Policy activities, campaigns and partnerships

The RCPsych in Scotland followed up its response to the initial Scott Review call for evidence with extensive engagement between the Executive Team and our Legislative Oversight Forum.

Following several meetings with the Review’s executive team on how best to input into its work, a breakthrough was made with initial draft ‘Clinical Scenarios’ developed to highlight the complexity of cases psychiatrists and other mental health professionals face.

The Government’s Transition and Recovery Plan was published in early October. The College in Scotland has been actively engaged in consulting on the drafting of this plan and has provided extensive feedback to ensure that the needs of those with severe mental ill health were not forgotten.

Upon publication, much of our detailed response was fed directly into the plan, and a proposal to overhaul mental health services, including through the establishment of quality standards, constituted a big win from our engagement.

This group has been established to improve mental health and wellbeing in primary and community care settings. It’s aim is to improve outcomes for people with mental health problems and distress in the community by providing a vision of how mental health care could be delivered better in Primary Care and in localities and suggesting models that could be implemented by health and care systems across Scotland.

The group brings together a wide range of stakeholders and the College is represented by Vice Chair, Linda Findlay.

Following a change of membership, the College has two members form its Addictions faculty now engaging with proposals for adopting UK-wide guidance in a Scottish context.

The establishment of this network, with a Programme Board, has seen some progress made. Applications from health boards for funding for specialist staffing are being progressed, though there remains gaps in provision by locality.

This was highlighted in a media campaign which the Policy Officer successfully built on by securing a motion and written questions in parliament questioning the government on the time taken to get this up and running.

Following extensive engagement with members, it was agreed with the Mental Health Foundation Scotland that a joint leadership structure between the Foundation and the RCPsychiS would be proposed at the group’s strategy half day. This was confirmed at the session.

The Partnership has since successfully been mobilised to respond collectively to the Scottish Government’s recover planning work, which has opened a dialogue of engagement with them. This led to a response to the government’s Transition & Recovery Plan that established the group as a body to engage with.

Ahead of the passing (but not enactment) of emergency mental health measures, the College supported its membership to understand the implications of these measures if they were introduced through online guidance and a webinar alongside the Mental Welfare Commission.

Following efforts by the Equalities & Human Rights Committee to call for the revocation of these measures, the College gave oral and written evidence to the committee informing them why such calls may be premature. Following the evidence session featuring ourselves and other key partners, the committee was persuaded of the need to retain these measures for now, until we could be clear that the worst of the COVID-19 pandemic has passed.

The College has subsequently met with the Scottish Human Rights Commission, the main advocate for revoking the measures, to discuss their concerns.

The proposal submitted last July for funding for a managed network and roll out of national self-management training was referenced again in this year’s Programme for Government, and a commitment for funding made.

Following a pause in activities, efforts to reengage on this are underway. An updated proposal is with the Scottish Government. Having met with the Scottish Government, we secured a commitment to finalised and advance the proposals by the end of the year and discussed necessary tweak to ensure it can go forward.

'What good looks like’ intends to generate a set of service expectations across each speciality through developing service specifications in the style of that which was developed for CAMHS. The aim is to address current discrepancies between different localities in the minimum care standard provided.

Following the College’s suggestion, the Scottish Academy has agreed to develop a manifesto for next year’s Holyrood elections with healthcare system-wide calls for greater resources and efforts to support medical practitioners and those they provide care to recover from the pandemic.

Chair John Crichton continues to attend the Minister’s stakeholder group meetings alongside other key groups involved in the delivery of services and the advocacy of service users, with our Policy Officer also attending as a representative of Scotland’s Mental Health Partnership.

Following the launch of an Education and Skills Committee inquiry into vulnerable children, efforts were made to support the CAMHS and Intellectual Disabilities faculties to respond. This response was positively received by the committee, influencing its inquiry. It also saw engagement with key spokespeople for the opposition parties, who were willing to lodge questions on our behalf.

Following these initial efforts, a multi-stakeholder webinar was developed to cover the numerous impacts of the pandemic on vulnerable children. This saw large scale youth representative groups like Young Scot discuss alongside the College and other care providers the needs of this group as recover from the pandemic. The webinar was provided to the Education and Skills Committee to inform its scrutiny.

