Psychology Matters: Influencing at the heart of government

What do you think the impetus was behind the Scottish Government's move to appoint a psychology adviser and why was it significant?

Before I was appointed (February 2021), there had been a few initiatives / approaches over the years, including by the BPS, to highlight why psychological input would be beneficial in helping to influence policy development and change in a government context. I took up my role after the acute phase of the early onset of the pandemic, during which there was a greater emphasis on mental health. The pandemic could have been a factor in driving forward the appointment but there were already moves within government to look the option for having a psychology role at national level.

Initially, a focus of my role was around helping the policy team and local health boards to improve waiting times for psychological therapies because we have an 18-week target from assessment to treatment in Scotland, and to lead development of a national specification for the delivery of psychological therapies in Scotland. The national specification has now been published and we have just launched a self-assessment tool  that local areas can use to support improving the quality of psychological services and treatments offered.

The appointment was significant because it was the first psychology Government post in the four nations. The value and role of applied psychology, as part of a multidisciplinary team, can support policy, strategy and delivery of healthcare, including health promotion and prevention, which are core components of Scottish Government policy.

As I have worked with different policy teams across government, they have come to recognise the value of psychological input in different policy areas. The breadth of advice has therefore expanded over the last four years.

How have you been able to promote the role of psychology within government?

My role is an advisory and influencing one. Policy is led by civil servants, Ministers' priorities and government policy, and within that, I offer expert opinion and advice. 

I have worked to raise the profile of the value and role of psychological approaches that the psychological professions offer. This includes not just the acute end of the provision of care but also thinking about things like prevention that featured strongly in the Scottish Government's Mental Health and Wellbeing Strategy. National strategy also includes trauma-informed care and evidence-based treatments which can be used to prevent people from becoming more unwell. 

My role sits within the Mental Health Directorate and within that we have other professional lead posts, for example nursing and psychiatry. While working as part of a multidisciplinary group to promote a whole-systems, whole-person approach, I have been able, and continue, to share the value of what psychology has to offer and the breadth of that offering. My role and its contribution can support more parity with other clinical groups within government.

Psychology matters because, you can't have good health without psychological health. So, we have to stress the value of psychological health in helping people to remain physically and psychologically well. This in turn impacts on other areas of life, like people's ability to remain in work and fulfil successful roles in society.

How does your role at the heart of government allow you to ensure psychology's voice is heard?

What's important here is to be able to connect with key Scottish Government stakeholders. Having previously worked in applied psychology and director roles within health boards, I have a broad understanding of where psychology and applied psychological approaches can add value. But I also rely on my stakeholder networks (such as the Heads of Psychology Scotland Group and the specialist clinical psychology groups that exist) and all the clinical expertise my colleagues have, to understand what the pressures are within their areas of work.

Then, with my understanding of what government priorities and polices are, I work to link the two together in terms of opportunities and challenges. 

The role is about harnessing ideas and aspirations and thinking about how you make that tangible. I occupy that space in the middle between government and clinical systems, and advise, facilitate and influence to initiate change, where possible, in that space.

Part of that is to share the value of psychologically informed approaches and how that can support NHS and social care reform and the key ambitions of government. Taking a whole-system, whole-person approach is important when influencing deliverable change. 

What has been the biggest challenge in the role so far? 

The most challenging part is reminding yourself that the role is not an operational one. It's for the civil servants and, ultimately, Ministers to decide the direction of travel, government policy or decisions taken. I try to influence where I can and to provide the best information and advice to inform those decisions so that the optimum outcome is achieved to support operational delivery for the people we serve.

Another challenge is to continually remind myself, when working with new colleagues in government, to reiterate how psychological approaches can inform and support their work. It is also really important to me that the voices of those with lived experience are heard and considered, so the policy and delivery we are influencing can be as beneficial as possible to the people we are trying to help. The most complex, but rewarding, thing is to ensure that you continue to have key relationships of influence and support.

Can you tell us a little about the areas of work you're involved in that demonstrate the breadth of the contribution that psychology can make to policy development.

There are a few recent examples that come to mind, showing the collaboration across government policy areas to deliver Scottish Government priorities. One is the advice we were able to give by developing guidance, produced collaboratively, when the Ukraine crisis hit. We produced Scottish government guidance for families arriving from Ukraine, for host families and for services delivering care to Ukrainian refugees. We were able to stress the importance of psychological first aid and of providing trauma-informed care to support people coming from a situation of distress. 

Also, currently, we're redrafting guidance for psychological support for witnesses in the criminal justice system. I'm working with colleagues in the Scottish Government's Justice Directorate and acting as the advisory lead on work to update guidance that better fits our most recent evidence base, particularly around trauma-informed care. I have also provided advice to policy teams for those with long-term conditions, or those with physical health needs like cancer care.

Another project I am involved with is the work on psychosocial responses to mass casualty events. This could be a natural disaster, a terror incident or a major crash, any incident which requires a whole systems emergency response. We need to make sure that response is psychologically informed so that the psychological needs of victims are supported as well as any physical injuries. 

Can you share any examples where psychologically informed policy in Scotland has delivered real change for the public. 

