To ask the Scottish Government, in light of the Mental Welfare Commission for Scotland report, Investigation into the care and treatment of Mr TU, published in March 2023, what action it will take in response to each recommendation; when any such action will be completed, and how progress will be monitored.
The Scottish Government provided a response to the Commission regarding their recommendations and our proposed actions in October 2023. An update on those actions undertaken since then and still ongoing is provided for each recommendation.
Recommendation 1 The purpose of the SHORE standards should be to ensure that everyone has suitable accommodation to go to on the day that they are released from custody. The gap in these standards should be addressed by the Scottish Government in its review of these standards.
The SHORE standards were refreshed in November 2024 and now include an action plan which sets out areas of future strategic developments. A more thorough review of the SHORE standards, which may include the potential to develop further guidance relating to individuals who are released from remand or direct from court, as well as from police custody, is planned to be completed by the end of 2025.
Further to this, the Housing (Scotland) Bill was introduced to the Scottish Parliament in March 2024 and proposes new homelessness prevention duties, including new ‘ask and act’ duties for named relevant bodies. Relevant bodies which are listed in the Bill, include Scottish Ministers in as far as their functions extend to the Scottish Prison Service, and Police Scotland.
The prevention of homelessness duties are based on principles that prevention should be a shared public responsibility and that there should be earlier intervention across systems. By intervening at an earlier stage, and encouraging services to work together to respond to people’s needs, we can ensure fewer people and families are faced with having to rebuild lives affected by homelessness.
Recommendation 2 The Scottish Government and Community Justice Scotland should address the recognised gap for ‘Throughcare’ services for prisoners on remand.
A new national voluntary throughcare service, Upside, launched on 1 April 2025, replacing the throughcare services provided by Shine and New Routes Public Social Partnerships (PSPs). The PSP services provided support to women leaving short sentences and period of remand, and men leaving short sentences. Men on remand were not eligible for throughcare support under the PSP service. The new Upside service addresses this gap with support for women available now and support for men commencing in the summer.
In addition to this, Sections 25 to 27 of the Mental Health (Care and Treatment) (Scotland) Act 2003 already sets out a duty on local authorities (with the co-operation and assistance of Health Boards) to provide services for people who are not in hospital and who have or have had a mental disorder. These duties cover people who are in prison or recently released from prison although we acknowledge that there may be practical barriers to the use of these provisions for these people. The services include care and support as well as services which are designed to promote the well-being and social development of the people they are provided for.
The Scottish Mental Health Law Review has recommended that the existing duties on NHS Boards, Local Authorities, and integration authorities to secure care and support, including accommodation, for people with past or present experience of mental illness or intellectual disability be strengthened and broadened. We are addressing this through the Mental Health and Capacity Reform Programme.
Recommendation 3 The Scottish Government and Community Justice Scotland should consider innovative joint working/multiagency practices with NHS/social care/social work/Forensic Network to pilot a post-custody outreach service.
We recognise the importance of support for individuals on release from custody. While we are not currently pursuing a pilot on post-custody outreach, we are improving support for these individuals by introducing a new national voluntary throughcare service, Upside, which offers one-to-one support for men and women leaving short sentences and periods of remand. This service, which launched on 1 April 2025, will assist people with the immediate challenges they face post-custody, including accessing housing, healthcare and social security, while also linking them to the wider support services they may require, such as mental health or substance use services.
In addition to this, through the Getting It Right For Everyone (GIRFE) model, we are supporting Health Boards to provide a package of care and support in a joined-up, holistic manner across various services and agencies. This will also support people with their needs on release from prison.
Recommendation 4The Scottish Government’s national mental health workforce strategy should take full account of the individual impact of lack of continuity of care as highlighted in Mr TU’s case relating to recruitment and retention of consultant psychiatrists/senior medical staff in health boards.
As committed to within the Mental Health and Wellbeing Workforce Action Plan we are working closely with leaders in the Psychiatry profession to address the challenges they are currently facing and the Psychiatry Recruitment and Retention Working Group are currently working towards producing a series of recommendations which will be presented to Ministers in Spring 2025.
Whilst the working group has been ongoing, the Scottish Government has worked in partnership with the profession on a range of measures to support recruitment and retention in psychiatry. This has included funding and supporting recruitment stands at the Royal College of Psychiatrists (RCPsych) international congress events (2023 and 2024); working with NHS Education for Scotland (NES) colleagues on improvements to psychiatry webpages to increase engagement and on the promotion of vacancies; ensuring that the specific challenges facing psychiatry were considered by the Medical Locums Task and Finish Group and; supporting the Centre for Workforce Supply (CWS) in their direct work with NHS Health Boards to address challenges in filling vacancies and on the promotion of careers in Scotland.
We also continue to work with NES and the RCPsych to encourage medical students to consider a long-term career as a psychiatrist. This work includes the ‘Choose Psychiatry’ campaign, undergraduate taster sessions and improved psychiatric placements at Foundation level. Recruitment into Core Psychiatry has improved drastically in recent years, with the exception of one unfilled post in 2020, 100% of entry level posts have now been filled for the fourth consecutive year (up from 63% in 2018).
Recommendation 5 There should be additional investment in resources for outreach for complex co-occurring mental health/substance misuse issues particularly where this is associated with the risk of violence.
In line with the Mental Health and Wellbeing Strategy and the National Mission, work is underway to improve the integration between mental health and substance use recovery services, and to develop and deliver person-centred approaches. The National Mission is supported by an investment of £250 million over the life of this Parliament to improve accessibility and quality of treatment and support, including outreach support. This includes work with services to improve care for people with co-occurring mental health and substance use difficulties, working towards the full implementation of Medication Assisted Treatment (MAT) 9, and delivery of commitments made in response to the Rapid Review into Mental Health and Substance Use Services.
MAT Standard 9 states that All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery. In the latest Benchmarking Report published in July 2024 for MAT standards 6–10, 91% were assessed as RAGB provisional green (evidence that implementation was beginning).
The National Mental Health and Substance Use Protocol was published in September 2024. The protocol outlines how mental health and substance use services can work better together to deliver a whole systems approach. Implementation of the protocol will ensure every area has access to a high-quality document on which to base their own protocol. By implementing the exemplar protocol, local areas will also be implementing MAT 9 (mental health support when accessing MAT).
Recommendation 6 The Scottish Government should work with services to implement the three day follow up post discharge standard to bring it in line with National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) recommendations (72 hours).
Our work to embed NCISH recommendations across NHS boards focuses on translating evidence and experience into tangible learning and change. A staged, quality assured and data/experience driven approach to developing and testing improvement, will be key to supporting change and ensuring safety.
Over the last year, we have worked to raise awareness of NCISH recommendations and the NCISH safer services toolkit with mental health and mental health unscheduled care leads in NHS Boards. More specifically, we have supported focused improvement work to implement NCISH recommendations in a small number of NHS Board areas. This work included:
- Developing an implementation plan for agreed priority recommendations selected by participating NHS Boards (initially around risk management and carer involvement);
- Establishing connections with Healthcare Improvement Scotland and Scottish Patient Safety Programme;
- Establishing regular learning sessions with NHS Board areas to ensure momentum and provide peer support; and
- Sharing learning through NHS Mental Health Unscheduled Care and Mental Health Lead Network
Over the coming year we will be working to develop and implement a plan to produce a national improvement resource, focusing on risk management and family and carer involvement. We will also take every opportunity to raise awareness of the insights and learning from the NCISH resources, encouraging NHS boards to consider how they can use the recommendations to improve practice in a range of areas, including the 72 hour follow up.
