Response 31154552

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West Lothian Health & Social Care Partnership

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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?

If no, what priorities do you think will deliver this transformation?
It is clear that psychological assessment of functioning in a range of domains – cognitive, emotional, behavioural and psychosocial is essential to a full understanding of patients with complex needs who may present in a range of different settings from primary care to forensic, criminal justice or acute medical setting. While we support the priorities set out in this consultation, as the consultant leads of NHS Lothian adult psychology services, we would like to draw your attention to the following omissions. Currently, the HEAT standard for the delivery of psychological therapies with 18 weeks of referral does not apply to those within the prison population. There is insufficient resource allocated to the delivery of evidence based psychological interventions within prisons, particularly at higher levels of intensity, which limits the scope and effectiveness of rehabilitation programmes. Furthermore, this vulnerable population have a high incidence of head injuries, neuropsychological input to assess and manage the impact of head injuries is scarce, which further limits prisoners’ quality of life and rehabilitation. Those patients who are treated within forensic outpatient services are another group who are vulnerable and require greater consideration for improved outcomes. Evidence suggests that increasing access to specialised psychological treatment for this group would not only improve outcomes, but could also reduce packages of care and supervision. The demand for psychological treatments remains higher than the service capacity; increased funding is therefore allocated to the longest waits. Service provision is not necessarily correlated with need; vulnerable groups such as forensic outpatients tend not therefore to be prioritised. Although we support the focus on improving physical health for those with severe and enduring mental illness, we would also like to emphasise the need for increasing access to psychological treatments. .It is encouraging that the draft paper stipulates the need to improve identification and treatment of psychosis. This is a good example of where appropriately timed and targeted psychological interventions are evidenced to improve health care outcomes and are associated with significant economic benefits to the health service. However there are also significant difficulties in providing equitable access to psychological interventions for those who go on to develop severe and enduring mental illnesses. These people can equally derive significant health care benefits from psychological interventions and these interventions are also associated with a reduced longer term economic burden on health services. In summary, the focus in the draft paper on improving access to psychological interventions in early psychosis is very much welcomed, but we would like to highlight that an equitable focus is necessary for those who develop severe and enduring mental illnesses in relation to psychosis. Data sharing is essential in the context of health and social care integration. There are data sharing platforms such as Mydex which could facilitate this, yet concerns across some boards about data governance have stopped implementation of this software programme. We are seeking leadership from the Scottish Government to support data sharing that would improve efficiency of health and social care integrated care.

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?
Section 3 highlights the importance of setting up new models to support mental health in primary care. The Division of Clinical Psychology has been in discussions with the executive team of the RCGP to achieve greater collaboration given the high proportion of patients who go to see their GP with mental health problems. Innovative models have been set up within GP practices where early assessments have been conducted by a clinical psychologist, helping the patient to understand their mental health needs through a collaborative formulation. By using clinical psychologists in this way, patients can be matched quickly and effectively to the care that they need, whether this lies in the NHS, social care or third sector. This frontloading of expertise effectively bypasses the pillar-to-post process that characterises our current system. As a profession, we believe clinical psychologists can play a key role in the development of such innovative models of care at primary care level. Just as our GP colleagues are the generalists of physical health, clinical psychologists are the generalists of mental health. We are uniquely trained to work with patients across the age range, from children and families to older adults (birth to death) We are also have competencies through our training to work with forensic and learning disability populations, as well as with those who have cognitive impairment through head injuries, dementia or neurological conditions. We believe we are uniquely placed, therefore, to become the GPs of mental health, working closely with our colleagues at the coalface of primary care to provide genuine matched care. There is little in the consultation response regarding health and social care integration; which is a key driver to the redesign of all services across Scotland. We would like to have further consideration about how these priorities can be expanded within the integration context. For the forensic population there are several issues: the report highlights that intervention with children and young people would be expected to reduce the chances of contact with criminal justice later in life and this acknowledgement is welcome. Adult offenders often have complex psychological needs and can be a difficult group to engage so positive outcomes become harder to achieve. By specifically mentioning conduct disorder it implies that this is the only group of children who have problematic presentations which might end up being unhelpful. Responsivity is a key issue in risk management and the clearer we are about the mental health needs and cognitive deficits of individual offenders the more we and other agencies working with offenders can adapt their approaches to rehabilitation, leading to an increased likelihood of better outcomes both in mental health terms and offending terms. We note that the document talks about better integration of services within health but we think, as has already been mentioned, that there is more scope to mention the benefits that could be gained from psychology and mental health staff in general to be supporting other staff or agencies who are working with our patients. The focus on All of Me section” aims for parity between mental and physical health and promises to increase focus on improving access to mental health services for people living with other long term conditions. Provision of psychological support to those with long term conditions is patchy and there is an inequity of service provision and access. We would like the psychological needs of people who have acute and chronic medical conditions to be acknowledged, and a review of services offered to be undertaken to ensure good clinical governance, equitable services and appropriate supervision for non psychologists offering psychological interventions to those with physical health conditions.

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?
In 10 years time we would like there to be no mental health services in Scotland, only health services. We would like to see parity between mental health and physical health, and ultimately a merging of the two. In operational terms we would like it to be as easy to get help for mental health problems as it is to get help for physical health problems. To achieve this we think there needs to be a radical re-think of the way we organise our services, particularly at primary care level, and we have suggested one potential model above that might help us move in this direction. We would also like to see a psychobiosocial model adopted that addresses the broad range of factors affecting mental health. This would mean a genuinely person-centred care system, where anyone can self-refer to a local community-based one-stop-shop or hub, and psychological therapy is among a wide range of services on offer. Supporting this, we would like to see a person-centred IT system, where people own and hold their own personal data store.