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A process, based on a system of external peer review using written standards, designed to assess the quality of an activity, service or organisation.

acute sector
Hospital-based health services which are provided on an inpatient or outpatient basis. See secondary care.

Adults with Incapacity (Scotland) Act 2000
An Act of the Scottish Parliament which aims to help people (aged 16 and over) who lack capacity to make some or all decisions for themselves, for example by reason of mental disorder or inability to communicate. It enables carers or others to have legal powers to make personal welfare, health care and financial decisions on their behalf. Website: http://www.opsi.gov.uk/legislation/scotland/acts2000/asp_20000004_en_1

advance statement
This is a written statement, drawn up and signed when the person is well, which sets out the treatment s/he would prefer to receive, or not receive, for their mental disorder if s/he were to become ill in the future. It must be witnessed and dated. The Tribunal and any medical practitioner treating the person must have regard to an advance statement. If the wishes set out in an advance statement have not been followed the medical practitioner must send to the Mental Welfare Commission (and others) a written record giving the reasons.
It is not the same as a ‘living will’, which people sometimes use to say how they would like to be treated if they are dying.

adverse reaction
In pharmacology, any unexpected or dangerous reaction to a drug. An unwanted effect caused by the administration of a drug. The onset of the adverse reaction may be sudden or develop over time.

advocacy services
The new Mental Health (Care and Treatment) (Scotland) Act 2003 states that any person with a mental health ‘disorder’ has a right to access independent advocacy services. The Act places a duty on NHS boards and local authorities to secure the availability (to persons in its area with a mental disorder) of independent advocacy services, and to take appropriate steps to ensure that those persons have the opportunity of making use of those services. Section 259 (4) describes independent advocacy services as: ‘...services of support and representation made available for the purpose of enabling the person to whom they are available to have as much control of, or capacity to influence, that person’s care and welfare as is, in the circumstances, appropriate.’ Simply put, an advocate can assist someone, at a time when they may be particularly vulnerable, to say what they need and want. The phrase ‘as appropriate’ does not mean that the independent advocate will make a judgement about the level of control an individual can exercise over their own life. Rather, it indicates that persons to whom the individual’s views are put by an independent advocate are still able to exercise their professional judgement about how much of the patient’s views should be taken on board. For example, where an advocate tells a medical worker a patient’s views, the medical worker will make a professional judgement based on his/her codes of conduct.

See allied health professions.

A set of agreed or binding routines by which a process can be carried out.

allied health professions (AHPs)
Healthcare professionals directly involved in the provision of primary and secondary healthcare. Includes several groups such as physiotherapists, occupational therapists, dietitians, etc. Formerly known as professions allied to medicine (PAMs).

Assessment of motor and process skills

antipsychotic drug
A drug used to alleviate the symptoms of a psychotic illness, such as schizophrenia. Antipsychotic drugs are sometimes called neuroleptics. Atypical antipsychotic drugs are a newer type of antipsychotic drug which have a different way of acting in the brain from older drugs.

The process of measuring the quality of an activity, service or organisation.

Avon service user needs assessment
A descriptive instrument designed to enable self-assessment of need and help service users and carers identify their own needs and to provide information for service providers to help plan better service responses.

Use of a standard or point of reference for the purpose of comparison, usually in the context of improving performance.

bipolar disorder
A mental health problem involving extreme swings of mood (highs and lows). Both men and women of any age from adolescence onwards and from any social or ethnic background can develop bipolar disorder.

British medical Association

borderline personality disorder (BPD)
A severe and complex mental disorder characterised by pervasive instability in moods, interpersonal relationships, self-image and behaviour. One of the core signs and symptoms in BPD is the proneness to impulsive behaviour, a disturbance in the characterological condition and behavioural tendencies of the individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption.

