The Scottish Government

« Previous | Contents | Next »

Listen

MENTAL HEALTH OFFICER SERVICES: STRUCTURES AND SUPPORTS

CHAPTER FIVE: PRACTITIONER QUESTIONNAIRE FINDINGS

INTRODUCTION

5.1 A brief questionnaire was distributed to MHO practitioners in Scotland via the Scottish Executive MHO Newsletter. This provided a means of gathering views from practitioners 'on the ground', to complement the perspectives of service managers who responded to the mapping proforma and telephone interviews, as described in Chapter Three.

RESPONSE

5.2 One hundred and fourteen MHOs from 27 Local Authorities responded to the MHO Practitioner questionnaire. This represents approximately one in six of all approved MHOs in Scotland. The frequency of responses from different Local Authorities varied with City of Edinburgh, Fife, Highland, North Lanarkshire and the Borders providing the highest rates of response. It is important however to take into account limitations in the distribution of the questionnaires, which may have affected these response rates (see methodology for details). Fourteen completed questionnaires were received after the closing date and could not be included in this analysis.

5.3 Fifty percent of the respondents were MHOs deployed in CMHTs, 28% were from Adult Community Care Teams and 8% were from Criminal Justice / Offending Teams. Others were from a variety of teams covering the following specialties: out of hours, children and family, general acute hospital, brain injury service, learning disabilities and older people. The profile of practitioners who responded to the survey is therefore broadly similar to the profile of MHOs across Scotland as described in Chapter 3.

MHO EXPERIENCE

5.4 Within the last six months 18% of respondents had used measures that fell under current mental health legislation infrequently, 47% from time to time and 34% regularly. Fifty five percent of respondents in a specialist mental health team stated that they used these measures regularly compared to 16% of those in adult community care teams.

PRACTICAL SUPPORTS

Administrative support

5.5 Eighty percent of respondents were able to access timely admin support, this was not related to the kind of team respondents worked in or their LA.

5.6 Fifty four percent of respondents worked in departments with systems in place to ensure that they received automatic notification of deadlines and renewal dates for MHO work and 37% did not (9% did not respond). Access to this kind of support varied within and between local authorities. Those working in community care teams were more likely (65%) than those working within specialist mental health teams (52%) to receive this support.

5.7 Seventy five percent of respondents rated the administrative support that they received as satisfactory or better. There was little relationship here to type of team or LA.

Technical support

5.8 Ninety percent of respondents had access to a computer. For most (68%) of those who had access to a computer, this was for their sole use; the rest shared with colleagues. Eighty five percent of respondents had access to a mobile phone. Again there appeared to be no relationship between the availability of technical support and the type of team MHO respondents worked in. Thirty six percent of respondents had access to a pager. Twenty three percent of those with no such access had access to a pager. Seventy six percent of respondents considered that that the technical support available to them was satisfactory or better.

Support with transport

5.9 Forty eight percent of respondents had authorised car user status, 19% had a petrol allowance and 14% had both of these. The remainder had a variety of transport supports offered including car pools, taxis and public transport. Seventy percent of respondents described the provision made within their LA to assist MHOs with transport as satisfactory or better.

Satisfaction with support

5.10 Table 4.1 summarises the views of respondent MHOs to indicate levels of satisfaction and dissatisfaction with the support available to them.

Table 5.1 Satisfaction with support

Advice, risk and protection

5.11 Ninety seven percent of MHO respondents were able to access in house legal advice, information and support for their MHO work. Forty seven percent were able to access external legal support. Three respondents claimed that they were unable to access any support of this kind.

5.12 Seventy six percent of MHO respondents were able to access in house financial advice. Twenty six percent of MHO respondents were able to access financial advice externally and 12 % of MHO respondents claimed that they had no access to financial advice in house or externally.

5.13 The extent to which MHO respondents had access within their LA to specialist knowledge was as follows:

Table 5.2 Access for MHO respondents to specialist advice within LAs

5.14 Fifty-eight per cent of those working in adult community care and 82% of those working in mental health teams said they had no access to specialist knowledge on child and adolescent mental health problems. There was little difference between types of team in access to specialist advice on any of the other four topics.

5.15 Forty four percent of MHO respondents felt that the provision made within their LA to provide protection to MHOs in high-risk situations was limited or worse. Opinions on this issue varied within and between Local Authorities.

SUPERVISION AND LINE MANAGEMENT

5.16 Fifty one percent of MHO respondents reported that they had regular supervision

from someone with knowledge and experience of mental disorder and the current legislative framework. Forty seven percent of respondents did not. Two percent of respondents did not reply to this question.

Table 5.3 Supervision of MHO work by team type

5.17 As shown in Table 4.3, those working in specialist mental health teams were more likely than those in community care teams to receive regular supervision: 77% compared with 26%. Indeed within some LAs, those in mental health teams received supervision, whilst those in adult community care teams did not.

