NHS MEL (1997)62

SODD Circular 30/97

SWSG Guidance Package Index Ref : F.13

24 September 1997

To all holders of the SWSG/SWSI Circulars and Guidance Package

Dear Sir/Madam

FRAMEWORK FOR MENTAL HEALTH SERVICES IN SCOTLAND

A Circular on the Framework for Mental Health Services in Scotland was issued jointly by Health, Social Work and Housing Divisions of The Scottish Office on 18 September 1997. The copy attached is sent to you as a holder of the SWSG/SWSI Guidance Package for insertion into Section F13 of the package.

Please also note that circulars number SWSG13/97 to SWSG28/97 are existing circulars which are being revised and re-issued under new numbers. They will be sent to you shortly.

Yours faithfully

JOHN WILLIAMSON

Action

5. Health Boards, NHS Trusts and local authorities are asked to ensure that the Framework and this letter are distributed widely to all staff involved in the planning and delivery of health, social work and housing services for people with mental health problems.

6. They are requested also to take steps to implement the Framework in accordance with the timetable set out in paragraph 7 of the Annex.

7. A copy of the Framework and this circular is available on the Internet (at http://show.scot.nhs.uk) within the Scottish Health on the Web (SHOW) site.

Yours sincerely

KEVIN WOODS GILLIAN STEWART DAVID BELFALL

NHS Management Executive Social Work Services Group Development Department

ANNEX

FRAMEWORK FOR MENTAL HEALTH SERVICES IN SCOTLAND

Background

1. In its response to the Scottish Affairs Committee's Report on 'The Closure of Psychiatric Hospitals in Scotland' in 1995, The Scottish Office committed itself to production of 'A Statement of Aims and Points which we would expect to be covered in local strategies'. The Framework for Mental Health Services in Scotland fulfils that commitment and has been prepared to assist staff in health, social work and housing agencies, including Scottish Homes, to develop a joint approach to the planning, commissioning and provision of integrated mental health services. It is also intended to assist staff in voluntary and private sector agencies, and those who use services and who care for them to play their part as partners and stakeholders.

2. The Framework does not create new policy. Its purpose is to promote the implementation of existing policy and to assist the process of developing mental health services in Scotland by:

- generating consensus over the key issues in achieving transition to local, comprehensive mental health services;

- providing a template against which those responsible for mental health services can, in consultation with the people who receive these services and those who care for them, agree priorities for action that are related to outcomes and to clinical and cost-effectiveness, and can assess progress; and

- establishing a yardstick by which The Scottish Office can assess local strategies and action plans, and monitor progress.

3. A draft Framework was the subject of extensive consultation between October 1996 and February 1997. A large number of helpful comments were received during the course of a number of consultation seminars and through written submissions. The document has been revised in the light of these comments. In this process, The Scottish Office has been assisted by the Mental Health Reference Group, established under the chairmanship of Dr Angus Mackay OBE, to ensure that the development of mental health services in Scotland is informed by the experience of those involved in planning, providing, and receiving mental health services.

Framework

4. The Framework is in two parts:

- the Framework itself which sets out the essential features of a local mental health strategy; and

- an Appendix comprising 3 tables which summarise the elements a local, comprehensive service should include in order to meet the needs of people with mental health problems and which also offers examples of possible service responses.

5. A further document has been produced which provides wider information and discussion of each element of the Framework. This 'context' document is not part of the Framework and has been prepared to assist readers who would find it helpful to have background information on particular aspects of the Framework. Copies may be obtained from The Scottish Office, Room 246, St Andrew's House, Edinburgh EH1 3DG (tel: 0131-244 2787).

Supporting action

6. The Minister has also announced a package of initiatives and other documents to support implementation of the Framework. These are:

Mental Health Development Fund

A Mental Health Development Fund, amounting to £3m per annum over 3 years (1998/99-2000/2001), has been created to provide pump-priming funding to help Health Boards develop new ways of working with GPs, NHS Trusts, local authorities and other statutory and voluntary agencies in the development of local community-focused services for those with mental health problems. Details of the Fund, which is separate from the Mental Illness Specific Grant Scheme, including the arrangements for submission of bids, are set out in Appendix A.