There are key areas of government work where psychology can have an input. One of these, which we're trying to influence and support now through the programme of work stemming from it, is the Mental Health and Wellbeing Strategy. This is a psychologically informed policy because it takes a biopsychosocial approach, working across all systems looking at the whole person. 

The Psychological Therapies and Interventions Specification sets out what people should expect if they need a psychological therapy or intervention in Scotland, as well as what services and teams should do to improve the delivery of psychological therapies and interventions. So, it really is a tool that can be used to improve outcomes. 

Together with the Scottish Psychological Therapies Matrix , which allows clinicians to draw on the most up-to-date evidence for psychological therapies, and the Psychological Therapies and Interventions Waiting Times Standard Definitions, which Public Health Scotland published to reflect the new specification, we have clear standards for the delivery of psychological care in its widest sense. 

Not only is there a standard for when people should receive care (18 weeks), which of course is important, but standards to ensure that the treatment people receive is of a good quality.

What were the reasons for setting up the Scottish Government Psychological Therapies Care & Practice Forum and how can the forum contribute to policy work now and in the future? 

The forum was set up to engage with the wider network of stakeholders who deliver psychological care, to seek their views and advice on policy developments. It will continue to contribute in this way, providing a wider perspective and keeping us updated about developments within the different professions or networks that help us to understand their priorities and pressures.

It felt better to have a collaborative and inclusive approach rather than conversations with multiple individuals, especially when you are trying to encourage multidisciplinary working. In a group setting, people can hear about others' roles and their views, which can add value. After all, you don't know what you don't know. 

Setting up the forum also gave me the opportunity to boost my understanding of the different roles and professional bodies out there, so I am now better able to link policy colleagues in with the appropriate wider professional network when needed. 

How can the psychology profession engage more in policy development and influence decisions on policy priorities, as well as how these are put into action and assessed for impact?

Hopefully, the networks we've created in Scotland will help people feel more engaged in policy and development. But as well as through the formal channels we've set up, people can connect with the policy team leading on psychological therapies and with me, individually or collectively. I can then link them up with other policy leads as required.

The research base of anything that's developed is absolutely key and that is why we have the Psychological Therapies Matrix in Scotland. I think we need to use our training and applied evidence-based research, along with Qi methodology (quality improvement and measurement system) to seek continuous service improvement and better outcomes for patients.

One thing to think about is that a product is not necessarily the end of a task and implementation is as much part of a vision as the product itself. So, if there's a policy that exists that is valuable from a psychological perspective, we need to think about how we gather feedback and research about the impact of any work that's being done. The self-assessment tool we have developed and cascaded to all NHS boards in Scotland, for example, is one way of assessing that impact. 

Are there any challenges/barriers that would prevent the profession from having a greater role in influencing policy development, implementation and assessment? ow If so, how can these be tackled?If so, how can these be tackled?

I think the barriers or challenges are around the complexity of the system we work in both operationally and in how policy is developed. The way to overcome that may be to influence through the executive leadership structures within boards, as well through all the networks we've created for sharing information.

What makes great leaders and what skills do psychologists have that enable them to lead effectively?

Leadership is about turning your vision into a reality; but we work in large systems and organisations, human systems, complex dynamics, complex management structures, and vision alone won't get us the results that we want. Leaders need to be able to influence and bring about change.

The applied psychological professionals have unique skills and competencies to be effective strategic leaders because our core training encompasses just that: how do we influence and change the systems people are operating in to help them improve their lives? It's all about the power of knowledge, the power of influence and the power of the vision. Ultimately, it is about connections and relationships and how we use them positively for change. 

Business management support can also really help support operational delivery and change, enabling psychologists in leadership roles to focus on the clinical and strategic delivery.

But that doesn't mean that strategic leaders must always be in an applied psychology or psychology only leadership role. Perhaps we need to think about how our skills can be utilised in wider systems and organisations because we are systems thinkers. We have the training to be able to help systems to communicate and to operate better. 

Why do you think psychology matters and what more can we do to advocate for it?

Psychology matters because, you can't have good health without psychological health. So, we have to stress the value of psychological health in helping people to remain physically and psychologically well. This in turn impacts on other areas of life, like people's ability to remain in work and fulfil successful roles in society.

It's important that people have psychologically informed understanding about their health and the treatment pathways open to them. I don't think we're always the best as a profession at marketing the skills we have. What would help us is using an outcomes-focused approach and feedback, and that is where engagement with people with lived experience is crucial.

With anything new we develop, we have a concept ourselves of what we think is going to be beneficial and helpful. But all the stakeholder engagement work we've done has involved people with lived experience and I've been genuinely humbled by their views. They've reported positive and negative experiences of their contact with health services, and we need to listen to their voices; we need to hear what has worked well and what hasn't worked well for them and reflect that in the services we provide.

People with lived experience are or could be strong advocates for how psychological approaches have helped them feel heard, understood and supported on their treatment and recovery pathways. That is why the national specification outcomes have been set out firstly from the perspective of those with lived experience.

We need to harness the voices of people with lived experience, as well as clinical stakeholders, to highlight the impact and the reach of applied psychology in all areas where it helps people to improve their health and their lives, and to promote good mental health and wellbeing.