5.18 Further analysis showed that in a few LAs all practitioner responses stated that they had no regular supervision. In all other LAs, practitioner experiences of supervision were varied within the authority. Of those who did receive regular supervision as described above, 41% received supervision from a senior colleague only, both senior colleagues and peers supervised 36%, 8% were supervised by peers only and 14% also received supervision from external sources.

5.19 Fifty percent of MHO respondents regarded their supervision arrangements as satisfactory or better, while a third viewed their supervision arrangements as limited or poor. As might be expected, 89% of those who received regular supervision were satisfied compared with a rate of 6% satisfaction amongst those who did not receive supervision.

5.20 Seventy six percent of respondents reported that there was an identified lead manager with responsibility for the development and co-ordination of the MHO service. For 12 local authorities, different MHOs gave different answers to this question.

5.21 Fourteen percent of MHO respondents felt that the existing management structures within their authority supported them well, 50% felt there was adequate support and 33% felt that support was poor.

WORKLOAD MANAGEMENT

5.22 Respondents reported that the allocation of MHO work came through a variety of routes, including line managers, divisional heads, team leaders and NHS staff. According to respondents, MHO work was usually allocated by a rota or duty system or was dependent on availability and the nature of the skills and expertise required.

5.23 Fifty three percent of respondents found their workload manageable. For a further 20% workload fluctuated between being satisfactory and unsatisfactory. For the 22% who found their workload unsatisfactory, this was due to insufficient availability of MHOs with the skills required for the job or to workloads that were too heavy to provide a quality service.

5.24 For 47% of respondents, their workloads were monitored, but for another 40% there

was reported to be no mechanism in place for this (no responses were available for 3% of respondents). Twenty one percent of respondents were not sure about how data on their workloads were collected. Seventy four percent were aware that data on workloads was collected locally. Forty three percent of respondents considered that trends in workload and demand were used to develop MHO services, 27% did not believe that this was the case and 25% were not sure (responses were not available for the remainder).

5.25 Table 5.4 below indicates levels of satisfaction reported by respondents with supervision and workload management.

Table 5.4 Satisfaction with supervision and workload management

Percentages do not add up to 100 as respondents did not answer every question.

ARRANGEMENTS FOR OUT OF HOURS MHO SERVICE PROVISION

5.26 Sixty one percent of the respondents undertook MHO work in-hours only, 8% worked only out of hours and 31% worked both in and out of hours.

5.27 Forty six percent of respondents felt that the capacity of their out of hours service to meet demands was adequate and 42 % described it as limited or poor. Fifty two percent of respondents described the quality of the out of hours response as adequate and 37% described it as limited or poor. Fifty percent of respondents described arrangements for the follow-up of out of hours referrals as adequate, 23% as limited and 14% as poor.

TRAINING

5.28 Sixty-five percent of respondents considered that their LA made adequate provision to ensure that, as MHOs they were kept up to date with new developments in legislation, policy and services, 32% did not (3% recorded no response). Sixty six percent of MHO respondents did not feel that their LA had been taking adequate steps to provide sufficient preparation for MHOs in the face of anticipated changes in mental health legislation, whereas 25% considered that adequate steps had been taken to achieve this (9% recorded no response).

5.29 Respondents were asked if they considered that they had adequate training to be able to meet the demands on MHOs arising from current legislation (the AWIA and the MHA 1984). Forty-seven percent felt that their training was adequate and 49% disagreed. Sixty -eight percent of those working in adult community care teams considered their training inadequate compared to 41% of those working in specialist mental health teams. Forty percent of all respondents considered that they had received adequate training on departmental policies and procedures relating to these pieces of mental health legislation, 56% did not.

5.30 Forty percent of respondents received training two or more times a year, 26% received training annually and 26% less than once a year. Twenty-seven percent of MHO respondents took part in in-house training only, 18% trained with a regional consortium only, 3% receive training from professional networks and forums only and 57% receive training from all three sources. Forty four percent of respondents had taken part in joint training with health colleagues in the last 12 months on issues relating to mental health legislation, 56% had not.

5.31 Sixty-eight percent of MHO respondents rated the range of training and professional development activities they undertake as satisfactory or better, 29% described the range as limited or poor. The quality of training and professional development activities for MHOs was described as satisfactory or better by 78% of respondents whilst 20% described the quality as limited or poor.

5.32 Table 5.5 summarises respondents' views on training on current legislation and on departmental policies and procedures, and on the quality and range of training available.

Table 5.5 MHO assessment of training opportunities

Percentages do not add up to 100 as respondents did not answer every question.

