Questions and answers

Question reference: S3W-24327

Asked by: Mary Scanlon, MSP for Highlands and Islands, Scottish Conservative and Unionist Party
Date lodged: Thursday, 28 May 2009
Current Status: Answered by Shona Robison on 11 June 2009

To ask the Scottish Executive how much has been spent by each local authority on mental health services in each of the last 10 years.

The Audit Scotland report, Overview of mental health services, acknowledged the difficulty in calculating the exact amount spent by on mental health. This can be due to a number of factors and the diverse way mental health spend can be reflected in other budgets.

The following table contains net expenditure on social work services for all people aged 18 to 64 where the primary reason for care relates to a mental health need. This information is collected in the LFR 3 (Social Work) return. This is one of a series of financial returns issued annually to local authorities to gather revenue expenditure and income on services. The various categories of expenditure collected in the returns (including the Adults with Mental Health Needs category) are based on guidance provided to councils in the Chartered Institute of Public Finance and Accountancy (CIPFA) Best Value Accounting Code of Practice 2008.

Social Work - Adults with Mental Health Needs, Net Revenue Expenditure¹ (000)

	1998-99	1999-2000	2000-01	2001-02	2002-03	2003-04	2004-05	2005-06	2006-07	2007-08
Scotland	30,137	29,473	30,719	32,508	47,640	63,455	72,830	84,715	72,644	79,580
Aberdeen City	1,595	2,320	2,515	3,206	3,235	3,905	4,404	4,877	5,089	5,179
Aberdeenshire	989	1,116	1,379	1,630	2,037	2,025	2,864	2,875	3,036	3,364
Angus	511	543	1,074	405	704	408	530	994	635	995
Argyll and Bute	587	649	688	727	796	640	1,576	1,117	1,151	1,195
Clackmannanshire	190	375	273	234	810	721	732	967	896	1,034
Dumfries and Galloway	894	745	750	832	1,370	1,431	1,643	2,080	2,453	2,197
Dundee City	658	782	795	1,045	1,053	923	1,122	1,253	1,352	1,528
East Ayrshire	723	526	514	501	973	805	1,062	1,154	1,424	1,658
East Dunbartonshire²	-2	-17	190	212	173	110	1,582	2,051	1,710	1,740
East Lothian	448	406	444	568	490	860	883	1,025	1,023	1,205
East Renfrewshire	593	609	386	608	610	666	687	706	727	934
Edinburgh, City of	3,849	4,227	4,326	4,454	7,032	6,213	6,542	8,277	8,329	9,540
Eilean Siar	376	435	442	463	643	528	592	590	613	596
Falkirk	771	798	949	1,044	1,855	1,634	2,017	2,251	2,028	2,322
Fife	1,936	1,767	1,806	1,561	3,275	4,754	4,635	5,510	6,192	6,945
Glasgow City^2,3	1,826	-1,727	919	2,446	2,185	20,287	22,520	24,469	9,988	10,023
Highland	4,297	4,724	1,304	1,289	2,568	1,255	612	1,110	1,069	2,865
Inverclyde	645	421	634	694	815	567	934	962	899	1,153
Midlothian	499	591	618	568	905	874	882	1,217	1,232	1,074
Moray	951	699	707	451	736	1,097	1,105	1,277	1,452	1,443
North Ayrshire	458	468	599	639	1,237	1,199	1,557	1,198	1,283	2,077
North Lanarkshire	1,877	2,237	2,209	2,745	3,335	3,227	2,287	4,951	4,890	5,413
Orkney Islands	307	285	227	211	327	274	416	549	410	565
Perth and Kinross	707	842	1,034	1,007	1,642	1,680	2,369	2,581	2,329	2,124
Renfrewshire	533	1,193	698	856	2,057	1,355	1,246	1,416	1,755	1,806
Scottish Borders	568	656	737	744	1,403	1,521	1,879	2,165	2,129	2,287
Shetland Islands	447	611	862	100	388	118	553	502	671	765
South Ayrshire	649	484	681	461	516	222	120	208	1,017	615
South Lanarkshire	948	1,014	1,027	920	1,252	1,013	1,221	1,390	1,896	2,031
Stirling	379	446	631	624	1,009	979	1,340	1,711	1,187	1,132
West Dunbartonshire	399	512	588	432	931	1,125	1,381	1,409	1,760	1,303
West Lothian	532	735	713	830	1,278	1,039	1,537	1,873	2,019	2,472

Source: LFR 3 - Social Work, 1998-99 to 2007-08.

Notes:

1. Figures are not strictly comparable as from 2002-03 figures include other community care services previously not allocated to client groups.

