ITEM 6 Mental Health and Wellbeing Delivery Plan
North Lanarkshire Council · 19 March 2025
Back to Health and Social Care Integration Joint Board — 19 March 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 6 SUBJECT: Mental Health and Wellbeing Delivery Plan To: Integration Joint Board Committee Lead Officer for Report: Maggs Thomson, Head of Health North Lanarkshire Author(s) of Report Iain Sharkey Service Manager MH, Addictions and Learning Disabilities, Dr Adam Brodie - Associate Medical Director, MHLD&A DATE: 19 March 2025 1 PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2 ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ This paper has been prepared by Iain Sharkey Service Manager MH, LD and Addictions and Dr Adam Brodie - Associate Medical Director, MHLD&A 3 RECOMMENDATIONS It is recommended that the IJB: (1) Acknowledges the process and timeline to develop a Lanarkshire Mental Health and Wellbeing Delivery Plan aligned to the National, Scottish Government/COSLA Mental Health and Wellbeing Strategy and separate Delivery Plan, both published in 2023; (2) Through the Strategic Commissioning Plan, we are reviewing structures and will provide an update at future meetings. 3.1 The delivery programme comprised of 4 main work streams: • Good Mental Health for All.
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2 • Improving Access to Mental Health Support and Services. • Children and Young People Mental Health & Wellbeing – fully integrated in the North Lanarkshire and South Lanarkshire Children’s Services Plans. • Specialist Mental Health Services. The Strategy also had in place a number of cross cutting interdependent work streams. These included Communication and Engagement, Workforce and Finance. 3.2 The Mental Health and Wellbeing Strategy Board and the majority of project groups were stood down in March 2020 due to the COVID-19 pandemic. Whilst Strategy delivery was restarted in January 2021, there was a further disruption over the summer of 2021 when all non-essential meetings were stood down owing to the pressure on services. 3.3 Over the course of 2024, we endeavoured to take advantage of the opportunities and experiences of working in different ways. All work streams reviewed their delivery plans. Over the course of 2024 further progress has been made to compliment the work of the last few years, whilst retaining a focus on the vision and objectives set out in the original Lanarkshire Mental Health and Wellbeing Strategy. 3.4 This report outlines the progress made across all Strategy work streams and sets out our progress in developing a Mental Health and Wellbeing Delivery Plan for Lanarkshire aligned to Scotland’s Mental Health and Wellbeing, the new national Mental Health and Wellbeing Strategy launched in 2023 by COSLA and the Scottish Government. 4 ACHIEVEMENTS Good Mental Health for All 4.1 Challenging the stigma around mental health, promoting good mental health and addressing the barriers (social, environmental, financial or cultural) that make it more difficult for some people to take up opportunities to improve their wellbeing, are a priority across Lanarkshire. This remains a key drive with an even greater focus on Trauma Informed service delivery. 4.2 Now 2 years post the COVID-19 Pandemic the learning has been invaluable. The impact was not experienced equitably. It exacerbated long- standing inequalities in being able to thrive in the face of adversity. The Workforce have met the challenges directly exhibited by the innovative approach by continuing to embed the Triangulation of care. 4.3 Our approach to promoting good mental health and wellbeing and the collective actions/programmes of work undertaken by all community planning partners is distilled in our Good Mental Health for All North and South Lanarkshire Delivery Plans. 4.4 The Good Mental Health for All Delivery Plans cover 6 key areas: Mentally Healthy Infants, Children and Young People; Mentally Healthy Later Life; Mentally Healthy Environments and Communities; Mentally Healthy Employment; Reducing the Prevalence of Suicide, Self-Harm, Distress and
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3 Common Mental Health Problems. 4.5 There is also recognition that PLNS have received 3 awards, 2 for partnership working for the community police triage model and 1 for NHS staff awards. Recognition both locally and nationally of the good work and improved outcomes across partner agencies. 4.6 The below remains the same as the last report but there is evidence of outcomes being met and key indicators below being achieved. • Promoting a confident, diverse and skilled workforce through delivering training and building capacity for delivering training in-line with the NHS Education Scotland Framework for Mental Health Improvement and Suicide Prevention • Promoting a compassionate response to people presenting in distress by embedding Distress Brief Interventions into mainstream services and supports • Delivering a programme of work to tackle mental health stigma and discrimination and ensure people can talk about their mental health and wellbeing. • Driving a programme of work in line with the new national suicide prevention plan, Creating Hope Together • Improving access to a range of non-clinical supports to improve mental health and wellbeing via Well Connected and other social prescribing programmes and the Communities Mental Health and Wellbeing Fund • Delivering a Recovery Event for Lanarkshire enabling people with lived experience to share stories of recovery and explore what recovery means to them • Exploring robust Health and Equality Impact Assessments by means of strengthening active consideration of mental health and wellbeing to support a ‘mental health in all policies’ approach. Improving Access to Mental Health Supports and Services (IAMHSS) 4.7 IAMHSS has been concentrating on specific areas to ensure the right support is available at the right time within Primary Care, Emergency Departments, Custody Suites and Prisoner Healthcare and with some focus on the development of digital solutions. This workstream has also been responsible for developing and implementing proposals for the use of funding for mental health posts made available through Action 15 of the Scottish Government’s Mental Health Strategy, 2017.
