The move from institutionalised to community-based care is at the heart of Scotland’s strategy for patients with psychiatric, addiction of learning disability conditions. The number of patients treated as inpatients has fallen by 15% in the last 5 years. There will of course always be some patients who cannot be treated in the community.
This statement from the Royal College of Nursing sums up the need for this trend and one major reason for its success in Scotland, staff engagement:
Scotland’s mental health services, and related policy and legislation, have shifted over recent decades from a focus on institutional care towards community services delivering holistic and person-centred care which is designed in collaboration with the service user, to meet their own goals for health and wellbeing. The development of this change was highly collaborative, with leaders opening up dialogue with people who have lived experience of poor mental health, carers and families, and health and social care professionals. As nurses and others were engaged in this change, and their experience and advice reflected in how services were redesigned, they felt a real sense of ownership of the process. The shared approach to mental health care and support was embraced by professionals and, as RCN Scotland members and partner professionals have reported, the values of recovery-oriented care and support for people’s rights are still at the heart of mental health practice today.
file:///D:/Users/John/Downloads/Mental-Health-Care-Transformation.pdf
Talking-up Scotland 'Albatraz' 
I was at a dinner last week at which the speaker has a senior post within a Scottish council and is responsible for coordinating the services in the area and for developing a fully integrated system. From her description it appears to be quite a complex process with the number of agencies involved. Nevertheless, she presented quite an optimistic picture.
I think part of the problem is the ‘risk averse’ culture that is prevalent amongst many large organisations. It is, of course, important to minimise risk, but fear of litigation and the hyenas of the media, who like nothing more than a ‘fiasco’ so that they can demand ‘heads must roll’, means that there is not only belt and braces, but also safety pins and sticking plasters.
You can see the scenario – Reporting Scotland Down tells us of someone who has been in hospital for four weeks waiting for a care place. As a result of the brouhaha, the person is found a place, but, sadly, for some reason dies within a few days. The media then start shouting about why this person was moved when she/he clearly was not fit enough!
LikeLiked by 1 person