Associate Feature: Keeping our focus

How can we address the vexed question of alleviating poverty and inequality at this fractious time?

Over the past year, while political discussion across the UK understandably sought to focus on mid to longer term action to improve the economy, the issue of income inequality would not go away.

We now approach the festive season against a backdrop of balloted strike action not seen for many decades, affecting education, transport and health, amongst other sectors. In the health and social care sector, this comes on top of long running staff shortages and difficulty in recruiting and retaining staff.

Pressures are real

At the Mental Welfare Commission, we visit hospital wards across the country throughout the year, talking to patients and staff. We publish our findings every month.

Pressures on those working in health care are very real, and must be addressed. This year we reported concerns over staff shortages on many wards, highlighting the impact this has on patients, and on staff themselves. There can be a lack of continuity of care, and a reliance on agency staff. This does not help with recovery. 

One heartening fact is that, even when there are difficulties, patients often make a point of praising the ward staff who care for them. They want to make sure we understand the commitment demonstrated by health and care professionals.

When a solution is there but not being followed

Sometimes there is a solution in place, but it does not reach those it should.

In the autumn we published a report about services for people with mental ill health and alcohol or drug use – an issue centred in inequality. We wanted to know if care, treatment and support were in place for people struggling with these issues. Given Scotland’s high rate of drug deaths, having an effective service is critical.

We found an abundance of policies, standards and guidance nationally, but a failure to implement them locally. 

GPs had difficulty in referring individuals to mental health and addiction services, even when the person was in crisis. There was a lack of joint working, a lack of awareness of practices that should be being followed, and families felt excluded.

We made clear recommendations for change locally and asked that Scottish Government report on progress nationally by September 2023. 

Our priority is to focus on the most vulnerable

Mental health in prison

This year we also published a report on mental health services in prison, a decade after our last such report.

We found not much had changed. A majority of people arrive in prison with a history of mental ill health, yet the service was struggling - the vast majority of prison staff said they needed more in-depth mental health training.

We had serious concerns over acutely mentally unwell prisoners being held in segregation rather than transferring to hospital for treatment. 

What more can the Commission do?

For all of our national reports, such as the two mentioned above, we publish a closure report one year later, detailing the responses we received from all of those we asked to make changes. 

Many respondents rise to the challenge and bring in new training for example, or other improvements, but the overall quality of response varies significantly. We must continue to pursue gaps in these responses.

Sharing guidance and advice

When issues are complex we understand there is no quick solution, and we have supported discussion to share our concerns and to hear from others. And of course we learn from others too.

The Commission also offers advice wherever we can on issues such as mental health and incapacity law and the rights of the individual. We do this at national and local levels with authorities, and we do this with individuals and their families or carers. 

Our priority is to focus on the most vulnerable – the person with mental ill health or lack of capacity. 

Keeping that focus has never been more critical than amidst this time of increasing uncertainty.

Sandy Riddell is Chair of the Mental Welfare Commission. 

www.mwcscot.org.uk

This article is sponsored by the Mental Welfare Commission.