Associate Feature: Time to act on our promises to reform

If we only ever took account of political discourse, it might seem that life has recently been on a standstill while politicians regrouped, and government rephrased its purpose and priorities.
But the challenges faced by our services continue apace, and I wish to highlight something of what that means for people. 

I want to look at the local and the national – the short term and the long term.

I especially want to emphasise that some of the solutions are already here, ready to be implemented. We have an opportunity to act now and bring in reform.

Challenges
For the Mental Welfare Commission, and for individuals and organisations we work with, the growing disparity between demand and supply in Scotland’s mental health and learning disability services is daunting.

Problems include endemic staff shortages that have an impact on care and treatment for people in wards across the country. They also affect people in the community who are waiting for help and support. 

Staff shortages have high financial costs too, as public services spend precious budgets on expensive locum and agency staff. Where once that solution would have been short term, we now see this as an ongoing part of the care mix. It does not embed confidence. 

In our visits to hospitals around the country we find more wards running at full capacity, while promised upgrades to outdated environments have been stalled. The impact of poor conditions on vulnerable people in need of care, and on staff who must work there, can be considerable.

We see and hear how pressure on mental health and social care services has a broader impact, on services such as the Scottish Ambulance Service, hospital emergency departments and the police. 

At the heart of everything we do – along with our health and social care colleagues working in services - are individuals; people who need care and treatment, and who are often being let down.

How to make change
Finances are of course vital. I know the strain on budgets across health and care services and I will always call for budgets to be protected.

But along with money, there is the question of what changes can be made to our systems of care and treatment, and how to make them. It can feel like the challenge is too great, and new ideas need somehow to be found. 

But right now, I’d ask our decision makers to look first at what we already know.

Short term becomes long term
Issues that are perhaps more under the radar but share the connection of once being short term but have drifted into longer term, include out of area placements. A significant number of people with learning disability and complex mental health needs are being cared for many miles away from home, for years at a time. We wanted to know how this system is working and we found little planning for a return nearer home, in costly arrangements that have no national budget oversight. 

Another example is the steady increase in recent years of people living under compulsory treatment orders for mental ill health in the community - meaning they are obliged by law to receive medical treatment at home, often for many years. We found little evidence of planning to support the person to come off the order, or to receive care and support that might lead to a more positive future. Often all they get is compulsory medication and little opportunity to do more. Yet an increasing number of people find themselves in this position. 

While we believe better approaches have been identified, we know that to make a full and lasting impact we need a national, collective drive.

Law reform
There is no greater example of the opportunity to act on reforms already proposed than in mental health and capacity law. 

In 2019 we welcomed the government’s decision to commission a mental health law review, which completed its work in 2022, after wide consultation.  

The Scottish Mental Health Law Review’s recommendations were extensive, focusing on human rights and putting the individual at the centre of decision making.

A huge number of people and organisations replied to this and other consultations – it’s understandable they now want to see action.

In its response, government recognised that change is needed and suggested some shorter term work to be done now without the need for legal change, which we are engaged with, and longer term consideration of legislation.

In our own response, the Mental Welfare Commission confirmed we would welcome any of the additional powers recommended for our organisation by the Scottish Mental Health Law Review because we could see how they would help us drive forward improvements in care and treatment.

Supported decision making
One aspect of reform that could happen now is to fully bring into Scotland’s services the need for supported decision making. This allows people to keep their decision-making capability by choosing supporters to help them make choices.  This issue is well known, and has been discussed for years. It could make a major difference not only to the individuals involved, but also to the health boards, social work and other services that support people. 

Carers and confidentiality
Another issue that can make a huge difference now, is to impress upon services that it is critical to listen to family members when a person is mentally unwell or without capacity. Far too often we hear about staff missing opportunities to listen to family members because they are concerned not to breach patient confidentiality. We recently published a report into a tragic case with this issue at its centre. We have published updated guidance and want everyone – health and care professionals and the general public – to know that listening to family members should be part of the process. 

This issue may seem smaller, but the impact it can have is huge.

Keeping the momentum going
For government, there are large scale, ambitious projects that need to be driven forward and completed before starting on new consultations. 

They include Scotland’s mental health and wellbeing strategy; the dementia strategy; health care in prisons, the mental health scrutiny and assurance review; the independent review of inspection, scrutiny and regulation; the suicide prevention strategy as well as newly developed core mental health standards.

There is also a pressing need to ensure we have better services for those dealing with mental ill health and substance use.

Why listen to the Mental Welfare Commission?
Our work keeps us in very close contact with how people are experiencing their care, and how services are delivering that care. We see the pressures, from staffing to environmental. 

Last year we took around 4,000 calls for advice from individuals, families, psychiatrists, social workers, mental health nurses and others. Those calls sought help on issues related to individual cases, best practice in care and treatment, and mental health and social care laws in Scotland.

We make around 150 visits to local services and to people across the country every year and make targeted recommendations for change. We undertake detailed investigations into complex cases. 

Let’s use this opportunity to get things done
With all of the challenges, I still believe we can make headway if we act now. We need to reassure the public that we mean business, that they have been listened to, and that change will happen and will happen soon. 

This article is sponsored by Mental Welfare Commission

www.mwcscot.org.uk/