Access to mental health services on the NHS "remains slow and complicated for many people" with wide variations in the availability of face-to-face consultations, according to Scotland's public spending watchdog.

In a report today, Audit Scotland warned that while overall funding for mental health services had increased "significantly" since 2017, the mental health workforce is "under pressure, with high vacancy rates and turnover".

Vacancies for general psychiatry consultants "are the highest of all medical and dental consultant roles in Scotland" with non-consultant locums used to fill empty posts.

Meanwhile, vacancies for mental health nurses "more than doubled" between 2017 and 2023 and "turnover rate has reached a record high".

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Audit Scotland also highlighted delays in increasing the number of mental health workers and community links workers embedded in GP surgeries as a result of a £65 million cut to the primary care improvement fund and a £38 million reduction in mental health spending during 2022/23.

The Herald: Real terms spending on adult mental health services by NHS boardsReal terms spending on adult mental health services by NHS boards (Image: Audit Scotland)

The Scottish Government has pledged mental health and wellbeing services in every GP practice by 2026, but Audit Scotland called on ministers to provide a "costed delivery plan that sets out the funding and workforce that will be needed to achieve [this] aim".

As of March 2023, roughly one in five GP practices reported having no access at all to either a mental health worker or a community link professional - the latter of whom provide help to patients with non-physical issues which affect health, such as debt, housing, foodbanks and fuel poverty.

There has been a backlash recently to plans to cut community link numbers in Glasgow due to funding problems.

In addition, the watchdog said there was confusion over a target to ensure that 10% of frontline spending goes on mental health by 2026 because boards "were not clear about what spending should be included".

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Audit Scotland also criticised "long-standing issues with the availability, consistency and quality of data [which] make it difficult to track spending on adult mental health".

Overall, it said the mental health is system "fragmented" which "causes complications and delays" for service users. 

Patients who gave first-hand evidence to Audit Scotland via focus groups described being left in limbo when psychiatric referrals were rejected or how "one pathway leads to another pathway, but nothing seems to lead anywhere".

In 2022, Audit Scotland found that more than half (55%) of psychological therapy appointments took place remotely - via phone or video - but this varied hugely by area.

Among the mainland boards, face-to-face consultations were as low as 16% in the Borders compared to 86% in Ayrshire and Arran.

Even islands showed large variation, with more than 90% of patients Orkney and Western Isles treated remotely, while on Shetland two thirds are seen face to face.

Feedback from patients indicated that while some appreciated the flexibility and convenience, others were avoiding treatment entirely because "it’s being done online when they don’t want to do it online".

The Herald: Psychological therapy appointments, face to face vs remotely, in 2022Psychological therapy appointments, face to face vs remotely, in 2022 (Image: Audit Scotland)

Finally, while waiting times for psychological therapy have improved - nearly 81% are seen within 18 weeks of referral - the watchdog said the Scottish Government must also begin measuring "the quality of care or the outcomes" for patients.

Stephen Boyle, Auditor General for Scotland, said:“The Scottish Government needs much more information to understand the difference its investment in mental health services is making, from specialist services to community-based support.

“That planning must include moving beyond using waiting times as the sole measure of whether services are improving the lives of those in need. And it needs to include a costed delivery plan for the care that people can expect in their communities.”

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A spokeswoman for the Scottish Government said it will "take time to carefully consider the recommendations", adding that it will publish the Mental Health Strategy Delivery Plan and Workforce Action Plan in the autumn.

She added: "These will set out the actions we intend to take to address many of the issues set out in this report. Since 2007 mental health spending has doubled in cash terms from £651 million to £1.3 billion.”