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.

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 City2,3	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.

The review, together with the Scottish Government''s response and a consultation paper, will be published shortly.

I refer the member to the answer to questions S3W-24326 and S3W-24331 on 11 June 2009 which is available on the Parliament''s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/Apps2/Business/PQA/Default.aspx.

The HEAT target on dementia focuses on a diagnosis of dementia and inclusion on the GP register. Inclusion on the register triggers automatic physical health reviews and carer assessments, both of which are of direct benefit for those who suffer from dementia and their carers.

The target it supported, by the piloting in three NHS board areas of effective practical steps for better and earlier identification and interventions and also awareness raising work to ensure people seek help at the earliest possible opportunity.

These initiatives are also supported by the development of local integrated care pathways (ICPs) to ensure that the right care is available at the right time in the context of local ICP standards developed by NHS Quality Improvement Scotland.

This information is not held centrally. The Scottish Government publication Closing the Gaps “ Making a Difference, published on 10 December 2007, states that the UK Psychiatric Morbidity Study on adults living in private households showed that 12% of males and 6% of females had some form of substance dependence combined with a current psychiatric illness.

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.

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.

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.

The Scottish Government initiated the Mental Health NHS Benchmarking Project in 2007, which is mentioned on page 26 of the Audit Scotland report, to obtain more comprehensive information around both inpatient and community services.

In relation to community mental health services, common definitions of services have been established across Scotland so that they are able to measure and compare the services in each NHS board area in terms of type of service, availability and staffing. This data collection has been piloted in the NHS board areas and a further collection round is due for completion in August 2009. A costing pilot to relate costs of community services to individual services has been completed in NHS Greater Glasgow and Clyde and NHS Forth Valley. A recent workshop was held with Finance Officers in each NHS board area in Scotland to explain the methodology to them and each NHS board will now attempt to match costs to community services by the end of the year.

Local authorities also provide community mental health services both directly or through the voluntary sector. The Mental Health Benchmarking Group has representation from the local authority and through them we have approached the Association of Directors of Social Work (ADSW) who have taken forward a piece of work to commission common core definitions around local authority services. This report has now to go to ADSW and local authorities for consultation and approval.