2. Negative figures due to income from Health Boards/Trusts recorded by councils as having exceeded expenditure.

3. Glasgow City''s changes in level of expenditure in 2003-04 and 2006-07 due to council re-examining its social work accounting procedures.

Question reference: S3W-24333

Asked by: Mary Scanlon, MSP for Highlands and Islands, Scottish Conservative and Unionist Party
Date lodged: Thursday, 28 May 2009
Current Status: Answered by Shona Robison on 11 June 2009

To ask the Scottish Executive whether it will ensure that data on waiting times for mental health services are routinely collected and made publicly available.

We are currently working to establish, by April 2010, a referral to treatment waiting time target for specialist child and adolescent mental health services (CAMHS).

We have set up a Waiting Time Delivery Board to take this CAMHS agenda forward and to inform an implementation timetable. This includes ensuring that appropriate systems are in place to properly monitor the performance of NHS boards and are transparent to the public.

In the coming months we will be giving similar consideration to establishing a waiting time target to access psychological therapies.

On the wider mental health agenda, we are currently addressing information issues through the Benchmarking Project and the Mental Health Collaborative Information Project with its focus on HEAT targets and the development, accreditation and measurement of variance of Integrated Care Pathways.

Question reference: S3W-24326

Asked by: Mary Scanlon, MSP for Highlands and Islands, Scottish Conservative and Unionist Party
Date lodged: Thursday, 28 May 2009
Current Status: Answered by Shona Robison on 11 June 2009

To ask the Scottish Executive how it will monitor the amount of money spent by local authorities on mental health services.

The concordat with local authorities means that the relationship between government and local authorities is one of partnership and co-operation rather than direct management and monitoring.

The Scottish Government Mental Health Division has, through the Mental Health Benchmarking Group local authority representatives, developed a set of core definitions to measure local authority mental health community services and their function. These are currently being reviewed by the Association of Directors of Social Work (ADSW) and, through them, individual local authorities. The Scottish Government Mental Health Division has recently appointed a Social Work Benchmarking Manager to work with local authorities and government to look at the practicalities of this data collection and to explore the current information systems are fit for purpose to collect this data.

Agreement is being sought through each local authority for the above work to progress in a way that fits with their individual systems and local needs but provides, through common definitions, a picture of services across Scotland. A further complexity is that individuals with mental health problems often appropriately access community services that are not specific to mental health and it is therefore difficult to quantify this spend on these individuals in these services.

Question reference: S3W-24344

Asked by: Mary Scanlon, MSP for Highlands and Islands, Scottish Conservative and Unionist Party
Date lodged: Thursday, 28 May 2009
Current Status: Answered by Shona Robison on 11 June 2009

To ask the Scottish Executive how the reduction in admissions to psychiatric units illustrates an improvement in patient care, this being a HEAT target.

The HEAT target is intended to focus attention on three areas of patient care. It is intended to improve attention to crisis services to reduce the number of unplanned admissions. It also focuses on the quality of care within the inpatient unit and discharge planning. Thirdly, meeting the target will require that community services provide good quality care that enables people to remain safe and well in the community.

Question reference: S3W-24340

Asked by: Mary Scanlon, MSP for Highlands and Islands, Scottish Conservative and Unionist Party
Date lodged: Thursday, 28 May 2009
Current Status: Answered by Shona Robison on 11 June 2009

To ask the Scottish Executive for what reason NHS Fife has four times as many staff working in mental health psychology as NHS Highland, which have average waiting times for psychological therapies of 58 and 77 weeks respectively, as highlighted in the Audit Scotland report, Overview of mental health services.

Different NHS boards have different configurations of services, including different numbers of doctors, nurses, psychologists and allied health professionals and these reflect different patterns of service structure and historical investment.

Many common psychological therapies, including those such as cognitive behavioural therapy, are routinely and appropriately delivered by trained nurses, social workers and others and so there is no direct relation between the number of psychologists and access to psychological therapies.

We have recently announced an additional £6.5 million to increase the number of psychologists working in specialist child and adolescent mental health services (CAMHS). This is in addition to the £6 million announced for specialist CAMHS services previously.

Question reference: S3W-24348

Asked by: Mary Scanlon, MSP for Highlands and Islands, Scottish Conservative and Unionist Party
Date lodged: Thursday, 28 May 2009
Current Status: Answered by Shona Robison on 11 June 2009

To ask the Scottish Executive whether appropriate crisis and out-of-hours services for people with mental health problems are available in each NHS board to meet local demand.

NHS boards, local authorities and other partners address prevention, intervention and recovery through the careful management of individuals during periods of acute illness, relapse or mental distress. Crisis response and out-of-hours services may be delivered in a number of ways, reflecting the needs of the local areas and settings and will include, but not be restricted to, specialist crisis teams, community mental health teams, outreach teams and other services.

