The Scottish Government

« Previous | Contents | Next »

Listen

National Mental Health Services Assessment: Final Report

EXECUTIVE SUMMARY

The Mental Health (Care and Treatment) (Scotland) Act 2003 was passed in April 2003 and will be implemented by April 2005 (apart from the right to appeal against the level of detention, which does not come into force until the following year). Given that the new legal requirements will add to existing pressures on services, the Minister for Health and Community Care proposed an assessment of the current ability and readiness of the partner agencies to implement the new provisions. A small team was established, seconded from the care services, and was given a very broad remit:

The National Mental Health Services Assessment Interim Report (December 2003) focused mostly on services for adults. However, the individual locality reports which were published at the same time captured other services. This Final Report expands on this and includes chapters and sections on client groups, care needs and services available for all age groups.

The Review Team involved and consulted service users and carers, NHS bodies, local authorities, the voluntary sector and other interested parties. A wide range of available information on existing services was also taken into account. The focus was on the current provision of services, although likely changes in demand for services resulting from demographic trends, changing patterns of morbidity, changing patterns of care and other factors were also anticipated. A multi-faceted approach was followed gathering information from a range of sources and wherever possible more than one source of corroborating information was sourced. The assessment worked from 3 principles: Focus on people; use of existing information; and validation.

The new Act

The Mental Health (Care and Treatment) (Scotland) Act 2003 ("the new Act") received Royal Assent on 25 April 2003. The Act was also developed with the
co-operation and participation of patients, those who care for them, the statutory and voluntary sectors and other interests. The provisions are designed to bring real benefits to people with mental disorder and for those who care for them. An Introduction to the Mental Health (Care and Treatment) (Scotland) Act¹ provides a straightforward guide to the new Act.

The main provisions of the new Act will be introduced in April 2005 and will ensure that compulsory measures of detention and other care may only be applied where strict criteria have been met. A new forum, the Mental Health Tribunal, will be appointed to make important decisions in relation to such compulsory measures including powers for the Tribunal to intervene where important elements of a Compulsory Treatment Order are not being provided. Wherever possible the objective will be to treat offenders who enter the mental health system in the same way as civil patients.

The Act establishes key care and approach principles including: recognition of the present and past wishes and feelings of the patients; the importance of patient participation in the design of care; and the need for services to respond directly to patients' assessed needs and to the needs and circumstances of the patient's carer.

The Act also sets out principles relating to the way in which the care must be delivered. That will involve approaches designed to include the minimum restriction on personal freedoms; the promotion of equal opportunities; and, in the case of children, will ensure their best interests and welfare.

Additional duties will be placed on NHS Boards including: services and accommodation for children and young people in hospital; for mothers admitted with their babies; and a duty in collaboration with local authorities to ensure access to independent advocacy services for all with mental disorder in their area.

New duties are also placed on local authorities including, among others, a responsibility to provide care and support services and services to promote well-being in social development. Assistance with travel for people with mental disorder is included together with duties designed to contribute to the avoidance and reduction of the risk of harm. Local authorities will also have a duty to provide education for children subject to the new Act or the Criminal Procedure (Scotland) Act 1995.

Meeting the requirements of the new Act

The new Act will require a comprehensive range of responses organised on a joint agency basis and involving service users, carers, the voluntary sector and others in the assessment, planning and delivery processes. This report comments on these approaches, focuses on the current organisation of mental health services and offers conclusions and recommendations on what changes are needed to meet the main provisions by April 2005.

This report concludes that for the statutory agencies, their partners and other interested parties to combine to implement the provisions and objectives of the new Act, will require urgent and continued attention on the planning and, most importantly, the delivery of comprehensive mental health services, care and support as set out in the Framework for Mental Health Services in Scotland² and its successor documents. That solid grounding and range of provision will be required as the foundation on which to build the new services and approaches called for in the new legislation. The minimum range anticipated by this report should include joint agency and other partners' approaches to cover:

1. A range of crisis and responsive services available throughout the 24 hours.

2. Multi-agency and multidisciplinary community mental services, including the voluntary sector, for the range of care groups, including people with a learning disability.

3. Access to a range of appropriate inpatient facilities through local and regional planning and managed care networks (e.g. young people, mentally disordered offenders, mothers with perinatal illness and their babies)

4. A range of therapies including psychosocial interventions, structured daytime activities and employment, and support for recovery.

5. A local consensus on the way forward for workforce planning and development, including independent advocacy.

6. Training in the specific requirements of the Act, and appropriate arrangements for administration.

The principal conclusions and recommendations of the Assessment are set out overleaf.

CONCLUSIONS AND RECOMMENDATIONS

The Mental Health (Care and Treatment) (Scotland) Act 2003 enshrines recent developments concerning human rights. Extensive consultation by the Millan ⁴ Committee with people who use the services and those who care for them, as well as with those who plan and provide services, helped to develop the principles behind the new Act. This has ensured a degree of awareness about what is needed in addition to the changes in statutory procedures.

