Quality standards for adult secondary mental health services

I have a long history of poor mental health including a diagnosis of anxiety, depression and ADHD. My concern is around the GP/referral area. A high number of people at my adhd support group are really struggling with even being given a referral to access services or be assessed. From what I read in the standards, I believe that the mental health services may improve. But I’m not confident in any improvement of people being able to access them. I would be keen to hear how you are going to educate GPs on making referral more accessible. Would you consider self referral? No one would self refer if they are not really struggling. Additionally, I am concerned about the statement that services will prioritise referrals of “those most in need”. Who decides who is most in need? We have a problem of medical misogyny and it’s accepted that women with adhd/autism etc tend to mask their symptoms more. So this may mean they struggle to be seen as quickly. I would like to see clear criteria on how you rate who is most in need. Would you consider allowing people to write a statement about how their life is affected by their mental health so that is judged on a fair basis? Rather than someone making a decision and asking those who want to be referred different questions based on biases that the medical professional has.

Gynaecology is struggling immensely right now. I have endometriosis and I know of so many struggling. It took me 10 years to get a diagnosis and treatment and I only got those as I went private. A lot of women are not treated with dignity throughout the process and are denied referrals.

I really hope that these standards are implemented well and improve the landscape for mental health in Scotland. Unfortunately those that are working and have the capacity to go on and pay tax/build economy are seen to not need help. This leads to lots of sickness in the workplace and wasted potential overall. We need to strive to not only help the worst off.

What you will do to improve waiting times. You claim we will receive care in a timescale appropriate, how will that be done? People are waiting 2 years for referrals and so many people I know have not been able to access therapy etc. I’m not expecting these to be included in detail but the answer is not to add more pressure to your staff- you need more. And you need to accept private diagnosis’s, this is the only way out of this.

A clear complaint process, so we can keep you accountable for when there are failures in the standards.

I find it hard to comment too much until
I see how we are to access crisis services. Often these standards can be wishy washy. I had an experience of a mental health crisis due to a family situation. I had agreed a plan with a psychiatrist at the priory before that in times of extreme stress, I would take diazepam as there was a clear history that extended anxiety led me to depressive episodes. I called the GP 47 times in the morning before I got a hold of someone and they wouldn’t give me an appointment until the afternoon as they were dealing with emergencies in the morning. I appreciate you may not want to hear personal experiences in this box, however the point I’m trying to make is that in crisis, you need to offer emergency medication that is provided in a timely manner.

Something stating how you will work with private mental health services. Some people have private healthcare, which shouldn’t be discouraged until you have enough capacity to treat everyone through nhs. If you are able to access a psychiatrist, the nhs should figure out a way of working with them to reduce the burden on the services.

A point that certain types of care will not be withheld if you disclose that you are substance abuse user. I know that help has been withheld from some people who have adhd as the common medications are stimulants. This is uneducated and we should be focusing on harm reduction.
There should be a mention of medical professionals asking the individual what type of treatment they prefer to take, if they have a preference.

Treating your staff well is the key to improving health outcomes in Scotland. I have a few friends that work for the NHS and bullying is rife. Everyone is overworked, underpaid. Those friends have taken long term sicknesses due to stress and that seems to be common place.
How can we expect to be treated with dignity and compassion from someone who is being bullied by co workers and is exhausted from being overworked?

Ensuring that the complaints go all the way up the ladder, and are not palmed off.

Perhaps we should be send feedback questionnaires for the first year of the standards being implemented to ensure we can track accurate progress.

More staff. You are adding extra workload to an already understaffed service. I think regular staff meetings to understand their scores and reflection together about what they can focus on improving.
Metrics that are implemented in the nhs are often focused on reporting that they are doing better which often means additional stress for the employees. Accept that the reports at the start will not be good. Us hearing reports that the nhs is doing well but our personal experiences are terrible only functions to alienate us and make us lose trust in the services.

I’m not sure that the self assessment tool should be the measure of success in isolation. It sounds like it is useful as you could use it against the feedback given from those using the services.
Using this as a sole metric in any reports is likely to lead to alienation of those seeking mental health services. We already feel like our complaints are covered up. I think within these self assessments, they should also have to provide examples where their care hasn’t met the standards so the focus is on continual improvement rather than data that makes it look like the standards have worked.

Often data can be skewed to prove the point that the government wants to make to the population. Ultimately, a measure of success would be using another survey aimed at population to measure how successful the standards have been.

These questions are all very similar and will likely produce answers from service providers on how positive their service is and may not spark real positive change to experiences, while giving the government a way to report in a positive light.
This self assessment tool should also have questions such as “what more could be done to support wellbeing or staff” or “are there ways we can improve access to services further?”- making sure the services are not penalised for highlighting areas of improvement. There should also be a space for the service providers to state what more support they can receive from the government to enable the services to improve.

Proportion of people in mental health services seen for at least 1 month that show improvement in any personal outcome measurement over the previous month- there needs to be various indicators on the same lines are this. I’m not sure how many personal outcomes there are, but we need “show improvement in 2 personal outcomes” etc. As the standards continue to improve, we need to have a range of indicators that will improve.
We need waiting times in there. The only reason it would not be helpful as an indicator is because the waiting times are not acceptable. These measures should not be used as a tool to punish staff if they are not positive. They should be used as a method of learning for everyone. Waiting times are not unacceptably long because the service providers are not performing well or working hard enough, it is because they are not staffed or funded properly. These measures should also be keeping the government accountable in how they are improving support and funding to the service.
Barriers to accessing mental health services remains one of the most important problems. And waiting time plays a crucial role in that.
Staff should be given anonymous feedback forms about personal well-being and treatment from other staff, culture.

Use the data collected from service users alongside their gender race, sexuality, education level etc to ensure there is no biases.
Properly fund and staff all service providers to ensure they can give the right level of care to everyone. Use a standardised referral questionnaire to ensure that those who need care the most are judged fairly. Asking the services users their opinion on what type of help they need. Reducing the stigma around particular types of mental health conditions.
And treating everyone with the same seriousness, not denying people help or putting to the end of the queue because they went to university and can hold down a job. These are ridiculous biases that are harmful.
Asking for continuous feedback from service users and actually using that information to continuously improve