A manifesto for next year’s Holyrood elections is under development, based on a No Wrong Door agenda. This sees the RCPsychiS call for policies which will create fully integrated mental health care system with pathways to the right care and treatment, in the right place, and at the right time. This is an agenda championed by the Chair.

This would be backed by earmarking a proportion of all future increases in healthcare spend to mental health, alongside the introduction of wellbeing assessments for funding decisions as part of future budget processes to ensure mental health is prioritised across policy areas.

The College works with a number of cross-party groups (CPGs) to consider and represent the views of our members across a range of policy stances. Updates on our work within these CPGs are below.

Mental Health

The College responded to the CPG’s inquiry into the impact of the Mental Health Strategy on accessing care and treatment. We also attended its AGM, where the findings of this consultation were discussed.

Improving Scotland’s Health

On behalf of the Addictions Faculty, we secured a question to the public health minister, Joe Fitzpatrick, at the latest meeting of the CPG on the need for a national drug treatment strategy.

Learning disability

At the first meeting back after the pandemic, Jana De Villiers of our Intellectual Disability Faculty raised our concerns around the implementation of the Rome Review, which was critical of those with learning disabilities and autism being subject to the Mental Health Act.

Following this, we have facilitated engagements with MSPs to highlight implications of the Rome Review’s recommendations and the harm they could cause.

The Scottish Coalition on Tobacco (SCOT) is a dynamic coalition of health charities, Royal Colleges, civic and regulatory stakeholders campaigning and joining forces with a focus on tobacco to shape a positive future for public health in Scotland.

With co-ordination provided by ASH Scotland, the organisations involved in SCOT share information and best practice, create approaches and identify solutions for a tobacco-free Scotland, campaign on specific tobacco or smoking-related issues, respond to relevant consultations, and provide feedback to policy makers, elected representatives, the Scottish Government and the media.

SCOT response to the consultation on the new National Public Health Body, Public Health Scotland.

The Scottish Obesity Alliance (SOA) serves as a forum for organisations to collaborate to influence policy and practice on obesity prevention in Scotland.

Members work together to influence the Scottish and UK Governments policy on overweight and obesity.

We do this by:

• advocacy and communication
• identifying policy-relevant evidence and solutions
• sharing knowledge and evidence between members.

The Scottish Obesity Alliance launched on 5 December 2018.

The National Rural Mental Health Forum is a strong dedicated network of over 170 organisations from third, private and public sectors, with outreach to 500,000 people in rural Scotland.

The Forum is an action point of the  Scottish Government’s Mental Health Strategy (2017 – 2027) and is named in their  Suicide Action Plan, Every Life Matters. 

ADHD in adults: good practice guidelines

This document was written by the Royal College of Psychiatrists in Scotland special interest group in ADHD, co-chaired by Marie Boilson and Prem Shah.

The aims of this publication are to:

• provide psychiatrists with practical, evidence-based guidance in managing adults with attention-deficit hyperactivity disorder (ADHD) in mental healthcare settings
• provide those involved in designing mental healthcare services in Scotland with a consensus view on how best to meet the needs of adults with ADHD.

This guidance draws on evidence summarised in established documents, including the National Institute for Health and Care Excellence (NICE) clinical guideline CG72 (NICE, 2008), the British Association of Psychopharmacology’s guidelines (Bolea-Alamañac et al, 2014) and the European Consensus Statement (Kooij et al, 2010).

This is a compact reference guide for those working with this patient group. It is not a substitute for the more extensive guidelines referred to above or for formal clinical training.

Where there is insufficient trial-based evidence, our guidance draws from the clinical experience of the psychiatrists of the Royal College of Psychiatrists in Scotland Adult ADHD Working Group.

This guidance has been developed by the Royal College of Psychiatrists in Scotland to assist psychiatrists and those designing services in Scotland with providing evidence-based care for adults with ADHD.

It is written to be applicable to the Scottish health system. However, the evidence, principles and approaches it sets out may also be relevant for other jurisdictions of the UK.

This Position Statement sets outs the College’s view on promoting optimal use and management of antidepressants. It discusses the challenges with prescribing antidepressants, including considering the evidence around efficacy, benefits and harms, ensuring they are used when clinically indicated and managing withdrawal.

