Delivering for Mental Health

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Responding better to depression, anxiety and stress

Depression, together with the related conditions anxiety and stress, is the most common mental health problem or illness in western industrial nations. The World Health Organization says that by 2020 it will be the number one form of disability. We can work to promote resilience and capability to reduce the likelihood that people will develop these disorders and offer support to reduce their impact, but we also must offer an effective treatment response.

In Scotland between 25% and 30% of all General Practitioner ( GP) consultations involve depression, stress or anxiety. Historically the options available to GPs were prescribing, referring the person to more specialist services or offering limited support. Work that we have taken forward under the Doing Well by People with Depression programme and the subsequent National Evaluation Report published in 2006 has shown how we can offer a response that better meets the needs of patients. This can be achieved by addressing needs using a stepped care approach and providing a range of appropriate treatment options.

The General Medical Services Quality Outcome Framework (the ' GP contract') rewards GPs for identifying patients with depression, and we will work with and build on this.

Commitment 3: We will work with GPs to ensure that new patients presenting with depression will have a formal assessment using a standardised tool and a matched therapy appropriate to the level of need. We will also develop treatment models for those who have depression and anxiety and who have coronary heart disease and/or diabetes, who are identified under the new QOF arrangements.

The 'Keep Well' (Prevention 2010) initiative will focus on increasing the rate of health improvement within the age 45 to 65 population group in deprived communities. In particular it will allow us to develop ways of taking a population based approach on diet, exercise and alcohol use, recognising that these problems are often linked to problems such as depression, anxiety and stress.

Widening the approach that we need to take, we also know that many prisoners have mental health care needs, which while they do not warrant a transfer from prison to secure health care, do require a response. We will provide a better response to those inmates within the Scottish Prison Services who have depression, anxiety and stress by exploring opportunities for introducing and rolling out the lessons from the Doing Well by People with Depression work, particularly self-help approaches and psychological therapies.

However, if we are to provide a range of appropriate treatment options consistent with the stepped-care approach that means significantly increasing the availability of and access to psychological therapies and support for self-care.

Commitment 4: We will increase the availability of evidence-based psychological therapies for all age groups in a range of settings and through a range of providers.

To do this we will work with NHS Education for Scotland, Health Boards and other service providers to increase the capacity within the current workforce who are trained to deliver psychological therapies and support service change and to ensure that the new resource is used effectively in practice. A plan for increasing capacity to deliver these interventions will be in place by April 2007.

This work will support the achievement of a new NHS target on anti-depressant prescribing that seeks to reduce the year-on-year increase in prescribing of anti-depressants and to improve the fit between guidance on best treatment and practice. This is not a criticism of existing practice or of anti-depressants, but reflects the need to ensure that general practitioners are able to call on and offer the best treatment for these illnesses and not just those that are the most convenient.

Target 1: Reduce the annual rate of increase of defined daily dose per capita of anti-depressants to zero by 2009/10.

In Delivering for Health, we committed to producing an evidence-based practice guide on depression in primary care in 2006. That work, which focuses on guided self-help, has been completed and will be published before the end of 2006. The lessons from the wider Doing Well by People with Depression programme are being embedded within the standards for the Integrated Care Pathway on depression, as well as in the GP contract, the work on promotion and prevention, commissioning more training and education in talking and psychological therapies and the HEAT target for levelling off the prescribing of anti-depressants.