Response 25199651

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3. Are you responding as an individual or an organisation?

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Centre for Youth and Criminal Justice

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1. Our framework sets out 8 priorities for a new Mental Health Strategy that we think will transform mental health in Scotland over 10 years. Are these the most important priorities?

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Ticked No
Don't know
If no, what priorities do you think will deliver this transformation?
We welcome the focus on prevention and early intervention, and the prioritisation of improving access to services and think that these are definitely the right priorities. However, this will still not meet the needs of many young people. The strategy appears to offer little with respect to continuing to improve provision for individuals with complex mental health needs – the group who use services most frequently and who represent the greatest economic cost to services – with the exception of attending to their physical health. The strategy needs to prioritise the provision of highly skilled workers and resources to provide treatment and support to individuals with complex mental health needs. A key aspect of delivering the identified priorities will be ensuring partnership working and collaborative development of the workforce. We therefore feel that this should be an additional priority for the new Mental Health Strategy.

2. The table in Annex A sets out a number of early actions that we think will support improvements for mental health.

Are there any other actions that you think we need to take to improve mental health in Scotland?
Yes. Priority 2 – Focus on prevention and early intervention for infants, children and young people. There is already an established evidence base for therapies for vulnerable young people (e.g. psychological therapies matrix), what the strategy needs to focus on is increasing access to these therapies and ensuring staff have the resources available to deliver them to a high standard. Given the link between adverse childhood experiences (ACEs) and later health-harming behaviours, health issues, mental health issues, and high risk behaviours, it is crucial that where we have been unsuccessful in preventing the experience of trauma, abuse and loss in children and young people we are able to provide early and effective intervention to prevent escalating difficulties. We think that there should be a specific action in relation to addressing the experience of complex developmental trauma. As indicated in Q1 this will require partnership working and a collaborative approach to developing the workforce. Consideration should be given to the provision of consultation to other professionals and carers as opposed to solely delivering the service directly to the young person as they are the people who spend most time with the young person / child (have an existing relationship with them) and need to be supported to address the issues. Those young people who do not have the protection of a stable, committed relationship with a supportive parent, caregiver or other adult should be prioritised as they are more at risk of escalating difficulties. There should also be a fast track for those young people / children where they end up involved in a significant offence that suggests CAMHS intervention may be required rather than having to wait for a Court direction to undertake it which is not always carried out anyway. Also consideration needs to be given to key transition points and how to make these as smooth and effective as possible e.g. young people moving to adult services, young people moving to a different health area, between secure care / custody and the community. It is great that the national roll out of targeted parenting programmes for parents of 3 & 4 year olds with conduct disorder will be completed. An additional action to prevent escalation of difficulties for those for whom these programmes were not effective, and / or for those families where problems develop later in childhood, should be the national roll out of intensive evidence based parenting programmes such as Teen PPP, Multisystemic Therapy, Functional Family Therapy. Priority 5 – Improve access to mental health services and make them more efficient, effective and safe. As well as increasing capacity and addressing waiting times there also needs to be greater flexibility in terms of where intervention / support takes place as not everyone will be able to attend at clinics given that their lifestyle can often be quite chaotic and this should not preclude them from a service. Greater flexibility around engagement and less rigidity regarding cessation of the service when appointments are missed is crucial.

3. The table in Annex A sets out some of the results we expect to see.

What do you want mental health services in Scotland to look like in 10 years' time?
A national mental health service which: • offers equity of access and is flexible in its approach • supports staff and trains staff to a high level of skill • is driven by the evidence base and presenting individual or community needs • focuses on measuring outcomes as wellbeing indicators rather than waiting times • embraces partnership working • provides a timely and effective response to help young people deal with trauma, loss and bereavement