Learn more about how the The Matrix can support services in Scotland
We know that inequalities; poverty and health inequalities, gender and protected characteristics such as being in a minority ethnic group, members of the LGBTi community as well as experiences of trauma and adversity act as risk factors for poorer health and mental health and can act as barriers to people accessing the services that they need. People’s lives are multi-dimensional, individual and complex. This is known as “intersectionality” and it is critical that we do more to understand and improve accessibility and experiences for people across Scotland. These factors need to be considered when planning services that meet the needs of all citizens of Scotland.
Mental health and wellbeing are complex, involving unique individual experiences within broader networks of relationships, community and society and routes to recovery reflect this. Although approaches such as psychological therapy and intervention have good evidence of effectiveness for many it is also important that we recognise the wider range of options which should be available including peer support and engaging with personally meaningful activity.
All services must be delivered with a compassionate, person centred, trauma informed and responsive focus and aligned with a human rights approach and Getting it Right for every Child (GIRFEC). This is further described in the Psychological Therapies and Interventions Specifications, which was published in Autumn 2023.
In producing this Matrix resource, the authors have tried to hold in mind the reality that language holds power and meanings change over time and across different groups and populations. We aim to hold the highest standards in making the language we use accessible and non-stigmatising and welcome comment or feedback on this (and any other issue) throughout this resource. Information on contacting us is available at the end of this page.
- Support planning and decision making for managers and strategic leaders through provision of an overview of the best available evidence base for psychological therapies and interventions, the wider factors such as cost and ease or challenge of implementation and guidance (or links to guidance) on the effective running of psychological services with consideration of how to deliver services to sufficient scale to meet local need.
- Support practitioners and clinicians by easily accessible summaries of the available evidence base to support collaborative, shared decision making with people using services. The information should also support informed career and continued development planning conversations and ensuring that supervision and governance requirements are met. This should be considered alongside all the necessary workforce wellbeing requirements. Our workforce is our most important asset, and we need to work with them to ensure that they are best placed to deliver the services needed by the population.
- Support people using services to understand the range of evidence-based treatment options that may be available and what to expect from services and themselves in terms of engaging with these. It should also set out expectations for the broader context of accessible and compassionate services.
This document is for guidance and does not replace any local policy or governance decision making as this remains the responsibility of the local or national Health Board, Integrated Joint Board or any other services provider. However, local policy should be aligned with the best available evidence base, as outlined in this Matrix resource. Scottish services have evolved to fit the needs of certain settings or populations in diverse ways and the guidance reflects the options available to represent informed choices about which psychological therapies and interventions to provide as well as the mechanisms by which these can be safely and effectively provided to support best outcomes for the population of Scotland.
Due to the ongoing nature of evidence review, the evidence tables and intervention information will be iteratively updated following a standardised prioritisation approach which has been agreed with stakeholders including Scottish Government Mental Health Division, Heads of Psychology Scotland and representatives of relevant sectors, professions and organisations including people with lived experience. Evidence is continually evolving, and the Scottish services should be active consumers but also active contributors to this, particularly in more specialist and specific areas where international evidence may be less well developed.
- set out the evidence base for psychological therapies and interventions that might be delivered in Scotland. This should support services, commissioners, clinicians and the public to make informed choices about psychological therapies and interventions based on evidence of effectiveness but also additional information on what might be the best fit in a local context, but also wider implementation factors such availability, usability and cost of training and supervision.
- provide further guidance on delivering this in a safe and effective way for example considering the training, governance and support for the workforce. This can include health and social care, local authority and 3rd sector providers.
- Provide a directory of all possible helpful interventions and approaches, the focus here is only on psychological interventions and therapies. For instance, there is clear evidence that having good social connections and support, safety, and adequate income and living conditions are important factors for psychological health but detailed consideration of these and other factors and approaches is beyond the scope of the Matrix.