These underlying principles provide the basis for a new style of service delivery designed to have a major impact on improving the experience of service users and those who care for them. The new provisions link to the range of initiatives underway to progress mental health and well-being and to improve health and social inclusion generally, reflecting the broader approach to mental health policy and practice in Scotland and the work being done to improve treatment and care services.

The Act

Conclusion

The process of consultation and involvement has worked well and people are waiting for further training and guidance. The new Act is recognised as being part of a broader range of mental health initiatives and the Joint Local Implementation Plans will reflect this.

Recommendation

The Scottish Executive should continue with the current implementation process and provide central guidance to inform the priorities in local training action plans and Joint Local Implementation Plans, to be implemented by the agencies within set timescales.

Organisational Culture

Conclusion

There are major staff morale, attitudinal and cultural problems which, unless attended to consistently, will inhibit full implementation of the underlying principles of the new Act.

Recommendations

People who use the services and those who care for them should work together with staff who share the same values, to jointly bring about change and ensure that the principles behind the Act are adhered too.

Front-line staff should lead on bringing about the changes required by the new Act, using it as a development opportunity for the service, those working in it and those receiving care.

The senior managers in local authorities and NHS Boards should devolve more authority, responsibility and accountability (including budgets) to front-line staff, with a clear objective to work closely with the voluntary sector and service users and carers.

The Scottish Executive should focus on the implementation of existing policies in mental health services and the implementation of the Act and avoid creating additional policies at this point in time.

Information

Conclusion

There are serious and major problems in accessing adequate data about mental health services. However, there are a number of significant developments that should improve this.

Recommendations

The Scottish Executive should continue with its current work on developing a Mental Health Information Strategy and ensure that it is locally adopted, resourced and fully implemented in the medium term (3 years).

The work of the Improving Mental Health Information Programme should continue and expand so that it can become an expert resource for local services as well as providing national data.

Staff and managers across agencies should agree on the minimum set of data to be recorded to help improve service delivery and quality and ensure that this is collected.

Information that informs decision-making should be made available to all stakeholders.

Inequity

Conclusion

Mental health services in Scotland have some way to go before every citizen has access to the same level of high quality service, including services mentioned within the provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003.

Recommendations

Flexible and responsive 24-hour support services should be developed locally and planning should involve service users.

By the time the Act is implemented in 2005, everyone with a serious mental health problem should have their assessed community needs met by a multidisciplinary and interagency team, which should include the voluntary sector.

Admissions to hospital for reasons other than appropriate regional service provision (i.e. where the local facility has no spare capacity) should be monitored and analysed by regional planning groups, with the aim of improving national bed management.

The accommodation where care is delivered should provide a good environment. When necessary, people should have planned and timely access to age appropriate facilities and specialist services, including mother and baby units.

Day activities and therapeutic opportunities should be available both in the hospital and community, including psychological and social interventions.

Workforce

Conclusion

Workforce gaps are probably the most difficult issue to address in the short-term (one year) but this must be done in order to fulfil the obligations of the Act from 2005. This will mean major changes to personal roles, responsibilities and job plans. It will also have an impact on the strategic and structural issues involved in redesign initiatives.

Recommendations

At a national level, work should be carried out to clarify issues about roles, responsibilities and pay scales between different disciplines, organisations and levels of seniority and experience. This must involve the staff-side as well as senior management and should be compatible with ongoing human resource development strategies and life-long learning strategies.

Locally, there is no time to wait for a national directive so interim compromises and solutions should be found in order to ensure the legal rights of people using the services are met. It is essential that this interim work and experience informs and shapes the national guidance and regulations.

The National Mental Health Workforce Group should lead on these issues.

Finance

Conclusions

There is insufficient standardisation and clarity about the funding of mental health services and how the money can be tracked into services at a local level.

There is insufficient expertise within the statutory sector at a care delivery level about how to develop a business case and obtain resources to fund it.

There is a perceived under-funding of mental health services. Until it is clear exactly what is being spent, how well and to what effect, an unanswerable case for an increase is difficult to make. The need for resources will become greater in order to implement the new Act.

Recommendations

The Scottish Executive, NHSScotland and local authorities should ensure that there is a standardised and transparent system for recording financial data that contains not only national data, but regional and local spend.

A system should be developed whereby money spent can be tracked to local service provision and accounted for within the monitoring systems

Staff as well as managers should take responsibility for understanding financial issues in relation to improving outcomes, including the concept of opportunity cost.

Robust business cases should be put forward for increasing resources within the statutory sector and voluntary sector.

NHS Boards and local authorities should give increased priority to mental health service resource allocation especially in relation to the pressures and commitments associated with the new Act.

« Previous | Contents | Next »