Scottish Mental Health Nursing Review

14. Annex C - Sharing Best Practice and Innovation

A call for submissions was made through which mental health nurses could highlight best practice and innovation that could be shared on a national basis and help inform the work of the Review.

The submissions received have been summarised below and highlight best practice and innovations driven, led by mental health nurses in Scotland at all levels of practice across the health, social care, and the education sectors.

As part of this work, a series of podcasts have been developed to learn more about the about the nurse behind the submission, their leadership, and their drive to support best practice and change in mental health services in Scotland.

Doing Well, an MDT approach to addressing social isolation and skills deficits, within a Community Mental Health Setting.

Social isolation is more common among people with mental health problems than in the general population. The Badenoch, Strathspey and Nairn CMHT explored introducing group-based interventions to support socialisation and reduce social isolation.

Based on the work of Parkinson (2014) ‘Recovery through activity, increasing participation in everyday life’ the CMHT developed the ‘Doing Well’ ten-week group programme. This was co-designed, developed and delivered in partnership with people with lived experience and the local third sector organisations.

Supporting group members to acquire and re-acquire social skills and connections through purposeful activity provided opportunities to develop and address challenges in a meaningful way to them. Evaluation of the pilot saw positive results, with all members reporting improvements in wellbeing.

Following the initial pilot and feedback the programme was reviewed and has continued to be delivered. It is evolving with more connections and links to the local communities.

University of the Highlands and Islands - Undergraduate Mental Health Nurse Education in the Highlands and Islands

To enhance the curriculum, the University of the Highlands and Islands have introduced mental health content from the beginning of the pre-registration nursing programme for adult and mental health nursing students. Education sessions were co-designed and delivered with people with lived and living experience.

Embedding mental health case studies and increasing the application of mental health content within the teaching sessions was achieved through mental health simulation. This has enabled assessments to be undertaken via Objective Structured Clinical Examinations for mental health assessment and care planning skills.

Feedback was received from students and clinical staff within practice. Building on prior learning within a stepped-care approach, and across a variety of teaching themes relating to mental health has been received positively by students, but with feedback that a preference would be to receiving field specific teaching and learning from year 1.

It is hoped that these developments can be sustained and further developed moving forward to equip nurses to support mental health care in the future.

NHS Grampian - The Advanced Clinical Nurse Specialist in Older Adult Community Mental Health

A skilled multi-professional workforce is required to support care within Community Mental Health. The Advanced Clinical Nurse Specialist (ACNS) role is felt to be a valuable role within dementia care. (Clibbens, Depledge and Hemmingway, 2019).

NHS Grampian have developed the ACNS within their Older Adult Community Mental Health Team as a specialist role to support dementia care in line with the national Transforming roles programme. As ACNS’s, they bring specialist knowledge and skills to the care delivered achieved through master’s level study, with the ability to undertake assessment and manage care effectively to improve patient outcomes, often supporting patients with more complex care need. As independent nurse prescribers, they can also initiate treatment and monitoring of Cholinesterase inhibitors and other relevant medications.

The ACNS’s work alongside the multidisciplinary team where they provide clinical leadership, support, and expert advice to staff across three teams, and routinely support continuing professional development of colleagues.

While this development is in the initial stages of implementation, the feedback has been positive, and the role will continue to be developed.

NHS Greater Glasgow and Clyde - Alcohol and Drug Recovery Crisis Service (ADRS) Glasgow City

The Glasgow City Crisis Outreach Service was established in 2021 in response to the increasing number of non-fatal overdoses and drug related deaths from street drugs recorded across the city. The team was established with 12 nursing staff, with the remit to promote the service across health, social work, third sector and voluntary services, and to identify and engage individuals who were most at risk of a drug related death or been known to have had a non-fatal overdose from street drugs.

In 2021, there were 933 male and 397 female drug deaths in Scotland, with people in the most deprived areas 15 times more likely to die from drug misuse than those in the least deprived areas in Scotland. 1 in 4 drug misuse deaths were in Glasgow

City. To deliver on the recommendations from the Scottish Drug Deaths Taskforce “Changing Lives” Final Report, the team established partnership working and engagement with recovery networks to reflect upon and evaluate their service response.

The team also provided education sessions and practical support to families, carers, and support service staff to raise awareness of the impact of alcohol and substance use on a person’s physical and mental health and wider social networks.

Interventions have included training on recognising and managing a drug overdose, provision of naloxone, and training on its use, and access to recovery or support services. At the six-month evaluation highlighted areas of good practice including:

• Correct identification of the target population in respect of sex, age range, recent non-fatal overdoses, and risk of future fatal overdose.
• Appropriate referrals are made with the correct presenting issue.
• Good partnership working links with Scottish Ambulance Service, Emergency Departments and Police Scotland.
• Good partnership working with Alcohol and Drug Recovery Community Services.

The service has expanded to include a 7-day home supported alcohol detoxification service, continued development of the social worker and social care worker role specific to crisis outreach, and ongoing development of links with community homeless service, third sector partner and recovery communities.

NHS Ayrshire and Arran - The Transitions Development Programme for Newly Qualified Nurses

Recognising that the transition from student to registered nurse can be a challenge, NHS Ayrshire and Arran mental health services designed a development programme for Newly Qualified Nurses (NQNs) to support this.

Complementing the support from the clinical areas and the NHS Education for Scotland - Flying Start® programme, the need to support the transition from student to registered nurse was felt to be important, recognising the need to value and nurture the newly qualified nurses.

Initially developed with informal online reflective support alongside formal action learning sets, this provided an opportunity to develop reflective practitioners and created opportunities for peer support enabled by senior mental health nurses.

Six development days with key themes pertinent to be a NQN are part of the regular opportunities available. This protected time for learning, along with the opportunity to undertake self-directed time to reflect and complete evidence for the Flying Start® programme, has been welcomed by the participants and feedback has indicated the positive impact on the wellbeing of the workforce during this transition period.

Evaluation feedback highlighted that NQNs found the programme to be of benefit and noted personal and professional growth as a result, with the programme as found to be a supportive function for NQNs.

The programme has evolved over time, and based on feedback from NQNs the content has been enhanced. The transitions programme had been run several times and is now mandated for all newly qualified nurses in mental health services.