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4 4.8 Primary Care Mental Health & Wellbeing Teams: • PCMHW model developed with Mental Health Liaison Nurses now covering 91 GP practices supported by LAMH Mental Health and Wellbeing Workers providing a non-clinical role. This service is currently under review which may impact on the delivery model. It is anticipated that this review will be completed by summer of 2025 and any transition plans completed by March 2025. • A Task and Finish Group is focussing on - The review of the Primary Care Mental Health (PCMH) service model is ongoing. The aim remains the same to learn from our experience to date and ensure we make the most effective and efficient use of resources. We aim to provide a central point of referral for self & practitioner referrals of people experiencing mild to moderate mental health problems and divert patients from GP practice; - The review remains focused on enhancing and developing standard internal referral processes between the PCMH service, Primary Care Occupational Therapy (PCOT) and Community Link Worker (CLW) programmes, CMHTs, Mental Health Flow Navigation Centre & Community Addiction Services. • Assessment Plus CBT model is no longer part of the service. This was a test of change and assessment concluded that this can be incorporated into Psychological Treatment Teams. 4.9 Transforming Mental Health in Emergency Departments (ED) • Flow Navigation Centre (FNC) fully established 24/7 providing an alternative to ED triage for a mental health assessment. • Direct links with Psychiatric Liaison Nurse Service for Community Police Triage and Scottish Ambulance Service triage fully established in hours via FNC and Out-of-Hours at Douglas Street. • Out-of-Hours service expanded and fully embedded. Patients triaged and assessed via telephone, virtual platform, or face-to-face. • Mental Health Advanced Nurse Practitioners now form part of unscheduled care and liaison services and have developed good links with primary care services to support overall senior decision making. • Overall reduction has risen to 82% in police attendance at ED. 4.10 Custody Suites: • We have 4 Lanarkshire Custody Suites. As a service we developed a new Mental Health and Wellbeing Team staffing model. This was aligned to the Unscheduled Care Team, the Primary Care Team, and the Community Mental Health Teams. This complements current models established to support people affected by poor mental health.