The Scottish Development Centre for Mental Health Services

In response to an application from the Scottish Association for Mental Health and the Centre for Mental Health Services Development, Kings College, London, The Scottish Office has agreed to provide launch aid in support of the establishment of a Scottish Development Centre for Mental Health Services. Its purpose is to provide development assistance, advice and support to agencies in the field, and will also offer training to front-line staff and undertake developmental and evaluative research. It will work in close collaboration with the key stakeholders involved in planning and delivering mental health services, including those who use these services and those who care for them, to ensure the effective implementation of policy at local and national level. Further details are available from the Centre which is based temporarily at 17A Graham Street, Edinburgh EH6 5QU (tel: 0131-555 5959).

Local Care Partnerships

A scheme has been established inviting bids for funding in support of local care partnership pilot initiatives designed to assist Health Boards to work in partnership with GPs, NHS Trusts, local authorities and other agencies in the effective and efficient local integration of health, housing and social care services provided for vulnerable individuals and groups in their area. As the remit of this Scheme is wider than mental health, details are being published in a separate MEL (MEL(1997)57).

Making it Happen

With the support of the Mental Health Reference Group, a brief working guide to implementing the Framework has been prepared for those charged with ensuring its implementation. In a series of 4 steps it lists the practical actions, arrangements, and expected outcomes which are necessary for successful implementation of a local comprehensive mental health service. It is a route map, in which the milestones and major destinations are identified, designed to be read in conjunction with the Framework itself. This document is being distributed with the Framework.

Guide to Good Practice on Advocacy

The Framework stresses the importance of involving those who receive mental health services in their own care and in the planning of services. Advocacy has a key role in enabling people to make informed choices about, and to remain in control of their own care. Based on work undertaken by the Scottish Health Advisory Service (SHAS) and experience of the 4 patient's supporter pilot projects funded by the Management Executive, the Guide to Good Practice on Advocacy is designed to assist Health Boards and other agencies to establish effective advocacy services (further information is provided in MEL(1997)61).

SNAP Reports on Mental Health

The Scottish Needs Assessment Programme (SNAP) was established by the Scottish Forum for Public Health Medicine to assist Health Boards carry out health needs assessments. As part of its regular programme of work, SNAP established working groups to produce various reports on mental health issues. These reports, listed below, have informed the development of the Framework and Appendix 2 in particular, and will provide a useful source of information for those charged with developing local mental health strategies.

The Burden of Mental Health

Public Health and Mental Health Gain

Suicidal Behaviour Among Young Adults

The Involvement of Service Users in Assessing the Need for,

Commissioning and Monitoring Mental Health Services

Effects of the Changing Patterns of Service Provision and their Health,

Social and Economic Implications

Mental Health in the Workplace

Dementia

Schizophrenia.

Timetable for Implementation

7. The timetable for the implementation of the Framework is as follows:

By December 1997

- confirm joint aims and priorities in line with community care plans, Health Improvement Programmes etc;

- assess local needs for mental health services;

- undertake a service review of current services, identifying:

• gaps and shortfalls in services

• existing plans to fill these gaps

• lead responsibility in implementing these plans;

- identify existing NHS, social work and other resources available for mental health services.

(ie at least Steps one and two in 'Making it Happen'.)

By April 1998

- draft an implementation plan (covering 6 years, ie 2 community care planning periods) to put in practice existing plans and new plans developed in response to the service review. The implementation plan should identify a timetable for achieving each step, the resources required and their source, and lead responsibility for each component in the plan.

(ie Step 3 in 'Making it Happen'.)

April-June 1998

- Discussion and agreement of these implementation plans with The Scottish Office.

Monitoring Arrangements

8. The Scottish Office Department of Health, Social Work Services Group and Development Department have worked together in developing the Framework and are committed to maintaining this approach in promoting its implementation. In monitoring progress they will expect evidence of greater co-operative working by the NHS, local authorities and other agencies and will have regard to the issues set out in paragraph 49 of the Framework. Details of the monitoring arrangements will be announced later.

APPENDIX A

MENTAL HEALTH DEVELOPMENT FUND

Introduction

1. Bids are invited for funding support to assist Health Boards, working in partnerships with GPs, NHS Trusts, local authorities and other agencies, to make quicker progress toward the development of local, community-focused comprehensive services which better meet the needs of people with mental health problems.

Background

2. The Mental Health Development Fund (MHDF) is specifically designed to help with the implementation of local strategies arising from the Framework for Mental Health Services in Scotland. It is quite separate from awards made under the Mental Illness Specific Grant Scheme.

