many frustrations in terms of ability to access relevant services, but they also highlight great variation in both the degree and appropriateness of response within and between service sectors. These seem to reflect both the presence or absence of relevant statutory rights and duties, and also the differing extent to which resources match needs, with MH services being clearly identified as the most inadequately resourced service relative to need (and hence least responsive). There is an obvious requirement to identify a clear lead worker who provides continuity of contact and case management, from whatever base service is most appropriate, and ways of achieving this should be addressed by Health and Social Care Partnerships.
Local service availability and quality also clearly varies a good deal geographically, as revealed by our case studies, with cities, semi-rural and deeper rural areas facing distinctive challenges. The cities have a high prevalence of SMD cases and face very large numbers, which is clearly challenging, but have the advantage of being able to develop or maintain more specialist services. It seems wrong that people living away from the cities should be denied access to specialised services, but they may need to travel to use them.
The individual accounts of routes into SMD through childhood and adolescence identify the key opportunities for upstream prevention, which lie especially in the education sector. Truanting and exclusion should be treated as strong warning signals, particularly when combined with early substance use, and much more substantial resources should be deployed to get children and young people back on track at this stage. Cuts in ‘non-statutory’ services like youth work need to be critically challenged as well, as these may play a key diversionary role in the teenage years.
The study highlights much good work within the criminal justice system, but it must be acknowledged that relying on this as a ‘backstop’ is an absolute last resort and not remotely a desirable longer-term strategy. Significant Scottish research on youth transitions and crime suggest that it is better to keep younger people out of the criminal justice system as far as possible (McAra & McVie, 2016).
The key role played by statutory rights and duties in forcing some sort of service response is aptly
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illustrated by homelessness services, so often left to ‘carry the can’ when other services should be stepping up. But even when such duties exist they are not necessarily fulfilled in contexts where there is great pressure on resources, as can be seen from evidence of the large number of cases where homeless people are not secured the temporary accommodation to which they are entitled.
In addition to resource inadequacies, most notably in MH services but also in substance treatment, some gaps were identified: that is, situations where there were apparently no relevant services for particular types of case. This appeared to be the case in relation to DVA services for women who experience SMD, suggesting a need for innovation and possibly learning from elsewhere across the UK. Concerns were also expressed by some frontline workers about the lack of services for male victims of DVA, even in urban areas.
While resources are important in some cases, it is also the case that much can be done through workforce development and service design, and this may be key to some of the changes which are sought. There is much evidence from the qualitative studies of highly variable quality within service types between particular establishments (e.g. hostels) and between particular individual workers (in social work), which suggests a need for training, development and peer review. The wholescale development of psychologically- and trauma-informed environments is clearly critical here, and likely involves a coordinated training and development programme across a range of sectors. The new emphasis on ‘compassion, kindness and dignity’ heralded by the Scottish Government also implies a need for many organisations to reflect on how they deal with people, particularly those in need of emotional support, as is so often the case with those who face SMD.
Two final recurring themes from the qualitative research were ‘stickiness’ and ‘timeliness’. The former refers to a style of case management where the worker remains ‘on the case’, working persistently and assertively to achieve progress and not giving up on people who ‘fail to engage’. ‘Timeliness’ of service response was identified as critical in certain instances, notably substance treatment. There is a great premium
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