JOB SATISFACTION

5.33 The four main sources of job satisfaction that MHO respondents reported were: working with clients and meeting their needs; multidisciplinary working; having challenging and stimulating work; and protecting vulnerable people and helping them make informed choices. Other sources of satisfaction mentioned were:

• Feeling valued by colleagues
• Ensuring a professional approach/independent opinion
• Involvement in planning and decision-making
• Specialist interest/knowledge and defined role
• Continuity of work in on-going cases
• Own professional and personal development
• Finding alternatives to detention under the MHA (1984)
• Autonomy of the work
• Using legislation (advising other colleagues)
• Protecting client and public safety

5.34 The main sources of job dissatisfaction for MHOs were: stress arising from increasing workload and conflict with other commitments; feeling undervalued by their employing authority (in terms of pay and recognition); inability to do the job to best of ability; lack of continuity for cases / no alternative resources for clients; lack of cooperation and communication from other professionals. Other sources of dissatisfaction were:

• Lack of appreciation of the MHO role
• Isolation and inadequate management/regional structures
• Unpredictability of type/amount of work
• Lack of training
• Shift from being a service provider to assessor of needs
• Inappropriate referrals to MHO
• Legislation (continual changes/developing new procedures)
• Out of hours rota system (lack of rota/not knowing when the phone will ring)
• Future uncertainties (i.e. joint working or adequate MHOs)
• The court process

LIAISON WITH HEALTH SERVICE COLLEAGUES

5.35 Thirty percent of MHO respondents reported that their LA was developing joint protocols with health service partners to guide staff in implementing the MHA (2003) and the AWIA. Two out of three respondents had no knowledge of such protocols being developed locally.

5.36 Forty percent of respondents stated that there were joint protocols between the LA and the health service on information sharing, referrals to the MHO service in and out of hours and on discharge from acute psychiatric care. Twenty-five percent stated that there were joint protocols for referral to the MHO service in and out of hours only.

5.37 Seventeen percent of respondents were aware of there being a mechanism in place to resolve disputes with health colleagues in implementing mental health legislation, 52% stated there was no mechanism for this and 24% did not know whether such a mechanism existed (7% recorded no response).

5.38 Fifty-three percent of MHO respondents considered that their health colleagues did not have an adequate understanding of MHO roles and responsibilities, 33% considered that they did have an adequate understanding and 11% said that health colleagues had some understanding of the MHO role (3% recorded no response).

5.39 Respondents were asked to rate the effectiveness of local joint working at operational level, for example in developing joint protocols. Forty-six percent of respondents described the effectiveness of local joint working with health service colleagues in implementing mental health legislation at operational level as satisfactory or better, 42% rated the effectiveness as limited or poor (12% did not record a response).

5.40 In addition respondents were asked to assess local joint working at practice level, for example, joint working on cases, communication and information sharing. Seventy-six percent of respondents described the effectiveness of local joint working with health service colleagues in implementing mental health legislation at practice level as satisfactory or better, 19% rated the effectiveness as limited or poor (5% gave no response).

SUMMARY OF KEY ISSUES FROM PRACTITIONER QUESTIONNAIRE

• MHOs who responded to the practitioner survey were mainly members of specialist mental health teams, where mental health legislation was most likely to be used
• Although the majority of respondents were satisfied with the administrative and technical support they received, more than a third of respondents had no access to automatic notification for legislation deadlines and renewal dates
• Legal and financial advice for MHO respondents was mainly provided in house. One in eight respondents reported no access to financial advice from either internal or external sources
• There appeared to be gaps in access to specialist advice for client groups, particularly child and adolescent, substance misuse and mentally disordered offenders
• Safety was an issue for MHO respondents, and nearly half of the respondents were not satisfied with the protection afforded to MHOs when in high-risk situations
• Regular supervision was not available for nearly half of the respondents. Those working in specialist mental health teams were more likely to receive regular supervision, although this varied between local authorities. Both senior colleagues and peers provided supervision. MHOs who were receiving supervision were generally satisfied with its quality
• There appeared to be some confusion amongst MHO respondents as to who provides leadership to MHO services within local authorities
• MHO workloads varied across the country. Although most MHO respondents found their workload manageable, some reported heavy workloads and insufficient skilled staff within the service
• Although activity information was being collected, there was a perception amongst practitioners that this information was not utilised optimally to monitor and inform the development of MHO services
• The perceived quantity and quality of out of hours services varied, with only 50% of respondents feeling that service provision met demand
• Most respondents rated the quality of training provided highly, but access varied and in some cases was limited. While two thirds of respondents considered that they were kept up to date with new developments in legislation and policy, there was a perception that local authorities were not yet taking the steps required to provide sufficient preparation for MHOs in the face of the upcoming legislative changes
• Awareness of formal joint protocols with health partners on implementing legislation, on information sharing and on mechanisms to resolve disputes was patchy amongst respondents, although some local authorities clearly had these protocols and could offer examples of good practice
• MHO respondents were of the opinion that health colleagues had a limited awareness and understanding of the MHO role
• From the perspective of the MHO practitioners who responded, joint working appeared to function better at practice level than at operational or managerial level
• Key factors in job satisfaction for MHO respondents were working with clients and meeting their needs, multidisciplinary working, having challenging and stimulating work and protecting vulnerable people to help them make informed choices
• Key factors in job dissatisfaction for MHO respondents were stress (increasing workload and conflict with other commitments), feeling undervalued, inability to do job to best of ability, lack of continuity for cases / no alternative resources for clients, lack of cooperation and communication from other professionals

« Previous | Contents | Next »