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5 4.11 Two Advanced Nurse Practitioners are in post through Action 15 funding and are providing a valuable mental health assessment resource to support people who present with mental health needs when detained. This is out of hours and the SOP remains in place at all other times. The ongoing review of the service will maintain positive outcomes. 4.12 Prisoner Mental Health: • Mental health Multi-Disciplinary Team staffing model for Shotts Prison developed to ensure the level of care for prisoners reflects the services offered to the rest of the population. There is ongoing input across the prison estate to embed best practice. • Prisoner population of HMP Shotts now has improved access to a wider range of mental health services – in particular psychological therapies and health improvement – through a match-stepped model of care. This is now embedded in Shotts and outcomes are being monitored. 4.13 Digital Solutions: • Digital solutions explored to help provide services in new ways that make them more accessible and enhance patients’ experience. Services actively promoting opportunities for patients to give feedback. • Near Me well-used with CAMHS, Psychology, and Psychiatry the top 3 users of the system. • MORSE transition completed for all previous Midis users. Work remains underway for migration of remaining services. • Successful collaboration with Connecting Scotland to provide devices and support to service users. • Digital champions remain in place supporting the teams. Child and Adolescent Mental Health Services 4.14 In 2021, the Scottish Government Children and Young Peoples Mental Health and Wellbeing Taskforce published national specifications for Child and Adolescent Mental Health Services (CAMHS) and Neurodevelopmental Services. Both specifications aim to ensure that children and families receive the supports and access to services that meet their needs at the earliest opportunity, based on the GIRFEC approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. These services are required to be available for all children and young people who are aged 0-18 years, and young adults aged 18-24 (and up to age 26 for care experienced people). 4.15 The Lanarkshire CAMHS and NDS Programme Board has been in place since 2021. The Programme Plan articulates how the National CAMHS Service Specification, as well as associated Scottish Government directives will be locally implemented. The purpose of this programme was to assess, evaluate and where appropriate redesign Child & Adolescent Mental Health
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6 services ensuring a whole systems approach based on children and young people’s rights and relationships. 4.16 The board remains committed to delivery of safe, effective and child centred mental health care for children and young people across Lanarkshire who require support and intervention to manage their complex mental health challenge. 4.17 The strategic commissioning of CAMHS and NDS for the NHS Lanarkshire area is hosted by the North Lanarkshire IJB and managed by the North Lanarkshire Health and Social Care Partnership (HSCP). In April 2021, North Lanarkshire HSCP received confirmation from Scottish Government of recurring funding via the Recovery and Renewal Fund (RFF) specific to CAMHS of £3.3 million. 4.18 A significant change to the CAMHS model was required to meet the national service specification. Plans were submitted to the Scottish Government outlining how it would be implemented. This specification focusses CAMHS on the needs of children and families affected by complex mental health problems, moving early intervention support to the Schools Counselling Model, School Nursing and the Community Wellbeing Framework. It also separated the request for assistance pathway for children and young people who primarily required assessment and diagnosis of neurodevelopmental disorders including Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Intellectual Disability (ID), Foetal Alcohol Spectrum Disorder (FASD), Developmental Coordination Disorder (DCD) and Tourette’s and Tic disorders. 4.19 In order to co-ordinate and monitor the delivery of the programme plan, North Lanarkshire HSCP established the CAMHS & NDS Recovery and Renewal Programme Board, which his is chaired by the North Lanarkshire HSCP Medical Director and has support from a Professional Adviser from the Scottish Government. 4.20 There have been 6 work streams within the Programme. These have all either been fully completed or are well progressed to a business as usual model of operational delivery: - • Neurodevelopmental Service – all work completed. All neurodevelopmental requests for assistance are now channelled via established Neurodevelopmental Service. This combined 3 previous waiting lists (CAMHS, NDS and Paediatrics) and provided transparency of referral pathway, consistency of response and quality assurance of assessment. This is a highly skilled workforce and maximum efficiencies within resource are assured. Time limited commission of an external provider has provided additional capacity that facilitated assessments of young people before they graduated to adult service referral routes. Demand for assessment continues to exceed capacity. This has been highlighted nationally and is common across all health board areas. It is advised that national work will influence next steps with neurodevelopmental services. • Choices & Partnership Approach (CAPA) Implementation within CAMHS- all work completed. This new model of patient management has been operational since May, 2023. It can now provide robust data capable of assuring planning of service capacity and informing trajectories over a longer time period.
