Health and social care system failing mental health patients, say psychiatrists

Scotland’s integrated health and social care system is “failing patients” accessing mental health services, a report from the professional body for psychiatry has said.

A report published by the Royal College of Psychiatrists in Scotland (RCPsychiS) said the current system is “poorly co-ordinated” which it claims has had a damaging impact on patient safety, clinical leadership and financial transparency.

The college is calling for a Scottish Parliament inquiry to examine the impact of its integrated health and social care system.

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.”

In 2014, the Scottish Government introduced legislation to bring together health and social care services through a system of integrated planning and delivery.

This created 31 integration arrangements across Scotland which became responsible for the planning and funding of services that had previously been managed separately by NHS boards and local authorities.

However, the report said the current system has resulted in “fragmented decision-making and unclear accountability risk reducing the impact of funding intended for mental health services”.

While NHS Boards remain responsible for workforce, patient safety and clinical governance, the report highlighted that the key decisions affecting funding, service capacity and resource allocation sit elsewhere.

Clinicians report having “no seat at the decision-making table” with little influence over the financial and strategic decisions that shape services.

The college has called for clinical staff to have a greater role.

Dr Srireddy said 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.

He continued: “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.”

The Scottish Conservatives have been critical of the SNP in light of the report.

Scottish Conservative MSP Miles Briggs said: “This is a damning verdict from Scotland’s psychiatrists on the SNP’s mental health system.

“Too many of our most vulnerable young people are being failed, waiting too long for treatment and falling through the cracks.

“These experiences are the result of a system that simply is not working.

“The SNP cannot ignore these warnings and must guarantee people can access the timely mental health support they need, instead of being left to navigate a broken system.”

Mental Wellbeing Minister Maree Todd said: “I thank the Royal College for their report which highlights a number of important issues.

“This Government has shown its clear commitment to improving access to mental health services and support and this will continue to be a priority as we reform Scotland’s public services.

“The wide range of partners working together demonstrates our commitment to ensuring everyone in Scotland, wherever they live, has 24/7 access to the right mental health and wellbeing support and I expect all organisations to work together across boundaries to achieve that.

“It’s also important to be clear we already work closely with Health Improvement Scotland, the Mental Welfare Commission and others to regularly assure the quality of mental health services across Scotland.”