Marking 60 years since its founding, the Mental Welfare Commission has delivered its annual report which details work throughout 2021-22, highlighting concerns around workforce pressures and racial inequality in Scotland’s mental health and social care sector.

Publishing its annual report on the rights and services provided to people with mental health issues, learning disabilities, dementia and related conditions, the Mental Welfare Commission (MWC) details areas for progress across Scotland.

Increased workforce pressures

MWC Chair Sandy Riddell raised concerns over the rising pressures facing health and social care workforce, stating that many of the difficulties faced by mental health and social care services “were evident before 2020” and vacancies since have heightened these.

Mr Riddell said the annual report shows overreliance on agency and bank staff has only increased the pressure further, adding:

“Pressure on staff of course has a direct impact on vulnerable patients.

“While the economic outlook is increasingly difficult, we must never lose sight of the need to ensure that mental health and social care services for adults and children are safe, and people who need care and treatment are protected.”

The report outlines four ‘strategic priorities’ for the MWC in 2022-2025, including challenging and promoting change, focusing on the most vulnerable, increasing impact in its work, and improving efficiency and effectiveness.

With this, the MWC also issued a statement commits to long term work, adapting to needs but delivering continuity in its work which has “always approached from the individual first.”

A spokesperson for the Scottish government said it is well-aware of “significant pressures” on mental health services and social care sector, adding that this is under constant review:

“We are working to increase capacity in the social care workforce, to reduce the reliance on agency staff.

“We are also working with the Scottish Social Services Council and key partners to promote career opportunities and deliver policies on upskilling and developing the workforce in order to help attract new people to the sector.”

The government is taking steps to grow the mental health workforce, and the spokesperson added that “substantial investment” has led to record numbers of staff providing “more varied” support to more people in Scotland.

A commitment to recruit 800 more mental health to A&Es, GP practices, police station custody suites, and prisons has been exceeded by the Scottish government.

Yet, the MWC annual report states that while patients often convey a clear appreciation of staff, patients and relatives also share that care has been negative affected by shortages. Impacts of mental health workforce pressures and staff vacancies are reflected in assessments of individual wards and units.

Racial inequality

Racial inequalities in mental health services recommendations on this made a year ago were reintroduced as a key area of focus. The MWC’s annual report draws upon findings from this earlier report, from both patients and staff across Scotland.

A lived experience group – half of the membership of which were refugees – described a ‘constant drip of micro-aggressions’ impacting their mental health and sense of belonging within services. The MWC has recommended greater awareness in primary care of the impact of the asylum system on mental health.

Almost a third of health professionals said they had seen or experienced racism within the NHS. The report also describes a real need and desire among staff for improved diversity and ethnicity training, with over 70% of staff responding that NHS Scotland’s available training had gaps.

In September 2021, the MWC reported on these concerns issuing a call to action, and  made a series of 30 overarching recommendations to the government, health and social services boards, Public Health Scotland, NHS bodies, and other organisations.

These highlighted a need for improved data collection, reporting and investment in diversity and equality programmes from the government. MWC also called upon health and social care partnerships to review protocols and improve reporting and support processes by September 2022.

A Scottish government spokesperson told healthandcare.scot:

“We are firmly committed to supporting a more diverse and inclusive health and social care workforce. Discrimination, harassment and any form of bigotry has no place in our NHS.  

“We have also established a new National Minority Ethnic Forum, for the NHS to work with Scottish Government and Health Boards, as a collective voice to drive systemic change in the workplace.

“We are working with NHS Education for Scotland to explore how to best deliver a more robust and up-to-date learning on equality, diversity and inclusion based on engagement with those with relevant experience and expertise.”

Scrutiny within MWC

Reviewing its own service provision, MWC stated that a sample audit from its advice line found a 97% accuracy in advice given against a 97.5% target, and that MWC received 8 complaints throughout 2021-22, down by around 27% from 2020-21.

This report comes as the Scottish Mental Health Law Review proposes the expansion of powers and responsibilities to the MWC throughout the system.

Julie Paterson, chief executive of the MWC, said continually connecting with communities has been essential to improvements made thus far:

“In 2021-22 we continued to develop the organisation itself, in tandem with developing our ways of operating post-pandemic.

“This meant scrutinising the ways we work to deliver the best possible service with tight resources. We reviewed the vital input of our advisory committee, which includes representatives from 32 external organisations from across Scotland, aiming to increase their involvement.”

The MWC have developed a further model of investigating services and added in its annual report that 41 of 89 cases from 2021-22 are still open and under investigation. These look at serious concerns raised around poor care or mental health service failings across Scotland.

Ms Patterson added that the MWC has and will continue to develop and share good practice going forward:

“We continued to build on our links with other national public sector organisations, seeking to create efficient routes of communication, and ensure we can effectively share expert advice and good practice – all vital activities, particularly during the very difficult times services are now facing.”

A Mental Health Workforce Plan will be published in the “first half of this parliament”, and the government has committed to recruiting 320 additional staff in Child and Adolescent Mental Health Services (CAMHS) by 2026.

Read more: Staff shortage concerns in latest MWC reviews; Mental health review: Expand MWC scope; Call to prioritise psychological therapies

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