Chamber and committees

The Scottish Government sets national direction of policy on mental health and provides funding to agencies, including NHS boards and local authorities, to support implementation of policy. The management of local actions in implementing national policy, and decisions on local spending priorities are the responsibility of relevant local agencies.

Mental Health is included in the Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract in the domains of dementia, depression and mental health. It is also included in other long-term conditions such as diabetes and coronary heart disease. The indicators identify individuals through appropriate registers, assess their mental health condition and severity, and tailor management according to their individual needs, taking account of the views and needs of their carers. Achievement against these indicators in GMS practices in Scotland continues to improve in most domains. The figures from 2009/10 are: dementia 99% of the available points achieved; depression 85.6%; and mental health 96.6%, diabetes 97.4% and coronary heart disease 99.7%.

The Scottish Government provided £548,000 funding for the three year Living Better partnership project led by Royal College of GPs in Scotland to help local primary care services respond to the mental health needs of people living with long term conditions such as diabetes, chronic heart disease, and chronic obstructive pulmonary disease. A final outcome report detailing findings is expected by June 2011.

The Scottish Government sets national direction of policy on mental health and provides funding to agencies, including NHS boards and local authorities, to support implementation of policy. The management of local actions in implementing national policy, and decisions on local spending priorities are the responsibility of relevant local agencies.

Decisions on treatment, and referral to exercise schemes for people with a mental illness, are matters for clinicians to consider in consultation with the individual. In treating patients with mental illness, clinicians will take a holistic approach and consider a range of factors including ongoing attention to diet, weight management and healthy eating to ensure healthy and sustainable dietary habits.

Our Towards a Mentally Flourishing Scotland action plan recognises physical activity as an important factor in mental health improvement, and promoting mental health. We have reviewed current evidence based approaches on smoking cessation, weight management and physical activity for those experiencing mental illness and a range of tailored user and carer led health information is available.

We have published Standards designed to improve care pathways for mental health and this highlights the need for regular physical health assessments, with attention to diet and nutrition at:

http://www.healthcareimprovementscotland.org/programmes/mental_health/icps_for_mental_health.aspx.

We have also published guidance for NHS boards to help embed improving the physical health of those with mental illness within existing health improvement policies and practice at:

http://www.scotland.gov.uk/Publications/2008/11/28152218/0.

We are also funding The Thistle Foundation (£178,000 over 2008-12) to pilot a range of activities with the aim of improving local levels of physical and mental wellbeing. Work has included developing a referral network, for example from local GPs and other service providers, developing gym access and developing outdoor initiatives.

Spend on mental health promotion, early intervention and appropriate treatment for mental health patients will continue to be drawn from the overall funds allocated to NHS Scotland by the Scottish Government. In this respect the overall health budget will increase to a total of £11.4 billion in 2011-12.

The Scottish Government sets national direction of policy on mental health and provides funding to agencies, including NHS boards and local authorities, to support implementation of policy. The management of local actions in implementing national policy, and decisions on local spending priorities are the responsibility of relevant local agencies. It is therefore the responsibility of NHS boards to work with their partners and regularly review spending decisions to deliver fit for purpose services which respond to local needs.

The Scottish Government sets national direction of policy on mental health and provides funding to agencies, including NHS boards and local authorities, to support implementation of policy. The management of local actions in implementing national policy, and decisions on local spending priorities are the responsibility of relevant local agencies. NHS boards are responsible for training and providing information about services for patients with mental health problems in their board area.

The links between alcohol use and underlying mental health issues are well established and have been recognised in the Scottish Government’s Mind the Gap (http://www.scotland.gov.uk/Publications/2003/11/18567/29477) and Closing the Gaps (http://www.scotland.gov.uk/Publications/2007/12/10141643/0) reports and in the Alcohol Framework (http://www.scotland.gov.uk/Publications/2009/03/04144703/2.)

Guidance and recommendations contained in these reports are being implemented, where appropriate, by a range of relevant stakeholders including: NHS boards, local authorities, alcohol and drug partnerships and third sector organisations.

The Scottish Government funded NHS 24 to pilot telephone delivered cognitive behavioural therapy (CBT) and guided self help based on a CBT methodology from July 2009 to July 2011, in five NHS board areas.

