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5 National supports needed
5.1 The second question posed in the consultation paper was: What national supports would help you to meet these objectives and actions? In Section 10 of the TAMFS paper, four potential areas for national support were suggested. These were:
- Undertaking and commissioning national research and evaluation, and disseminating evidence of what works and what looks promising.
- Helping to build capacity though evidence-based training and providing opportunities for networking and learning.
- Undertaking social marking and national campaigning, and supporting the media on issues to do with mental health promotion, suicide prevention and improving the quality of life of people living with mental illness.
- Developing national indicators of mental health and wellbeing and supporting data collection and review.
5.2 Respondents strongly agreed that ongoing national support for each of these activities would be valuable and necessary. Respondents frequently voiced concern that the shift towards greater activity at a local level must not be at the expense of national co-ordination activity and initiatives, such as 'see me,' Choose Life, Heads-up Scotland and the Scottish Recovery Network, to name a few. These initiatives were clearly perceived as important and effective, and respondents stressed that there was ongoing need for national support and co-ordination in these areas.
5.3 In addition, respondents commonly saw a need for national support in relation to:
- Funding, in particular, long-term funding
- Setting realistic timescales for change
- Ensuring consistency in the implementation of national policy at a local level
- Giving greater recognition to the value and role of the voluntary sector in carrying this agenda forward.
5.4 Each of these points is discussed further below, and some comments from respondents are included to illustrate the points made.
Funding
5.5 Respondents commonly expressed a need for support in the form of funding. In some cases, individuals specifically called for more resources for their own organisations or special areas of interest. And it is perhaps worth noting that some of these organisations were not "mental health services" but rather services that could offer health-promoting activities, or which had a remit for supporting vulnerable people at risk of mental health problems.
5.6 Other respondents (including many service users, carers and their representatives) argued, more generally, for additional resources to be made available to support the work of mental health improvement in Scotland, particularly since, as one respondent pointed out, the pressures on existing mental health services (which are largely there to support people with mental illness), will also continue to require investment and development.
5.7 Some respondents wanted additional funding to be "mainstreamed." Others wanted it to be "ring-fenced." Some wanted both. However, all agreed that additional resources would be needed (particularly within the voluntary sector) to take this agenda forward, and that the funding should be long-term (that is, longer than three years). The issue of timescales is discussed below.
5.8 Several respondents specifically requested additional funding for Choose Life (suicide prevention) activity. One individual agreed that suicide prevention should be part of a wider mental health improvement agenda, but argued that there was also a need for specialist knowledge and long-term investment in this area.
Setting realistic timescales for change
5.9 Respondents repeatedly made the point that change in the area of mental health improvement required major attitudinal and behavioural changes among individuals and communities - a "cultural shift" as one respondent called it. It was felt that this would take time and a long-term vision by the Scottish Government to sustain it.
5.10 Respondents stressed the need for mental health policies to be "politically neutral" and "not subject to unnecessary change if the party in power changes." As mentioned above, many argued that there was a need for longer-term funding in this area, and highlighted the disruption that was caused, particularly to voluntary sector agencies, through the constant need to pursue short-term project funding.
"A period of three years is too short to bring about the long-term change inferred in the consultation document…. There needs to be a longer, more sustained approach towards mental health improvement and building mental wellbeing." (Local authority respondent)
"Projects need adequate time and money to make an impact, and the Scottish Government needs to ensure that (when a project is found to be successful after evaluation) the funding continues. Fragmented and unstable funding sources contribute to the fragmented nature of mental health services, particularly in the voluntary sector." (Voluntary sector respondent)
Ensuring consistency in implementation of national priorities at a local level
5.11 Another major theme concerned the relationship between national priorities and local actions. There were a range of views on this issue among respondents. However, in general, these represented differences in emphasis, rather than disagreement.
5.12 Some respondents suggested that there was a lack of consistency across Scotland in the interpretation of national strategy and in service delivery, more specifically. These individuals felt there was a need for national support and guidance to ensure greater consistency in the interpretation and implementation of national policy at a local level. There was a call for the development of service standards ( "minimal and 'gold standard'") to ensure best practice and consistency of service quality across agencies.
"The National Programme needs to continue to work more closely with local partners - national strategy can be confusing and subject to local interpretation resulting in inconsistency of approach. . . . Need a mechanism in place to ensure consistency across Boards / CHPs / Local Authorities when interpreting national actions locally." (Multi-agency consultation event)
"If targeting early years is the best way of addressing wellbeing, then national policy should give this clear direction. Targeting early years, including parenting, should be the main health inequalities / wellbeing priority. This also needs to be a clear and consistent message across both Local Authorities and the NHS." (Local authority respondent)
5.13 In contrast to this view, other respondents suggested that the Government should set general objectives with clear outcomes, but allow for flexibility in action at a local level.
