Scottish Government

Main findings

• There was considerable variation between the structures of MHO services of different LAs, with evidence of the beginning of a strategic approach within LAs towards MHO recruitment and deployment, placing MHO skills where there was most need and demand locally.
• Instances of dedicated MHOs had increased in recent years. However, a high proportion of MHOs had not practised in the 12 months preceding this research.
• Deployment of MHOs was moving towards the community and into Community Mental Health Teams (CMHTs) where there was the greatest demand for statutory work. Some MHOs were deployed across non-mental health specialties to promote wider access to MHO advice and expertise, but they received less support to make time for their MHO role.
• Formal supervision was not available to all MHOs in relation to their statutory work. Those who were most likely to receive supervision were those deployed within a CMHT with an MHO as manager.
• Many LAs reported that they were struggling to maintain a consistent out of hours response.
• Joint working relationships with other agencies were generally perceived to be good, especially if MHOs were deployed in mental health teams. However there was a need to improve awareness of the MHO role. Joint working with primary care and substance misuse services required particular attention.
• The benefits of having a dedicated lead MHO post to co-ordinate the MHO service as a whole were recognised and all authorities aspired to achieve this. Three LAs reported that they had established Divisional MHOs as a means of ensuring oversight, co-ordination and quality assurance.
• For rural areas pressures were often acute in developing and maintaining links with other, often physically distant, professionals and in maintaining MHO practice competence. Services in some rural areas relied, to varying degrees, on practitioner
  good-will and commitment.
• There was a lack of consistency and completeness in collection of routine MHO activity information regarding statutory work. Many LAs had not yet undertaken a review of their MHO service and there were inconsistencies in approaches to this task. Many authorities were looking for national guidance and direction to support them in this.

Introduction

The role of the MHO in Scotland has evolved in recent years as a consequence of changes in patterns of service provision for people with mental health problems or a learning disability and in response to changes and developments in legislation affecting these groups. The principal aims of the research, commissioned by the Scottish Executive were to:

• Investigate models of MHO service provision and how they address the need to provide a responsive professional service which takes account of local circumstances and the demands of new and existing legislation
• Explore local authorities' readiness to respond to the demands on MHO services arising from the Adults with Incapacity (Scotland) Act 2000. The research also set out to examine early preparations being put in place locally for the implementation of the new Mental Health (Care and Treatment) (Scotland) Act 2003

The research entailed:

• A national survey of all Scottish LAs, to describe current structures and supports
• Telephone interviews with service managers in each local authority
• A short postal questionnaire for MHO practitioners, focusing on key issues relating to workload, support and supervision, training and job satisfaction
• A series of focus groups with MHO practitioners and health service professionals

Future directions

From the findings, three key priorities for development emerge for local MHO services and for relevant national bodies: service design and organisation, service quality and key relationships.

MHO service review and redesign

This study has highlighted key considerations which should be examined in any process of review and redesign. These include:

• Local demographic patterns and anticipated need for statutory intervention
• Ensuring accessibility and responsiveness of the service and continuity of care where required
• Protecting and maintaining practice standards and competence and supporting practitioners
• Facilitating opportunities to work collaboratively and develop effective working links with other professionals
• Learning from the range of different models of MHO provision in place across Scotland to inform the development of local services in line with local circumstances and needs

Revisions to service structures need to be accompanied by steps to promote effective co-ordination, planning and leadership at strategic and operational level to ensure effective use of MHO capacity to meet local needs and demands.

The Mental Health (Care and Treatment) (Scotland) Act 2003 brings new responsibilities for MHOs, strengthening their role in decision making and giving greater weight to multidisciplinary decision making. The challenge for local authorities is to develop MHO services which have the capacity to prepare and support individual MHO practitioners for their new statutory functions. A critical test in any review and redesign of services will be to consider the extent to which the service equips and supports MHOs as autonomous decision makers and enables them to practice confidently in a multidisciplinary environment.

Capacity is not only a question of staffing numbers; it is also about the structures, supervision arrangements, advice, practical support and quality of working relationships with peers and others. Strategies to enhance MHO recruitment and retention need to be accompanied by efforts to make greater use of the existing MHO resource, of which at least a quarter appeared to be under used.

Quality

Audit and review of the local service will be increasingly important to raise the profile of the MHO service and to ensure its quality and consistency. This will require enhanced monitoring of activity and demand and responsiveness to stakeholder views on process and outcome. The development of national MHO service standards will further support quality improvement and will afford opportunity to improve the quality of local and national MHO activity data collection and on-going monitoring and evaluation of the service.

Key relationships

LAs have established solid foundations on which to continue to build links and relationships internally between MHO services and assessment and care management teams, to further improve continuity of care. These foundations should also facilitate links between MHO services and LA legal departments, a key resource in fulfilling MHO duties. Externally, the move towards greater integration between health and social work should work to the benefit of MHO service relationships with key health colleagues, whilst maintaining the integrity and independence of the MHO role. Training and the development of policies and procedures for the implementation of the new Mental Health (Care and Treatment) (Scotland) Act 2003 provide an opportunity to increase mutual understanding of roles and responsibilities within the local multidisciplinary networks in relation to the provisions of new as well as existing legislation.