The pilot has been evaluated and the assessment made was that the telephone delivered CBT was not cost effective as a general Scotland-wide approach, but that the case was made for continuing guided self-help.

On that basis, the Scottish Government has continued the allocation of £200,000 to NHS 24, in 2011-12, all of which will now support the guided self-help work. In addition, NHS 24 has offered to make telephone based CBT available, on a cost recovery basis, to those boards that would wish to access it. It may be that NHS boards with remote and rural populations find the approach to be cost effective for them.

NHS 24 is currently engaged in development work to create a national approach to delivering computerised CBT.

Information on waiting times for access to mental health services has not historically been collected.

The HEAT targets for 2010-11 were published in the local delivery plan guidance on 1 December 2010. This included a HEAT target to improve access to mental health services by delivering 18-week referral-to-treatment for psychological therapies from December 2014. It also encompasses the target to deliver the referral to treatment target for child and adolescent mental health services within 26 weeks by March 2013.

In 2011-12 ISD’s (Information Services Division) focus will be on supporting NHS boards to begin to collect the required information to enable monitoring against the target and to support the continual improvement of data quality, both in terms of completeness and comparability through the development and implementation of relevant data standards.

ISD is collecting the data on a monthly basis using a live database. The data collected will be published when it is of sufficient quality to ensure accuracy, reliability and comparability.

This information is not held centrally.

The national performance framework underpins delivery against the government’s agenda and mental health services are monitored through NHS board annual review, local delivery plan, and single outcome agreement processes, including a rolling programme of Scottish Government mental health team implementation review visits to local service delivery partners.

Joint working between agencies and staff is essential to providing co-ordinated, quality care and support for people with mental health problems, their carers and families. Significant progress continues to be made by the NHS Scotland and local authorities in providing co-ordinated services including our focus on reducing delayed discharges and improving services for people with dementia through delivery of the National Dementia Strategy.

Improvement will continue through delivery of the Scottish Government’s £70 million change fund to enable NHS boards, local authorities and voluntary agencies redesign services for our growing older population, and development with NHS Scotland and COSLA of the integrated resource framework to provide more effective integration; improve people’s experience of services, and enable better models of care to be provided more efficiently.

Sections 25 and 26 of the Mental Health (Care and Treatment) (Scotland) Act 2003 impose a statutory duty on local authorities to provide, or secure the provision of care and support services, and services designed to promote the wellbeing and social development for persons who have, or have had a mental disorder and who are not in hospital.

The new public sector Equality Duty, (Equality Act 2010), which came into force on 5 April 2011, requires all public bodies to have due regard to the need to eliminate discrimination, advance equality of opportunity, and foster good relations in the course of developing policies and delivering services. These duties complement the duty under the 2003 act and are subject to enforcement under the Equality Act 2010.

Social work services provided by local authorities including those provided under sections 25 and 26 of the Mental Health (Care and Treatment) (Scotland) Act 2003 are subject to scrutiny by Social Care and Social Work Improvement Scotland (SCSWIS). Where SCSWIS identifies that services fall short of the expected quality local authorities will be expected to make the necessary improvements. In addition care services provided by local authorities that meet one of the definitions in the Public Services Reform (Scotland) Act 2010 are registered with and scrutinised by SCSWIS.

Under Part 2 of the 2003 act, the Mental Welfare Commission is under a duty to raise any concerns with certain bodies (including SCSWIS) about the provision of a care or social service provided by a local authority in relation to individual patients (section 8A). This power could therefore be used to alert SCSWIS to problems in the provision of a service at a local level, which would assist SCSWIS in carrying out their scrutiny role in relation to these services. The Mental Welfare Commission also have power under the 2003 act to bring to the attention of Scottish ministers any matters regarding the operation of the 2003 Act (section 6); this is another route by which the commission could raise concerns about the adequacy of the provision of social work services under sections 25 and 26 of the 2003 act.

Scottish ministers placed a legal duty on local authorities under the 2003 act, to ensure that these services are available to people who need them. They expect public bodies upon whom statutory duties have been placed by an act of the Parliament to comply with those duties. Failure to comply with a specific statutory duty could leave those bodies open to judicial review.