"We would stress the need to balance national activity on evaluation, training, skills development and communication with the need to deliver on these issues locally, have local ownership and be able to deliver initiatives that take into account local circumstances." (Multi-agency consultation event)
5.14 Some respondents were very concerned about the impact of incorporating monies that had previously been ring-fenced for Supporting People and Choose Life, into the general budgets for local authorities. Several feared that the result would be a lack of prioritisation for promotion and prevention activities within local authorities.
"Both the Supporting People Grant and Mental Health Specific Grant have been abolished with this money being incorporated into overall funding for local authorities. This is of serious concern given that mental health improvement work and services for people with mental health problems are frequently not seen as a priority for local authorities." (Voluntary sector respondent)
"Concern that loss of ring-fenced funding to local authorities will result in loss of priority for this area. Also concerned that the HEAT targets will result in this area being perceived as only an NHS responsibility." (Multi-agency consultation event)
"Need proper checks and balances at a national level to ensure that mental health and wellbeing remains a priority under the new local authority funding arrangements, as there is a real danger that it could fall off local agendas due to competing priorities for funds." (Multi-agency consultation event)
The role of the voluntary sector
5.15 Comments (generally received from the voluntary sector and from multi-agency events), frequently highlighted the importance of the voluntary sector in taking forward the mental health improvement agenda. Respondents requested that the role of the voluntary sector should be given greater emphasis and endorsement in the TAMFS document, and suggested that there was a need for national support to ensure that the voluntary sector has an equal role with other partners in the planning of local services.
5.16 One local authority respondent suggested that national support was needed to address a perceived need for "ongoing development of a shared language and improved understanding of contributions of the non-healthcare sector to mental health improvement." However, it was not clear from this comment whether the improved understanding was needed by service providers outside the healthcare sector, or inside it.
Other issues
5.17 Respondents highlighted a very wide range of other issues which they felt would benefit from national support in taking forward the mental health improvement agenda over the next three years. Those mentioned by three or more respondents included:
- Reviewing the benefits system: Respondents felt that Scotland needed a benefits system that supports people when they are out of work, but which also supports their return to work. One individual made the point that people with few skills often gain little financially from being in work, particularly if they have low wages and high rents. Another respondent asked that employment regulations be changed so that people can do voluntary work while on benefits (having travel expenses reimbursed).
- Making mental health improvement everyone's business: In different ways, respondents pointed out that the work of mental health improvement had to be undertaken by services and initiatives far beyond the health-care sector. Respondents suggested that national infrastructure support was needed for local post offices, public transport, community facilities, housing and economic development, particularly in areas of deprivation, or in remote and rural areas. At the same time, there was a concern that mental health improvement may be seen as "everyone's business but no one's responsibility." Thus there would be a need for clarity about who was accountable at a local level for progress in this area. (Issues of accountability and performance assessment are discussed in the next chapter.)
- Ensuring 'joined-up' policies: Related to this last point, respondents clearly saw mental wellbeing as a cross-cutting policy issue. The view was expressed that significant ongoing work was needed at a national level, to ensure that Government departments were "joined-up" in this respect. One respondent argued that ministerial portfolios in every policy area should include the priority of promoting and maintaining mental wellbeing. One individual also suggested that national support was needed to introduce Mental Health Impact Assessment into all major local policy decisions.
- Making leisure, sporting and cultural activities more accessible and affordable: Several respondents argued that participation in recreational, sporting and cultural activities (including walking and gardening / community allotment initiatives) were proven to have a positive impact on mental wellbeing, and that the Government needed to ensure that these types of activities and initiatives were more widely accessible and affordable at a local level. One respondent requested that the Scottish Government establish a working group to develop a strategy and action plan for gardening in Scotland, in relation to its role in supporting positive mental health and wellbeing.
- Employment guidance: As discussed in the previous chapter, respondents strongly felt that NHS and local authority organisations should act as "exemplar employers" in promoting mental health and wellbeing among their staff, and in providing opportunities for people with mental health problems to return to work. However, some respondents requested guidance from the Scottish Government in developing policies that promoted positive mental health, as well as guidance about the duty of care employers had in relation to the Disability Discrimination Act.
- Reducing self-harm: It was pointed out that there are many complex issues surrounding the issue of self-harm, and that it would be helpful to have a national strategy and action plan on reducing self-harm.
- Developing post-suicide resources: Several respondents felt there was need in their local area to provide greater support to family and friends of people who had attempted or completed suicide, and there was a request for support in developing resources in this area.
- Developing a national "good practice databank": This would provide evidence of what works and support implementation of best practice locally.
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