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MENTAL HEALTH OFFICER SERVICES: STRUCTURES AND SUPPORTS
ACKNOWLEDGEMENTS
The authors would like to thank all those who acted as Local Authority Link People, all of the MHOs who completed questionnaires and took part in focus groups and those health care professionals who participated in the focus group. We are also grateful to the Research Advisory Group for guidance and support. Members of this group are listed below.
ADVISORY GROUP MEMBERS
George Kappler, Social Work Services Inspectorate, Health and Community Care, Scottish Executive
John Waterhouse, Social Work Services Inspectorate, Criminal Justice, Scottish Executive
John Storey, Directorate of Service Policy and Planning, Health Department, Scottish Executive
Ruth Stark, British Association of Social Workers
Christina Naismith, Chair, Association of Directors of Social Work Mental Health Group
Juliet Cheetham, Mental Welfare Commission
Allyson McCollam, Scottish Development Centre for Mental Health (research contractor)
Angela Hallam, Health and Community Care Research Team, Scottish Executive (project manager)
EXECUTIVE SUMMARY
BACKGROUND
The role of the Mental Health Officer (MHO) in Scotland has evolved in recent years as a consequence both of changes in the patterns of service provision for people with mental health problems or a learning disability and in response to changes and developments in legislation affecting these groups. The changing legislative and service landscape in mental health and learning disability poses significant challenges relating to the capacity and capability of current MHO services in Scotland.
RESEARCH AIMS
The principal aims of the research, commissioned by the Scottish Executive were to:
- Investigate models of MHO service provision and how they address the need to provide a responsive professional service which takes account of local circumstances and the demands of new and existing legislation
- Explore local authorities' readiness to respond to the demands on MHO services arising from the Adults with Incapacity (Scotland) Act 2000. The research also set out to examine early preparations being put in place locally for the implementation of the new Mental Health (Care and Treatment) (Scotland) Act 2003
APPROACH
Overseen by an Advisory Group comprising representatives from the Association of Directors of Social Work, the British Association of Social Work, the Scottish Executive and the Mental Welfare Commission for Scotland, the research was conducted over six months beginning in January 2003. The research entailed:
- A national survey of all Scottish local authorities (LAs), to describe current structures and supports
- Telephone interviews with service managers in each local authority
- A short postal questionnaire for MHO practitioners, focusing on key issues relating to workload, support and supervision, training and job satisfaction
- A series of focus groups with MHO practitioners and health service professionals
KEY FINDINGS
Service structure and capacity
- There was evidence of the beginning of a strategic approach within LAs towards MHO recruitment and deployment, placing MHO skills where there was most need and demand
- A high proportion of MHOs were inactive and had not practised in the preceding 12 months
- There was considerable variation in the structures of MHO services
- Deployment of MHOs was moving towards the community and into Community Mental Health Teams (CMHTs) where there was the greatest demand for statutory work
- MHOs were deployed across non-mental health specialties and this was seen as beneficial in many ways, in promoting wider access to MHO advice and expertise
- MHOs deployed in non-mental health specialties were less likely to be line managed by MHOs and consequently received both less support to make time for their MHO role and less formal supervision of their MHO practice. There were indications that this model of deployment could adversely affect the continuity of care provided and the opportunity for MHO practitioners to maintain practice competence and confidence
- Although most MHOs combined their MHO role with a wider social worker role, instances of dedicated MHOs had increased since a survey carried out by the Social Work Services Inspectorate in 1998
Supervision and support
- Formal supervision was not available to all MHOs in relation to their statutory work. Those who were most likely to receive supervision were those deployed within a CMHT who had an MHO as manager
- There were many opportunities for informal support and supervision, particularly from peers and through local MHO forums. This was of particular benefit to MHOs deployed in non-mental health teams
Operational issues
- Out of hours services were managed via rota systems. In some smaller authorities, dedicated out of hours staff were not available, with reliance on a stand-by or duty system. Many LAs reported that they were struggling to maintain a consistent out of hours response
- Joint working relationships with other agencies were generally perceived to be good, especially if MHOs were deployed in mental health teams. However there was a need to improve awareness of the MHO role. Joint working with primary care and substance misuse services required particular attention
Management and leadership
- Although 31 LAs claimed that they had a lead person identified for MHO services, these were not always dedicated posts and in many instances practitioners were unaware of the lead person. The benefits of having a dedicated lead MHO post to coordinate the MHO service as a whole were recognised and all authorities aspired to achieve this
- A number of LAs had established Divisional MHOs as a means of ensuring oversight, co-ordination and quality assurance
Rural issues
- For rural areas pressures were often acute in developing and maintaining links with other, often physically distant, professionals and in maintaining MHO practice competence. Services in some rural areas relied, to varying degrees, on practitioner good will and commitment
Local audit and review
- There was a lack of consistency and completeness in collection of routine MHO activity information regarding statutory work
- There was an emerging recognition of the MHO service as discrete and the accompanying need to review and monitor MHO service structures and delivery. However many LAs had not yet undertaken such a review and there were inconsistencies in approaches to this task. Many authorities were looking for national guidance and direction to support them in this
FUTURE DIRECTIONS
From the findings, three key priorities for development emerge for local MHO services locally and for relevant national bodies: service design and organisation, service quality and key relationships.
