Urgent inquiry required as decade of fragmentation in Scotland’s mental health services impacting patient safety, says RCPsychiS

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Today, the Royal College of Psychiatrists in Scotland (RCPsychiS) published a new report highlighting serious concerns about Scotland’s integrated health and social care system.

It reveals a disjointed and poorly coordinated system that’s had a damaging impact on patient safety, clinical leadership and financial transparency.

With decision-making and service delivery dispersed across multiple organisations, the effects have been particularly significant for secondary care and specialist mental health services. The College is now calling for an urgent Scottish Parliament inquiry to examine the impact of its integrated health and social care system.

The new system was implemented a decade ago to deliver more joined-up, person-centred services between the NHS and integrated boards. However, the report, 'Mental health at the fault line', sets out how the system’s fragmented decision-making, unclear accountability and complex governance arrangements are undermining the delivery of mental health care across Scotland, with profound consequences for mental health services and patient safety.

Decisions about governance, funding, workforce and accountability ultimately determine whether people can access timely care, and the report raises serious concerns, underscoring the substantial consequences of failing to ensure that people and communities receive safe, effective treatment and support when they need it most.

The complexity of Scotland's integrated health and social care system has had a particularly acute impact on mental health services, which supports some of the most vulnerable people in Scotland, including those at significant risk due to mental illness and complex long-term conditions.

Secondary and specialist mental health services sit on the intersection and the fault line between the NHS and integrated boards, leaving them vulnerable to fragmented funding, blurred accountability and differing decision-making processes. This can make it harder to ensure resources reach frontline services and patients receive timely, effective care.

As the number of organisations involved in decision-making grows, so too does the risk of competing priorities, inefficient use of resources, inconsistent investment and unwarranted variation in services even across areas served by the same NHS Board. As funding passes through multiple layers of the system, it’s often unclear where and how it’s spent, with limited visibility of how resources are allocated, used or diverted to address wider system pressures.

The report notes the lack of a comprehensive assessment of the effects of integration on mental health care since its introduction and the significant impact the changes have had on the psychiatric workforce’s ability to deliver care. Many clinical staff report feeling unable to provide the standard of care their patients need because of the complexity of the system and structures that they’re expected to work in.

The report makes clear that while NHS Boards remain responsible for workforce, patient safety and clinical governance, the key decisions affecting funding, service capacity and resource allocation sit elsewhere. Clinicians report having ‘no seat at the decision-making table’ and therefore have little influence over the financial and strategic decisions that shape services, reducing their ability to inform choices that have a direct impact on patient care and outcomes.

The RCPsychiS states that without greater financial transparency, clearer lines of accountability and stronger clinical involvement in decision-making, efforts to improve Scotland’s mental health services will continue to be undermined.

The College outlines that meaningful progress will only be possible if clinical staff have a greater role in shaping the decisions that affect services, resources and patient outcomes.

Dr Pavan Srireddy, Vice-Chair of the Royal College of Psychiatrists in Scotland, said:

“The current structure is failing patients. Mental health services support some of the most vulnerable people in Scotland, yet responsibility for these services is often spread across multiple organisations, with no clear line of accountability when problems arise. More than 10 years after integration, it’s right to ask whether the current arrangements are delivering the improvements that were intended.

“Too often, psychiatrists are excluded from key decisions about services and resources, limiting their ability to deliver the care patients need.

“Psychiatrists bring a unique understanding of patient need, clinical risk and service demand. Their expertise must be embedded in decision-making alongside policy and finance leaders to ensure that resources are directed where they can have the greatest impact on patient care.

“More than a decade after integration, there's a culture of split responsibility without clear accountability, and this is simply unacceptable for patients, families and staff. The College is calling for an independent inquiry by the Scottish Parliament into the effects of health and social care integration on secondary care and specialist mental health services. The inquiry should assess whether the current system is improving patient care, outcomes and the flow of mental health funding to frontline services.

“The beginning of this new Parliamentary session presents an opportunity to address these longstanding concerns and put patients at the heart of decision-making. The College is ready to work collaboratively to build a more transparent, accountable and effective system that supports our workforce, makes the best use of resources and delivers high-quality mental health care that patients need and deserve.”