Scotland has a new Mental Health Strategy.
The Scottish Government’s strategy for the period 2012 – 2015 was launched earlier this month. There was none of the fanfare that usually accompanies these launches, although that might be due to the timing: mid summer, in a parliamentary recess and post Olympics.
The document was finalised following extensive consultation with user and carer groups, and the Scottish Government is to be commended for producing a strategy that takes on board many of the issues that were raised. User and carer involvement is, quite rightly, at the centre of the strategy, which is very much a working document rather than a lofty statement of ambitions.
The overall tone is of building on successes while recognising that there are also weaknesses to be dealt with. It is realistic, and in times of declining resources it simply had to be. There are no promises of massive new investment in mental health – but then did we really expect there to be?
There is a lot about self management and preventative action, what people can do to improve their own mental health and the challenges that issues like unemployment and poor physical health can play. The recovery approach and anti-stigma work will also continue.
The strategy recognises that measures to improve quality of life can also improve the mental health of many people. It sees that medical treatment is only one part of the fight against mental illness. And it also accepts that government is not the only agency with a role to play here: many of the services that play such important roles are delivered by other public sector bodies and often by the voluntary sector.
The Strategy outlines 36 Commitments from the Government across seven key themes, which emerged from the consultation process. These are:
- Working more effectively with families and carers;
- Embedding more peer to peer work and support;
- Increasing the support for self management and self help approaches;
- Extending the anti-stigma agenda forward to include further work on discrimination;
- Focusing on the rights of those with mental illness;
- Developing the outcomes approach to include personal, social and clinical outcomes; and
- Ensuring that we use new technology effectively as a mechanism for providing information and delivering evidence based services
So what will we see happening in the world of mental health over the next few years?
The very first Commitment is that the Scottish Government will commission a 10 year on follow up to the 2004 Sandra Grant Report, which reviewed the state of mental health services in Scotland. This will be carried out next year for publication in 2014.
The detail of who will carry out this major review and with what exact remit will come later. This is the strategy after all, and the fine print on how it is implemented is to follow. But we can expect service user and carer involvement in the review, and it will provide another opportunity for us to put forward our perspective.
There is a Commitment to involve families and carers more fully in policy development and service delivery. This is to be welcomed and discussions have already started on how best to progress this work. It is fair to say that many carers’ organisations are not experts in the mental health field and focus primarily on the carers of those with physical illnesses. It is also the case that many partners, parents and friends of those who have mental illnesses would not call themselves carers: they provide support and love but don’t necessarily see themselves as care givers. This all needs to be carefully thought through – but many of the national mental health voluntary organisations offer support to carers as well as to those with mental illness and are therefore well placed to help shape the discussion.
E-health is an area where much progress is being made and the Commitment to develop a Scotland-wide approach to improving mental health through new technology is to be welcomed. There is much that can be done through better use of technology and I look forward to seeing some innovative ideas emerge.
There are several Commitments relating to children and young people, including better support for parenting programmes, developing specialised services for children in care and reducing the number of young people admitted to adult mental health wards. These are all positive developments and the priority given to addressing mental health issues as early as possible is an encouraging step.
And Commitments relating to older people include greater use of psychological therapies and better integration with general adult services. While there is a necessary focus on tackling dementia in service delivery it is good to see a recognition that this is not the only challenge that older people can face.
Work to identify new models of crisis care is an important Commitment. This will involve investigation of home treatment and other service delivery models, recognising that hospital admission should not be the only option available. There are several voluntary organisations that will have an interest in this area of work, and several other European countries already offer a crisis house model.
There are also Commitments relating to specific areas like alcohol and mental health, work in prisons, veterans and also better linkage of mental health services to local government, which is especially important as health and social care systems are integrated.
The final Commitment made is that systems will be put into place to co-ordinate, monitor and performance manage progress against all of the commitments made. This is not to be a document that gathers dust on a shelf, but one which really does drive progress. The method by which this work is carried out, and of course how progress is reported, will be important.
My overall response to the Strategy is a positive one. The commitments on service user and carer involvement and the emphasis on self management are welcome. There is, of course, an important role for primary care services in mental health, but there is also a great deal we can do in communities to reduce the likelihood of hospital admissions.
Mental health issues blight the lives of many people, and can have a big impact on their families and friends too. There is much that can be done to make life better, and many of the positives from this new Strategy involve designing new services that better meet the needs of those affected.
I’m looking forward to seeing a great deal of progress being made over the next few years.