The statement includes range of recommendations aimed at the UK Health Departments, national bodies and commissioners.

The group meets approximately three times in the year and attracts a large membership of voluntary agencies, professionals from health and social care organisations, MSPs and individual service users and carers.

Topics the group has covered range from Mental Health in Prisons to Suicide Prevention and meetings always offer up a lively discussion.

RCPsych in Scotland have identified maternal and early years mental health as a key clinical and public mental health priority.

We launched our new campaign 'Healthy Start, Healthy Scotland' at the Scottish Parliament on Wednesday 23 September 2015. 

Read more about the campaign.

Personality Disorder in Scotland Report: Raising awareness, raising expectations, raising hope

• Full report (Released 17 August 2018)
• Briefing paper  (Released 17 August 2018)
• Presentations from the Launch Event (Released 09 October 2018) -  Please email: scotland@rcpsych.ac.uk if you would like a copy of the presentations.

The Royal College of Psychiatrists in Scotland has identified Personality Disorder as a clinical and public mental health priority. It aims to promote education and awareness and campaign for service development in order to ensure the best possible outcomes for those with a personality disorder.

The College will achieve this through a 2-year campaign to raise awareness, identify areas of best clinical practice, make recommendations for change and breakdown barriers to effective care within and outwith our profession.

The publication of this report is intended to positively change attitudes of clinicians, the media and the wider public about the causes and prevalence and treatment of Personality Disorder.

The report was put together by the Short Life Working Group on Personality Disorder whose membership includes representatives from faculties of the RCPsych in Scotland, as well as others from various professional backgrounds and those with lived experience of the diagnosis.

What will the Royal College of Psychiatrists in Scotland do over the next two years?

Challenge misconceptions and reduce stigma around Personality Disorders

• The College will campaign to improve knowledge and awareness of Personality Disorder through public and professional educational events, engagement with politicians and healthcare providers, and media liaison.
• By producing and disseminating materials about personality disorders the College will seek to draw additional awareness to the campaign.

Advocate for adequate funding and equal service provision for personality disorders across Scotland

• The College will engage with politicians and healthcare providers to lobby for inclusion of specific actions on personality disorder in the Mental Health Strategy.
• The College will encourage each Health Board to have a Personality Disorder lead and to include personality disorder in mental health plans, ensuring availability of both long-term treatment and crisis care.
• The College will promote the establishment of a Managed Clinical Network for Personality Disorder to co-ordinate development of equitable service provision across Scotland. 

Promote best practice in service delivery across both primary and secondary care

• By producing and disseminating a report on Personality Disorder which includes a good practice guide, the College will promote best practice in service delivery.
• The College will work jointly with third sector, those with lived experience and the people who support them, to learn about their current and future expectations of care.

Examples of Crisis Planning Documents:

• Example 1
• Example 2

As part of the one-year anniversary of the report, the College has drafted a briefing report on the progress it has made in the campaign. 

For further information on the College's input to the reviews, please contact Andrew Fraser.

Review of the Mental Health Act

The review aims to improve the rights and protections of those living with mental illness and remove barriers to those caring for their health and welfare.

The review will examine developments in mental health law and practice on compulsory detention and on care and treatment since the current legislation came into force in 2005.

A review group will also make recommendations that reflect people’s social, economic and cultural rights and will consider the future shape of incapacity, mental health and adult support and protection legislation.

This follows on from work already underway to review incapacity law and practice.

Read the College's response to the announcement of the review. A focus group to represent the College's views is currently being established.

Independent Review into the Delivery of Forensic Mental Health Services

This is an independent review looking into how forensic mental health services are being delivered in hospitals, prisons and the community across Scotland. Forensic mental health services specialise in the assessment, treatment and risk management of people with a mental disorder who are currently undergoing, or have previously undergone, legal or court proceedings.

This review was announced in March 2019 by Clare Haughey, Minister for Mental Health in response to new developments and changes in the delivery of these services in recent years. This features the College's response to the initial announcement.

The College has established a focus group to respond to the review and will respond to the Stage 1 call for evidence.

More information on the Independent Review into the Delivery of Forensic Mental Health Services

The Independent Review of Learning Disability and Autism in the Mental Health Act

This review is about the Mental Health (Care and Treatment) (Scotland) Act 2003. This review is looking at whether this law needs to change for people with learning disability and / or autistic people and how well the law supports people’s human rights.