3. The purpose of the MHDF is to encourage the development of local community-focused comprehensive services for those with mental health problems. The Fund will provide pump-priming funding to help Health Boards develop new ways of joint working with GPs, NHS Trusts, local authorities and other statutory and voluntary agencies in this shared task. Bids for funding, whether for the joint planning process, infrastructure, or the initial phase of direct service provision, will need to demonstrate a clear link with a published, locally agreed mental health strategy which in turn should incorporate the principles of the Framework for Mental Health Services in Scotland.

4. We expect that applications in the first year of the Scheme (1998-99) will not generally include requests for financial support for direct service provision, reflecting the fact that agencies may not have reached that stage in terms of their Framework Strategy implementation.

Resources

5. Up to £3 million a year over 3 years is available from the MHDF.

6. Financial support from the Fund is restricted to the first year funding only of approved schemes. A clear commitment will therefore be required from all appropriate local agencies to the project and to their continuing its funding beyond the initial year. A matching contribution to any award from the Fund is not a pre-requisite for support, but all other considerations being equal such contribution will be regarded as an advantage.

Application and Assessment Criteria

7. Bids (for first year funding only) will be assessed on evidence:

• of a link between the project and a published, locally agreed mental health plan or strategy which incorporates the principles of the Framework for Mental Health Services in Scotland, particularly the key points set out in the "Making it Happen" Annex to the Framework document;

• that the project would enable services to meet the needs of people with severe and/or enduring mental health problems;

• which demonstrates that the interventions proposed would deliver effective outcomes for people who receive mental health services or those who care for them;

• of joint commissioning and the development of effective working between local agencies (statutory and others);

• of shared commitment to funding the project in, and after, the first year;

• of how applicants plan to jointly assess progress made in year (and to avoid separate agency monitoring);

8. All applicants will be required to comply in all respects with the conditions attaching to funding, which will include:-

• the joint applicants will formally accept the offer of funding and funding conditions;

• the Lead Organisation will notify NHS ME of the project start date, timespan, and any material change made to the project as it progresses;

• the Lead Organisation will ensure that expenditure is kept in line with the agreed project cost budget and expenditure profile;

• payment of funds will not be made in advance of need;

• the Lead Organisation will provide quarterly financial statements signed by the Finance Officer/Treasurer. These to provide details of the actual eligible expenditure incurred;

• all unexpended balance of funding will be surrendered to the NHS ME;

• all target dates for submission of interim and final reports will be observed;

• any equipment used for the funded project will be included on the Lead Organisation inventory and any disposal/write-off will be in line with Lead Organisation’s standard arrangements.

• specific merits that would attract support for schemes of an anticipated one year duration with no continuing requirement thereafter. Such schemes in particular may warrant matching funding from the joint applicants.

9. All applications for funding under the Fund should be co-signed at senior management level on behalf of the Health Board and relevant local authorities (Social Work and Housing as appropriate) and by all other agencies and individuals who have committed themselves to the scheme. Applications must include a completed proforma (Appendix B) which together with financial and other detail requires applicants to provide an assessment of the criteria for success by which they consider a successful outcome of their scheme should be measured.

Monitoring

10. The Scottish Office in liaison with the local agencies will monitor the extent to which the projects supported under the Fund achieve the objectives originally agreed. Successful applicants will be required to submit a Final Report on the funded scheme of not more than 200-400 words with information on the main results and conclusions achieved, the implications for the organisation of mental health services in Scotland and the relationship of the outcomes to the original, anticipated success criteria set out in the funding application.

Timetable

11. Health Boards are invited to co-ordinate and submit formal bids, for funding in year 1998-99 by 31 March 1998. The deadline for submissions for funding in years 1999-00 and 2000-01 will be 1 June in both 1999 and year 2000.

Individual funding decisions for 1998-99 will be announced in June 1998 and in August of the following years for the subsequent bids.

Action

12. Applications should be submitted by Health Boards to The Scottish Office, Department of Health, NHS Management Executive, Policy and Performance Management Division, St Andrew’s House, Regent Road, Edinburgh EH1 3DG

APPENDIX B

APPLICATION UNDER THE MENTAL HEALTH DEVELOPMENT FUND

PLEASE COMPLETE THIS FORM USING BLACK TYPESCRIPT

1. PROJECT TITLE

2. NAMES AND AFFILIATION OF JOINT APPLICANTS

APPLICATION UNDER THE MENTAL HEALTH DEVELOPMENT FUND

APPLICATION UNDER THE MENTAL HEALTH DEVELOPMENT FUND

APPLICATION UNDER THE MENTAL HEALTH DEVELOPMENT FUND