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7 • HR & Workforce – all work completed. A full review of workforce in line with CAMHS and NDS specifications was undertaken and professional and support staff gaps addressed. • Communication and Engagement- all work completed. An Engagement Officer role has established a process that facilitates consultation with children, young people and their families. This provides assurance that the child’s voice is represented in our strategic planning and individual care planning. A website has been established and design of CAMHS and NDS logos were undertaken in partnership with New College Lanarkshire and decided by public vote. • eHealth- all work completed. Trakcare build completed to facilitate delivery of CAPA Model. Electronic case record now in place across whole service. • Capital/Strategic Planning- ongoing. Large scale refurbishment delivered in South Lanarkshire. Work ongoing across 3 sites in North Lanarkshire to deliver same. • CAMHS RTT reported as being met in October 2024 and performance has been stable since. Analysis is ongoing to map variation in demand profiles to assist with service model development. Specialist Mental Health Services 5.0 Key achievements include: • Dedicated specialised Community Perinatal Mental Health Team established, incorporating psychiatry, community mental health nurse, clinical psychology, community nursery nurse, midwifery, occupational therapy and social work staffing. • Multi-agency, multi-disciplinary Infant Mental Health team established and now imbedded in service delivery. • Maternity and Neonatal Psychological Interventions Service embedded in service delivery. • New referral form in place with a single point of referral; pathway to community rehab now live; planned date of discharge in place; new Community Rehabilitation Team nursing model embedded in practice; new Rehabilitation & Recovery Service Operational Policy in place. • South Lanarkshire Community Mental Health Team (CMHT) funding and staff transferred from the previous hosted arrangements with North Lanarkshire to enable integration of Community Mental Health services within South Lanarkshire HSCP. • Scottish Government funding for Dementia Post Diagnostic Support (PDS) Services utilised to create a single dedicated PDS service that focuses on those individuals not requiring secondary care input of an Older Adult CMHT. • Adult Autism Assessment Service established as Phase 1 of a wider Adult Neurodevelopmental Pathway.
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8 5 MENTAL HEALTH AND WELLBEING DELIVERY PLAN (The below points 5 – 5.10 were included in the previous report but are relevant to the current information) Scotland’s Mental Health and Wellbeing 5.1 The new national Mental Health and Wellbeing Strategy recognises mental health as a cross-government priority, building on the partnership between the Scottish and Local Governments. 5.2 It recognises that underlying factors, inequalities and types of disadvantage affect certain groups of people who may suffer disproportionate impacts on their mental health. 5.3 We know that mental health does not just mean mental illness; it is a continuum that may include a range of needs, from having the right words to describe how we feel, through to everyday worries and feelings of distress or hopelessness. We must ensure that the right help is always available to those who experience severe and enduring mental health conditions and provide the wider support people may need to maintain good mental health. 5.4 In publishing the Strategy in 2023, the Scottish Government and COSLA acknowledge that all areas of Government will need to work together to achieve our shared vision and to make progress towards our outcomes, which are outlined below. The Strategy sets out a vision of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible. 5.5 The Strategy describes a whole system model which very much aligns with the Lanarkshire Mental Health and Wellbeing Strategy 5.6 The Strategy sets out the following outcomes: • Improved overall mental wellbeing and reduced inequalities. • Improved quality of life for people with mental health conditions, free from
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9 stigma and discrimination • Improved knowledge and understanding of mental health and wellbeing and how to access appropriate support • Better equipped communities to support people’s mental health and wellbeing and provide opportunities to connect with others • More effective cross-policy action to address the wide-ranging factors that impact people’s mental health and wellbeing. • Increased availability of timely, effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs. • Better informed policy, support, care and treatment, shaped by people with lived experience and the workforce, with a focus on quality and recovery. • Better access to and use of evidence and data in policy and practice. • A diverse, skilled, supported and sustainable workforce across all sectors 5.7 It also identifies ten priorities which provide the structure for the first national Delivery Plan for 2023-25: • Increased availability of timely, effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs. • Better informed policy, support, care and treatment, shaped by people with lived experience and the workforce, with a focus on quality and recovery. • Better access to and use of evidence and data in policy and practice. • A diverse, skilled, supported and sustainable workforce across all sectors • Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk • Improve mental health and wellbeing support in a wide range of settings with reduced waiting times and improved outcomes for people accessing all services, including Child and Adolescent Mental Health Services (CAMHS) and psychological therapies • Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery • Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk
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10 • Improve mental health and wellbeing support in a wide range of settings with reduced waiting times and improved outcomes for people accessing all services, including Child and Adolescent Mental Health Services (CAMHS) and psychological therapies • Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery Lanarkshire Mental Health and Wellbeing Delivery Plan 5.8 Given the close alignment between the 2019-2024 Lanarkshire and 2023 national strategies, the Integration Joint Board agreed at its Liaison Session on 8th November 2023, that, rather than produce a new Lanarkshire Strategy, partners should work together to develop a Lanarkshire Delivery Plan, aligned to the strategic actions set out in the national Delivery Plan, and clearly linking to local strategies and plans including both Health and Social Care Partnership Strategic Commissioning Plans, Our Health Together, Children’s Services Plans, the Plan for North Lanarkshire Community Plans and Local Outcome Improvement Plans. 5.9 Since then, work is continuing to: • Establish a programme sustainability plan- to identify any outstanding priorities and actions from 2019-2024 strategy to be carried forward into the new Lanarkshire Delivery Plan • The self-assessment of where we are in Lanarkshire in relation to the strategic actions set out in the National Mental Health and Wellbeing Delivery Plan is ongoing. • The contributions from stakeholders regarding existing and new priorities and actions (period of engagement and development) is being progressed through work streams already established. • Engage with stakeholders both at Lanarkshire-wide and locality level, via the Community Boards in North Lanarkshire and with an equivalent engagement process in South Lanarkshire, to identify any further priorities and actions for the Lanarkshire Delivery Plan • Review and ensure governance and leadership arrangements • Establish governance structures and implementation process (embed in operational governance and supported by in-house enablers)
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11 5.10 The timeline has not changed and remains the agreed process set out in Appendix 1. 6 CONCLUSIONS 6.1 Work is ongoing across all partners to continue to develop and deliver against the key workstreams of the plan. 6.2 Note progress over last 12 months 7 IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) An outcomes-focused Achievement Framework is now in place (Appendix 2) for the Mental Health and Wellbeing Strategy. The below has not changed but remains ongoing. We noted in our strategy that as GIRFEP was implemented, people in Lanarkshire would see campaigns to promote ways of improving our mental wellbeing, changes and improvements to the way they access mental health support and services, new ways of working, observe new staff roles, a programme of work to tackle mental health stigma and discrimination, increased interventions to support prevention and early intervention as well as every effort to improve services for people with severe and enduring mental health conditions.
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12 The ambition continues to reflect on culture in Lanarkshire and improve people’s physical wellbeing and mental health. This will be further discussed via work streams. A monitoring and evaluation framework is now in place to accompany the new National Strategy. This will be continually reviewed to measure outcomes. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A The landscape in relation to additional funding streams, including Mental Health, released throughout the year by Scottish Government, is complex with continued uncertainty around the scale and timing of future funding. The costs and funding available for 2024/25 and future years will be closely monitored and reported. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. This is currently no direct risk for the delivery plan. 7.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Discussion at Lanarkshire Links quarterly meetings Engagement events involving Mental Health and Wellbeing Strategy Board and Comms & Engagement Group Presentation/discussion at Community Boards Staff involvement Lived and living experience contribution involved via VANL and VASLAN
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13 ☒ Provide stakeholders with information on how to get involved As above ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs As above ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery As above ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership Presentation/discussion at Community Boards 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIAs were completed for the development of the 2019-24 Strategy and for most of the workstreams. These will be reviewed and will inform the completion of an EQIA for the Delivery Plan. EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS Getting it Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire, 2019-23 Scotland’s Mental Health and Wellbeing Mental Health and Wellbeing Delivery Plan, 2023-25
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14 9. APPENDICES Appendix 1 – Lanarkshire Mental Health and Wellbeing Delivery Plan - Timeline for Development Appendix 2 – Achievement Framework Maggs Thomson – Head of Health Members seeking further information about any aspect of this report, please contact Maggs Thomson, HSCP North, Head of Health at Maggs.Thomson@lanarkshire.scot.nhs.uk CHIEF ACCOUNTABLE OFFICER (or Depute)
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15 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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17 MENTAL HEALTH AND WELLBEING DELIVERY PLAN APPENDIX 1
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18 LANARKSHIRE MENTAL HEALTH AND WELLBEING STRATEGY ACHIEVEMENT FRAMEWORK APPENDIX 2