Chamber and committees

The 2002 review of latest evidence by the Scottish Intercollegiate Guidelines Network determined that 10 to 15% of women in Scotland who give birth can suffer from post-natal depression. Depression as a separate condition can affect a large proportion of women of childbearing age, though studies are evenly divided in reporting one condition more or less severe than the other. There is, however, some evidence that there is an increased risk of depression occurring in the early postnatal period. The care objective is to apply proper screening and follow up that identifies and responds to all assessed needs in each case.The Scottish Executive has not funded any research on the incidence of post-natal depression. Details of recent and current research on post-natal depression can be found in the National Research Register, which is available in the Parliament's Reference Centre (Bib. number 17404).

Core funding can be awarded under section 16b of the National Health Service (Scotland) Act 1978 and section 10 of the Social Work (Scotland) Act 1968. Facilitate (Scotland) have been given feedback as to why their applications under these two schemes have been unsuccessful.

Accurate data on the cause of depression in each case is not collected routinely.Addressing cause is important and our National Programme for the Improvement of Mental Health and Well-being and the available treatment services are designed to help prevent as well as treat the condition.

The work of the National Programme for Improving the Mental Health and Wellbeing of the Scottish Population, established in October 2001 and overseen by a National Advisory Group which I chair, will bear on children and young people. It will also link into the range of policies and initiatives in train across the Executive to help give children a better start in life and to cope better with the difficulties which might otherwise lead them to consider self-harm or suicide.

The Scottish Executive has no such plans.

This information is not held centrally. The following figures have been produced from data provided by the Mental Welfare Commission for Scotland. They indicate the number of admissions to hospital under section 18 in each year and do not necessarily reflect the total number of patients being treated under section 18 in any one year.

	Year
Board	1990-91	1991-92	1992-93	1993-94	1994-95	1995-96
Argyll and Clyde NHS Unified Board	61	73	63	87	97	110
Ayrshire and Arran Unified Board	22	33	34	42	42	42
Borders Unified Board	9	10	*	16	17	15
Fife NHS Board	18	35	49	49	45	58
Forth Valley NHS Board	20	21	19	30	31	33
Grampian NHS Board	61	57	72	80	81	87
Greater Glasgow NHS Board	115	151	126	158	161	163
Highland NHS Board	29	40	41	46	32	32
Lothian NHS Unified Board	78	104	118	131	130	160
NHS Dumfries and Galloway	31	26	28	31	32	28
NHS Lanarkshire Board	30	35	43	61	67	58
NHS Tayside Unified Board	61	68	84	59	97	94
Other	10	6	*	15	8	6
Total	545	659	693	805	840	886

	Year
Board	1996-97	1997-98	1998-99	1999-2000	2000-01	2001-02
Argyll and Clyde NHS Unified Board	112	113	116	82	108	88
Ayrshire and Arran Unified Board	41	57	59	71	86	75
Borders Unified Board	22	19	*	*	26	*
Fife NHS Board	75	72	89	68	53	87
Forth Valley NHS Board	31	32	36	32	41	42
Grampian NHS Board	76	95	86	89	108	97
Greater Glasgow NHS Board	170	164	186	185	204	222
Highland NHS Board	48	55	45	52	43	45
Lothian NHS Unified Board	156	158	180	186	191	201
NHS Dumfries and Galloway	25	41	41	31	40	40
NHS Lanarkshire Board	48	64	65	62	71	86
NHS Tayside Unified Board	78	93	118	116	100	113
Other	9	7	*	*	6	*
Total	891	970	1049	1005	1077	1132

Figures marked * are not available to prevent disclosure of personal information.Years are from 1 April to 31 March.Other includes section 18 detentions in the State Hospital, Shetland NHS Board and unspecified cases.A very small proportion of patients may have had more than one episode of detention in each year.These figures have been derived from the Mental Welfare Commission's patient record's system. Statistics for years up until 1996 derive from older patient information systems where data have been transferred. In addition, there may be slight variations between these figures and those previously published by the commission as they have been derived from an active system.