As part of the Mental Health Benchmarking Project, work is underway to develop collection of data around availability of crisis and out-of-hours services.

Question reference: S3W-24350

Asked by: Mary Scanlon, MSP for Highlands and Islands, Scottish Conservative and Unionist Party
Date lodged: Thursday, 28 May 2009
Current Status: Answered by Shona Robison on 11 June 2009

To ask the Scottish Executive how many people in each local authority have received direct payments for their mental health care in each of the last 10 years.

The number of people with mental health problems who are in receipt of Self-directed Support (Direct Payments) for Scotland is provided in the following table:

Number of People with Mental Health Problems who are in Receipt of Self-Directed Support (Direct Payments), Scotland, 2001-08

	Number of People with Mental Health Problems
2001	*
2002	6
2003	10
2004	16
2005	43
2006	62
2007	69
2008	73

Source: Self-directed Support (Direct Payments) survey, Scottish Government.

Note: *Disclosure control (cell suppression) has been applied due to small numbers.

Information is only available from 2001.

Limited Local Authority analyses for those people with mental health problems are available only for 2006-08 (due to the small numbers involved) in the following web publications:

Direct Payments Scotland 2006 (see Table 10)

http://www.scotland.gov.uk/Publications/2006/09/25160444/0

Statistics Release Direct Payments Scotland 2007 (see Table 10)

http://www.scotland.gov.uk/Publications/2007/09/24155213/0

Self-directed Support (Direct Payments), Scotland, 2008 (see Annex Table 2)

http://www.scotland.gov.uk/Publications/2008/10/27092036/0

Voices of Experience (VOX) (hosted by the Mental Health Foundation) has been funded to investigate the experiences of people with mental health difficulties in relation to Self-directed Support (SDS) and to develop and disseminate an information resource for service users. Social work staff will be provided with a support resource giving examples of best practice and advice on supporting mental health service users.

Question reference: S3W-24342

Asked by: Mary Scanlon, MSP for Highlands and Islands, Scottish Conservative and Unionist Party
Date lodged: Thursday, 28 May 2009
Current Status: Answered by Shona Robison on 11 June 2009

To ask the Scottish Executive for what reason there are no crisis mental health services for older people in Clyde or Highland, as highlighted in the Audit Scotland report, Overview of mental health services.

In West Dunbartonshire, NHS Greater Glasgow and Clyde provide both a crisis mental health service and an out-of hours mental health service for patients 18 years and over. This provides crisis services for older people if required. In practice, the need for crisis services by older people is very low as they are generally well connected with mental health services, and problems are generally identified during working hours.

Populations in Highland are widely dispersed and NHS Highland considers that they could not sustain separate crisis services for different groups of people with mental health needs duplicated across the same areas. Consequently, generic crisis response is offered using a combination of NHS 24, out-of-hours primary care, on-call CPNs (Community Psychiatric Nurses) in the inner Moray Firth area, access to telephone advice and 24 hour emergency inpatient services.

Question reference: S3W-24337

Asked by: Mary Scanlon, MSP for Highlands and Islands, Scottish Conservative and Unionist Party
Date lodged: Thursday, 28 May 2009
Current Status: Answered by Shona Robison on 11 June 2009

To ask the Scottish Executive for what reasons the prescribing of antidepressants continues to rise.

This is a complex issue. There are four reasons why anti-depressant prescribing can continue to rise. More people may be anxious or depressed at a level which would meet the guidance for prescribing of anti-depressants. Secondly, more people may present to their GP, perhaps because of the reduction in stigma or increasing public understanding of mental health issues. Thirdly, prescribing practice may change. Fourth, the range of illnesses for which antidepressants are used may increase over time.

Question reference: S3W-24334

Asked by: Mary Scanlon, MSP for Highlands and Islands, Scottish Conservative and Unionist Party
Date lodged: Thursday, 28 May 2009
Current Status: Answered by Shona Robison on 11 June 2009

To ask the Scottish Executive what action is being taken to address waiting times for mental services as outlined in the Audit Scotland report, Overview of mental health services.

We are currently working to establish, by April 2010, a referral to treatment waiting time target for specialist child and adolescent mental health services (CAMHS). As part of this work we are also working towards a new national performance target for NHS boards on faster access to specialist CAMHS.

We have also set up a Waiting Time Delivery Board to take this CAMHS agenda forward and to inform an implementation timetable. This includes ensuring that appropriate systems are in place to properly monitor the performance of NHS boards and are transparent to the public.

In the coming months we will be giving similar consideration to establishing a waiting time target to access psychological therapies.

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