The objectives of the evidence-gathering and analysis will focus on:

• The operation of the 2003 Act – are people with autism and learning disability well served?
• Increasing the role of psychologists in relation to the 2003 Act [we are looking at the role of psychology in the 2003 Act]
• The definition of mental disorder under the 2003 Act in relation to learning disabilities and autism
• The criminal justice system and the interaction with the Act
• The use of psychotropic medication (current prescribing practices)

The College has participated in this review since Stage 1. Read the College's response to Stage 3.

The Scottish Mental Health Partnership is a coalition of third sector mental health organisations, service providers and professional bodies working together to promote mental health awareness and improve outcomes for people experiencing mental health problems.

The partnership collaborates to offer new perspectives and a progressive vision for mental health in Scotland.

As such, we have a keen interest in the development of the mental health services in Scotland.

We believe that there is an appetite, and need, for a significant shift in our approach to mental health in Scotland and that by working in unity complex change may be more achievable.

This is driven both by a desire to reduce the incidence of mental health issues and to improve outcomes and experiences for people experiencing mental health issues.

Read the briefing paper Why Mental Health Matters to Scotland's Future'.

We are calling for a high level Commission of enquiry to lead and inform the transformation we need to place mental health and wellbeing at the heart of Scotland’s future.

This would have two objectives:

• To fully understand and map out how mental health promotion, prevention and support and treatment is recognised across the policy mainstream.
• To undertake a root and branch review of the way all public and third sector services support mental health and wellbeing from the perspective of people using them, drawing on best practice globally to describe a vision of what mental health promotion, prevention and support and treatment services should look like by 2020, and 2030.

This Commission must be independent, fully informed by people with experience of mental health issues and of wider inequalities, and be able to make binding recommendations for change, backed, where necessary by legislative reforms.

We call for cross party support for the commission and an appropriate allocation of funding to enable it to be launched as a commitment in the forthcoming mental health strategy. Its recommendations should be enacted through the lifetime of the pending and future mental health strategies.

If you have any enquiries on the briefing paper or any other Partnership matters, please contact the Secretariat, Aidan Reid.

Archive

• 2017: Response to Scottish Government Mental Health Strategy 2017-2027
• 2015: Ticking All the Wrong Boxes: Mental Health and Employment Support Allowance

The Scottish Obesity Alliance (SOA) serves as a forum for organisations to collaborate to influence policy and practice on obesity prevention in Scotland.

Members work together to influence the Scottish and UK Governments policy on overweight and obesity.

We do this by:

• Advocacy and communication
• Identifying policy-relevant evidence and solutions
• Sharing knowledge and evidence between members

The Scottish Obesity Alliance launched on 5 December 2018.

Read more about the Alliance's work

The Scottish Coalition on Tobacco (SCOT) is a dynamic coalition of health charities, Royal Colleges, civic and regulatory stakeholders campaigning and joining forces with a focus on tobacco to shape a positive future for public health in Scotland.  With co-ordination provided by ASH Scotland, the organisations involved in SCOT share information and best practice, create approaches and identify solutions for a tobacco-free Scotland, campaign on specific tobacco or smoking-related issues, respond to relevant consultations, and provide feedback to policy makers, elected representatives, the Scottish Government and the media. Our members are listed on the right and currently number 22.

SCOT response to the consultation on the new National Public Health Body, Public Health Scotland.

The Independent Inquiry was commissioned by NHS Tayside in 2018 to examine the accessibility, safety, quality and standards of care provided by all mental health services in Tayside. It was agreed that such an Inquiry should follow five core principles:

1. be open and transparent

2. include and involve staff from NHS Tayside, its partners and third sector providers

3. include and involve patients and their families

4. be truly independent

5. include a public call for evidence to ensure everyone’s voice is heard

In May 2019, the inquiry launched its Interim report. Following the release of this report, the College gathered evidence and wrote a response to the inquiry with this information, in the interest of our members in Tayside and for service users. 

On the 5 February 2020, the Final Report of the Inquiry was released. 

You can read our statement on the final report here. Our Twitter response is also available.