- consider the effectiveness and utility of specific professions or disciplines such as AHP, nursing, psychiatry or psychology. The focus is on the effectiveness of psychological therapies and interventions which may be delivered by practitioners from a range of professional backgrounds and roles and will be determined by their specific training and supervision in the therapy or intervention.
- remove the requirement for clinical judgement and consideration of the needs of the individual. There is often a complex interplay of factors when decision making is required at individual, organisational or system wide levels. Similarly, it is not intended to replace choice for the person receiving the therapy or intervention, but rather helps to make this choice more informed.
Evidence based practice should be at the centre of decision making which takes account of:
- The available scientific evidence base
- The choices and preferences of the person using services
- The expertise and experience of the clinician or practitioner who is delivering the therapy or intervention (as summarised in the image).
- Describe all therapies and interventions which will be available across different services in Scotland. It provides an overview of the available evidence and how to deliver these safely and effectively. However, local decision making based on recognised local needs and available workforce, as well as implementation factors such as availability of local training and supervision still need to be taken into account. However, the Matrix may support decisions on prioritisation of training and future staff development.
The Matrix is designed to be consistent with and support the delivery of all key Scottish Government strategies such as the NHS Healthcare Quality strategy (2020) and the Scottish Government Mental Health Strategy (2017-2027). However, we note the updated Mental Health Strategy is due in Spring 2023 alongside the Scottish Government Psychological Therapies and Intervention Specification also expected in 2023. The Matrix content will be reviewed and updated at this point.
Although psychological therapies and interventions are an important component of access to effective treatments aimed to improve health, mental health and wellbeing, they are just one element of a broader system such as those offered in the Third sector which might include peer support, social prescribing and a range of recovery focussed approaches. It is important to consider how these components fit together as seamlessly as possible.
The Matrix has been available since 2011 and has continued to evolve through the 2015 update. As the Matrix review is iterative and ongoing, if the current version does not include the relevant table that you are looking for please refer to the previous version . There is a workplan to update the remaining tables over 2023-2024. Please do not hesitate to contact psychology@nes.scot.nhs.uk if you have any questions or comments on the tables available here or would like to get involved with the updates to the tables which are upcoming.
Stakeholders consistently report The Matrix to be an invaluable and widely used tool in Scottish services. However, feedback sought from people with lived experience also showed that the Matrix itself, needed to be more accessible and reflect the complexities of individual circumstances and how these change over the lifespan. This update aims to move toward this although acknowledging that the current evidence base does not allow this to be fully achieved at the moment.
This update is set against a backdrop of ongoing context of increasing need of mental health and wellbeing services which was a consistent picture over previous decades, but evidence now confirms that this increasing demand has been exacerbated by the impact of the COVID 19 pandemic and economic instability.
This update also recognises changes in the policy and delivery landscape including increased momentum towards health and social care integration, changes in service delivery often because of emerging clinical evidence, changes in delivery options, the increasing range of workforce involved. The need to be equal partners with people with lived experience is another welcome cultural shift, and the Matrix hopes to be able to support informed choice in, evidence- based decision making between those who deliver services and those who access them. People with lived experience have been part of the redesign of the Matrix into this current form.
The need for informed decision making is particularly important given the ongoing growth of evidence-based psychological therapies and interventions available. Drawing upon Implementation Science, we have included ‘Hexagon Tools’* for each of the therapies and interventions with sufficient evidence to be included in the tables the Matrix. These Hexagon Tools include further information that is important for planning, local decision making and individual choice of therapies and intervention. These provide more detailed information on the wider implementation considerations such as cost, training barriers or opportunities of different treatment options, or usual number of sessions required in order to support planning of investment, local clinical decision making and ensuring the public has transparent information on what is being offered.
* Metz, A. & Louison, L. (2019) The Hexagon Tool: Exploring Context. Chapel Hill, NC: National Implementation Research Network, Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill. Based on Kiser, Zabel, Zachik, & Smith (2007) and Blase, Kiser & Van Dyke (2013).
Please contact psychology@nes.scot.nhs.uk for further information