm. A National Implementation Group has been formed to develop and support practical application of the guidance. This Group has members from a wide range of organisations who all work together to drive and support improvement nationally within the adult support and protection community.

The SMHLR follows wider related policy developments including broad cross-government work to address systemic issues for people with complex care and learning disabilities through the Coming Home Implementation plan. This plan sets out measures to reduce complex delayed discharge and provide care closer to home for people with a learning disability and complex needs. It also comes alongside work to develop proposed legislation to enhance and protect the specific rights of autistic people, people with a learning disability and other neurodivergent conditions.

The Independent Inquiry of Mental Health Services in Tayside previously noted that at a national level, there is limited scrutiny and oversight of mental health services in Scotland and recommended that the Scottish Government undertake a review of scrutiny and assurance. We have responded to that recommendation by commissioning a Review of Mental Health Scrutiny and Assurance, which will publish in Summer 2023. The findings from that Review will be considered alongside the SMHLR and the ongoing Independent Review of Inspection, Scrutiny and Regulation led by Dame Sue Bruce (due to publish in September 2023), to develop a strategic action plan to strengthen the collective scrutiny of mental health services.

There is also a wide range of work underway to improve mental health support including a programme of improvement to child and adolescent mental health services (CAMHS); the development of Mental Health Pathways for people experiencing crisis and distress and the ongoing implementation of the Suicide Prevention Strategy.

Significant progress is being made to improve unplanned and emergency mental health care. Through the Redesign of Urgent Care Programme, the Scottish Government is working with partners, including Health Boards, Police Scotland, and the Scottish Ambulance Service, on improving unplanned access to urgent mental health assessments.

The Enhanced Mental Health (EMH) pathway for those in distress or in need of mental health support who come into contact with Police Scotland, or the Scottish Ambulance Service is now well established. This pathway enables emergency calls received by emergency responders, where callers are identified as requiring mental health advice to be directed to a dedicated Mental Health Hub within the NHS 24 111 service. The Hub is staffed by Mental Health Practitioners and operates on a 24/7 basis, improving and simplifying the care pathway for people experiencing mental illness/distress and poor mental health and well-being who present to either the Scottish Ambulance Service or Police Scotland.

In addition, each Health Board is providing access to a mental health clinician, accessible to police officers, 24 hours a day, 7 days a week for those who require urgent mental health assessment or urgent referral to local mental health services. The aim is to support Police Scotland’s Community Police Officers and Police Custody Officers with presentations where a person is experiencing distress or a mental health crisis and may need specialist assessment or intervention. Similar pathways have been established for the Scottish Ambulance Service in some Health Boards and are in development for the others.

Police Scotland have also been key national partners in the development and implementation of the Scottish Government Distress Brief Intervention (DBI) programme. This can provide up to two weeks of personalised, compassionate support to people who present to the police and other frontline services in emotional distress but who do not require emergency clinical intervention. In addition to referrals by officers working in communities, it is now possible for police call handling centres to refer people to DBI, via the NHS24 Mental Health Pathway. This is being supported through an active programme of DBI briefings and awareness raising, which enables Police Scotland staff to play an important part in helping those in distress; future training plans, which are in development, will enhance this further.

There are also wider strategic and policy developments underway which support the rights of people covered by the current legislation. Our Vision for Justice in Scotland further sets out that justice services must be person centred and trauma informed. We are also working to reduce the numbers of people experiencing crisis and distress coming into contact with the police or entering police custody centres when they could be more appropriately supported within the community.

A Cross-Portfolio Ministerial Working Group on improving the healthcare for our prison population is being established with health and justice Ministers. Its work will cover the mental health, physical health, substance use, and social care needs of this population.

We have published a new Dementia Strategy, which sets a vision where people living with dementia have their strengths recognised, rights upheld, and are supported to live an independent life.

Work is ongoing to make improvements to the forensic mental health system and the way in which we are upholding human rights for patients, including in response to the Barron Review.

Additionally, we are introducing new standards and specifications for mental health services and psychological therapies, supported by a longer-term focus on recovery and embedding trauma-informed practices.

The SMHLR recommendations have, in many cases, already informed and influenced the development of ongoing policy in these and wider areas of policy development. We will also continue to consider the recommendations alongside proposals set out in previous reviews, particularly the Rome Review and Barron Review.



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