Chamber and committees

Guidelines which issued this year to NHSScotland from NHS Quality Improvement Scotland recommended that electroconvulsive therapy (ECT) be used only to achieve rapid and short-term improvement of severe symptoms after other treatment options have proven ineffective and/or the condition is considered to be potentially life-threatening, in individuals with severe depressive illness, catatonia or a prolonged or severe manic episode. The guidance instructed on the need for documented assessment of the risks and potential benefits to the individual and the risks of not having the treatment. The enhanced risks occurring during pregnancy, in older people, and in children and young people were highlighted alongside the important issue of unhindered, valid and informed consent on the part of the individual including the involvement, where appropriate, of patient advocates and/or carers. The guidance covered issues of on-going review of the treatment and effects and, given the longer-term benefits and risks of ECT have not yet been clearly established, the guidance recommended against the procedure as a maintenance therapy in depressive illness.NHSScotland are expected to apply this guidance in all respects. Arrangements in Scotland have also been subject to extensive audit by the Scottish ECT Audit Network, supported by the Scottish Executive, which showed practice to be of a high quality, closely adherent to standards and providing good therapeutic outcomes.

The Chief Scientist Office (CSO) within the Scottish Executive Health Department has responsibility for encouraging and supporting research into health and health care needs in Scotland. The CSO has in the past funded studies on non-pharmacological interventions including cognitive behavioural therapy and community nurse empowerment. At the current time, the CSO is funding the SALT (Scottish Adherence to Lithium) trial, which is looking at the effectiveness of a brief cognitive intervention to improve adherence to lithium in bipolar affective disorder - combining pharmacological and non-pharmacological interventions.The CSO is primarily a response mode funder and would be pleased to consider further proposals for research into non-pharmacological treatments for mental illness. All research proposals are subject to peer and committee review and are assessed in terms of their potential for health gain.

There are a number of mechanisms already in place to monitor outcomes and performance of mental health services. These include the visits and reports of the Mental Health and Well Being Support Group, the Social Work Services Inspectorate, the Mental Welfare Commission for Scotland and others. There are also monitoring and evaluation approaches in place for specific aspects of mental health services. For example, NHS Quality Improvement Scotland will be conducting a review of compliance with their published standards for schizophrenia care, to be followed in 2004 with a report on the implementation of the second tranche of these standards. It is also supporting a three-year national study, commenced 2002, to monitor the outcomes of care for service users with schizophrenia. And it is funding a two-year programme to identify and report on best practice in post-natal depression. The assessment of mental health services which I commissioned earlier this year, and which will report in the autumn, will provide valuable insight into the scope and effectiveness of current performance monitoring systems.

The information requested is not held centrally.Table 1 shows the estimated number of children, five years and under for whom a diagnosis of a mental illness has been recorded by a general practitioner participating in the Continuous Morbidity Recording in General Practice (CMR) scheme. The table also shows CMR prevalence rate per 1,000 population and estimated number of patients for Scotland for 2001.Table 2 gives a list of the Read Codes used to define mental illness in the analysis.Since CMR data is collected on a sample of the population balanced on an all-Scotland level, it is not possible to make comparisons among NHS board areas.Table 1Number of CMR Patients (Five Years and Under) Consulting a GP as a Result of a Mental Illness¹, CMR Prevalence Rate Per 1,000 Population and Estimated Number of Patients for Scotland for 2001

Mental Illness Condition	Number of Patients	Practices' Combined Population2 (0-5 years)	Prevalence Rate	Scottish Population3 (0-5 years)	Estimated Number of Patients for Scotland
Mood (Affective) Disorders	9	23,935	0.4	334,349	126
Depressive Episodes	6	23,935	0.3	334,349	84
Disorders of Childhood	111	23,935	4.6	334,349	1,551
Neurotic, Stress-Related and Somatoform Disorders	35	23,935	1.5	334,349	489

Notes:1. Source: Continuous Morbidity Recording (CMR), ISD Scotland. Based on 60 practices, population 370,605, January 2001 to December 2001.2. Source: General Medical Practitioner database, ISD Scotland (as at 1 October 2001).3. Source: General Register's Office (Scotland), mid year population estimates for 2001.Table 2