MHO service review and redesign
Structure
Local authorities face difficult choices in determining the future structure and organisation of their MHO service. As earlier research suggested, there is no single model that would fit local requirements. This study has highlighted key considerations which should be examined in any process of review and redesign. These include:
- Local demographic patterns and anticipated need for statutory intervention
- Recognising that different models of MHO service each have distinctive advantages and disadvantages:
- ensuring accessibility and responsiveness of the service and continuity of care where required
- protecting and maintaining practice standards and competence and supporting practitioners
- facilitating opportunities to work collaboratively and develop effective working links with other professionals
- Learning from the range of different models of MHO provision in place across Scotland to inform the development of local services in line with local circumstances and needs
Leadership
Revisions to service structures need to be accompanied by steps to promote effective co-ordination, planning and leadership at strategic and operational level to ensure effective use of MHO capacity to meet local needs and demands.
Capacity and capability
It falls to local authorities to make informed judgements about the optimum deployment of MHOs in the light of the findings from this research that indicate the inter-relationship between different models of MHO service structure on the one hand and service quality, effectiveness and efficiency, on the other.
The Mental Health (Care and Treatment) (Scotland) Act 2003 brings new responsibilities for MHOs, strengthening their role in decision making and giving greater weight to multidisciplinary decision making. The challenge for local authorities is to develop MHO services which have the capacity to prepare and support individual MHO practitioners for their new statutory functions. A critical test in any review and redesign of services will be to consider the extent to which the service equips and supports MHOs as autonomous decision makers and enables them to practise confidently in a multidisciplinary environment.
Capacity is not only a question of staffing numbers; it is also about the structures, supervision arrangements, advice, practical support and quality of working relationships with peers and others.
Strategies to enhance MHO recruitment and retention need to be accompanied by efforts to make greater use of the existing MHO resource, of which at least a quarter appeared to be under used.
Quality
Co-ordination and oversight of the local service will be increasingly important to raise the profile of the MHO service within the local authority and outside it and to ensure its quality and consistency. This will require enhanced monitoring of activity and demand and responsiveness to stakeholder views on process and outcome.
The development of national MHO service standards will further support quality improvement and will afford opportunity to improve the quality of local and national MHO activity data collection and on-going monitoring and evaluation of the service.
Key relationships
Local authorities have established solid foundations on which to continue to build links and relationships internally between MHO services and assessment and care management teams, to further improve continuity of care. These foundations should also facilitate links between MHO services and legal departments, a key resource in fulfilling MHO duties.
Externally, the move towards greater integration between health and social work should work to the benefit of MHO service relationships with key health colleagues, whilst maintaining the integrity and independence of the MHO role. Training and the development of policies and procedures for the implementation of the new Mental Health (Care and Treatment) (Scotland) Act 2003 provide an opportunity to increase mutual understanding of roles and responsibilities within the local multidisciplinary networks in relation to the provisions of new as well as existing legislation.
MHO practitioners were strongly committed to close collaboration with other services and recognised that working in partnership with health colleagues in particular was a critical aspect of their statutory role.
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