In 2001, a survey of progress by NHSScotland in implementing Scottish Intercollegiate Guidelines Network (SIGN) guidelines was carried out by a sub-group of the Clinical Resource and Audit Group (CRAG) and a summary report was published in July 2002. A copy of the report can be found on the CRAG website at: http://www.show.scot.nhs.uk/crag/. This survey demonstrated that the implementation of SIGN guidelines is widespread throughout NHSScotland. Targeted dissemination of guidelines routinely occurs in almost all trusts, and most trusts have an explicit strategy for implementing guidelines following dissemination. As recommended in previous studies on methods of implementing evidence-based medicine, a combination of approaches (appropriate to local circumstances) has been used in the service. However, the survey also demonstrated that the implementation of individual guidelines was highly variable. A number of success factors and barriers to implementation were identified, many of which were applicable to a number of trusts. Although the implementation of SIGN guidelines will continue to be the responsibility of trusts, the introduction of unified NHS boards and Board Clinical Governance committees provides an opportunity to facilitate successful implementation, and to overcome barriers.In addition, assessment visits carried out by the Clinical Standards Board for Scotland monitor compliance with condition-specific and clinical governance ("generic") standards. These assessments will ensure that procedures are in place to implement SIGN and other relevant evidence-based guidance.

The Chief Scientist Office (CSO), within the Scottish Executive Health Department, has responsibility for encouraging and supporting research into health services and patient care within the NHS in Scotland.The following table provides details of the amount CSO has spent both directly on mental health research projects and on other projects supported indirectly in the NHS through the Research and Development (R&D) Support Fund:

	2000-01Actual Expenditure	2001-02Actual Expenditure	2002-03Anticipated Expenditure
Direct Research Support	£1,043,853	£913,389	£975,600
R&D Support Fund	£2,729,260	£2,831,327	Information not yet available

Details on individual projects are available from the National Research Register a copy of which is in the Parliament's Reference Centre (Bib. number 17404).

In all cases the aim is to match care to assessed needs. This can involve a mix of hospital and community based care, as an individual's needs change. Where re-admission is required this is of course arranged. The aim overall is to provide the right care where and when it is needed in each case. There has been a planned reduction of in-patient beds, which reflects the policy of providing more care and support from community settings where this is appropriate. Information on hospital in-patient beds and patients admitted are provided in the following tables. The underlying reason for re-admissions cannot be identified.Table 1: Trends in Average Occupied Hospital Beds and Available Staffed Hospital Beds in Psychiatry Years Ending 31 March 1990 to 31 March 2002, Scotland^1,2,3,4

Year ending 31 March	Average available staffed beds	Average occupied beds	Average % occupancy
1990	14,407	12,634	87.7
1991	13,927	12,159	87.3
1992	13,251	11,640	87.8
1993	12,561	11,179	89.0
1994	11,727	10,289	87.7
1995	11,034	9,754	88.4
1996	10,392	9,084	87.4
1997	9,580	8,358	87.2
1998	9,076	7,791	85.8
1999	8,674	7,358	84.8
2000	8,145	6,917	84.9
2001	7,760	6,547	84.4
2002	7.306	6,216	85.1

Source: ISD Scotland [Form: ISD(S)1].Notes:1. NHS locations include any joint-user and contractual hospitals providing the service.2. Average available staffed beds: borrowed and temporary beds are included. Derived as: all available staffed beds/days in period.3. Average occupied beds - Derived as: all occupied beds/days in period.4. Data for 2002 are provisional.Table 2: In-Patient Admissions to Hospital Psychiatric Beds Years Ending 31 March 1990 to 31 March 2001, Scotland^1,2,3,

Year ending 31 March	No. of patients	No. of episodes	Average no. of episodes per patient
1990	20,478	29,644	1.45
1991	20,589	30,372	1.48
1992	20,375	29,955	1.47
1993	20,238	29,639	1.46
1994	20,151	29,823	1.48
1995	20,169	30,172	1.50
1996	20,092	30,245	1.51
1997	20,724	31,674	1.53
1998	20,793	32,150	1.55
1999	20,701	31,624	1.53
2000	20,230	30,985	1.53
2001	19,642	30,197	1.54

Source: ISD Linked Database, September 2002.Notes:1. Each patient is counted only once in each year.2. Excludes admissions to the learning disabilities specialty.3. Data for 2001 are provisional.

The Advocacy Safeguards Agency was established on 1 April 2002. The total budget for the agency for 2002-03 is £358,700. The cost of setting up the agency to 31 August is £7,169; the running costs up to 31 August are £63,992. The remit of the agency is divided into five core functions: developing support for commissioners; evaluation; policy development and implementation; research, and complaints and mediation. The agency is currently based in the offices of Scottish Human Services Trust in Edinburgh and is in the process of securing its own distinct, accessible premises.