Read Codes Used for the Analysis of Mental Illness	Read Code	Description
Mood (Affective) Disorders	1B17.	Depressed
	1B19.	Suicidal
	2257.	O/E - depressed
	E11*	Affective psychoses
	E2B*	Depressive disorder NEC
	Eu3*	[X]Mood - affective disorders
Depressive Episodes	1B17.	Depressed
	1B19.	Suicidal
	2257.	O/E - depressed
	E112*	Single major depressive episode
	E2B*	Depressive disorder NEC
	Eu32*	[X]Depressive episode
Disorders of Childhood	E14*	Psychoses-origin in childhood
	E2D*	Child/adolescent emotion probe
	E2E*	Childhood hyperkinetic syndrome
	E2F*	Specific delays in development
	Eu8*	[X]Disorders of psychological development
	Eu90*	[X]Hyperkinetic disorders
	Eu93*	[X]Emotional disorders with onset specific to childhood
	Eu94*	[X] Disorders of social functioning with onset specific childhood and adolescence
	Eu9y*	[X]Other behaviour and emotional disorders with onset usually occurring in childhood and adolescence
	ZV400	[V]Problems with learning
	ZV401	[V]Problems with communication, including speech
Neurotic, Stress-Related and Somatoform Disorders	E20*	Neurotic disorders
	E26*	Psychogenic physiol. symptoms
	E28*	Acute reaction to stress
	E29*	Adjustment reaction
	Eu4*	[X]Neurotic, stress - related and somoform disorders
	ZV402	[V]Other mental problems

Note:*Read codes beginning with these characters.

The National Research Register (NRR), a UK-wide database of all publicly funded research of relevance to the NHS, records that there are currently two projects on-going in the UK on electroconvulsive therapy (ECT), both of which are being carried out in England. The NRR also lists 18 completed projects on ECT, one of which was carried out at Tayside Primary Care NHS Trust and was completed in February 1999.Details of these projects are available from the NRR, a copy of which is available in the Parliament's Reference Centre (Bib. number 17404).

"Early years" was identified as one of the four major areas for a focussed approach to health improvement within Improving Health in Scotland - The Challenge. The Starting Well Health Improvement demonstration project will promote and encourage mental health and well-being among young children. Evidence suggests that the best way to make a difference for children is to reach them in their early years. Accordingly we have made a significant commitment to our early intervention approaches such as Sure Start Scotland which involves local authorities and targets support at vulnerable and deprived families with very young children.Revised guidance on Children's Services Plans was issued in October 2001, making clear that the plans should set out how the local authority is providing services for all children but also how they are targeting services covering all children in need in their area. More specifically, the Changing Children's Services Fund, which aims to allow major re-configuration of services for children, has the provision of mental health services for children as one of its key priorities. Work resourced through the fund will impact directly on mental health services but, more generally, better integrated services which respond promptly and effectively to children in distress or in trouble are key to dealing with the complex problems that may eventually lead to mental health problems.One of the five key priority areas in the National Programme for Improving Mental Health and Well-being in Scotland is "early years and young adulthood". Children, especially looked-after children, are one of the priority groups within Choose Life: A National Strategy and Action Plan to Prevent Suicide in Scotland which was published in December 2002.The need for concerted efforts in relation to health promotion and the prevention of mental health problems was one of the conclusions in the report of the Scottish Needs Assessment Programme (SNAP) review of child and adolescent mental health, published in March 2003. The Child Health Support Group will work closely with NHS boards and their partners to ensure effective implementation of the report's recommendations; a stakeholder working group has been established to take this forward.

Work in this area includes initiatives to encourage employers to employ and retain people with mental health problems; development, by NHS Health Scotland, of its Work Positive initiative (a package for businesses to prevent mental health difficulties in their workforces), and several projects to help tackle stress and mental health problems in the NHS. The Health Improvement Challenge, launched in March 2003, and the National Programme for Improving Mental Health and Wellbeing, also provide the opportunity to focus on mental health and employment and to challenge the stigma in relation to mental health problems which can be encountered in the workplace.The Training for Work programme offers work-related training opportunities to unemployed adults in Scotland. People with disabilities, including mental health problems, may enter the programme without having to wait the standard qualifying time on benefits.

The report by Analysys for the Executive entitled Research on broadband in Scotland contains information from a wide range of companies and organisations, which was provided on a commercial in confidence basis. It has been agreed with Analysys, however, that an anonymised summary of the report will be published. Copies will be placed in the Parliament's Reference Centre (Bib. number 27702).

The Executive expects to receive Analysys' final report of its forward look study of broadband in Scotland in due course.

In responding to the Deloitte & Touche option appraisal report on which the college's preferred option is based, I have asked the college, among other things, to re-examine the extent to which it proposes to relocate services from the west and north-east of Scotland to Edinburgh.