See borderline personality disorder.

care co-ordinator
A named member of staff who co-ordinates care and arranges to review the care plan regularly with the service user and other care providers. The care co-ordinator may change according to different needs along the care journey and it could be any member of the multi-agency care team who is given this role, or the service user themselves. Local guidance should be in place specifying who may be appointed to this role. This person should be able to make links to local mechanisms for commissioned and purchased services.

care governance
The system through which health and social care organisations are accountable for continuously monitoring and improving the quality of their care and services and safeguarding high standards.

care plan
See plan of care.

care programme approach (CPA)
A process which aims to ensure that people with severe and enduring mental illness (such as schizophrenia), who also have complex social care needs, are provided with co-ordinated care and supervision.

care record
Information about the physical or mental health of a service user, which has been made by, or on behalf of the care team.

See informal carer.

See cognitive behavioural therapy.

Confidential enquiry into maternal and child health

clinical governance
Ensures that patients receive the highest quality of care possible, putting each patient at the centre of his or her care. This is achieved by making certain that those providing services work in an environment that supports them and places the safety and quality of care at the top of the organisation’s agenda. Management of clinical risk at an organisational level is an important aspect of clinical governance. Clinical risk management recognises that risk can arise at many points in a patient’s journey, and that aspects of how organisations are managed can systematically influence the degree of risk. In jointly managed services, the above governance structures are called ‘care governance’ and operate across health and social work.

clinical psychologist
Clinical psychologists aim to reduce psychological distress and to enhance and promote psychological wellbeing. They deal with a wide range of psychological difficulties, including anxiety, depression, relationship problems, learning disabilities, child and family problems and serious mental illness. To assess a client, a clinical psychologist may undertake a clinical assessment using a variety of methods including psychometric tests, interviews and direct observation of behaviour. Assessment may lead to therapy, counselling or advice. Clinical psychologists work largely in health and social care settings including hospitals, health centres, community mental health teams, child and adolescent mental health services and social services.

cognitive behavioural therapy (CBT)
A collection of therapeutic approaches carried out with the aim of changing behaviour and altering thought patterns. The therapist helps the person to identify their own untrue or destructive beliefs in order to reduce distress and develop coping strategies.

Community Care and Health (Scotland) Act 2002
The Act makes further provision for social care provision in relation to arrangements and payments between NHS bodies and local authorities. Website:

community mental health team (CMHT)
A group of professionals from a variety of different disciplines (eg medical, nursing, social work) who work together to provide a range of mental health services outwith the hospital setting.

Groups of skills, behaviours or knowledge that are identified as performance standards for a particular job; the quality of being adequately or well qualified physically and intellectually.

Consent by a patient to a surgical or medical procedure or participation in a clinical study after achieving an understanding of the relevant medical facts and the risks involved.

consultant psychiatrist
A qualified doctor who has completed special advanced training in diagnosing and treating mental illnesses.

Clinical outcomes for routine evaluation

See care programme approach.

A broad range of situations where a person is not able to see the way forward. For example, a crisis could be a situation where a person receives bad news, has financial problems, feels anxious, frightened or depressed. A crisis could last from a few hours to a few days.

criterion (singular)/criteria (plural)
A rule giving the detailed and practical information on how to achieve a standard.

data set (national)
A list of required and specific information relating to a specific disease.

Delivering for Mental Health

A progressive illness which affects the brain. It can affect memory, thinking and actions. People of any age can develop dementia, although it is more common in older people.

A common, recurrent and disabling condition, and may occur with anxiety disorder, drug misuse and alcohol problems. It has a significant impact on physical health, and social and occupational functioning.

Identification of an illness or health problem by means of its signs and symptoms. This involves ruling out other illnesses and possible causes for the symptoms.

diagnostic information
Information, relating to, or used in a diagnosis.

Disability Discrimination Act 2005
The Act has been significantly extended since the 1995 Act and now gives disabled people rights in the areas of:
• employment
• education
• access to goods, facilities and services, and
• buying or renting land or property, including making it easier for disabled people to rent property and for tenants to make disability-related adaptations.
Website: http://www.opsi.gov.uk/ACTS/acts2005/20050013.htm

A discharge marks the end of an episode of care. Types of discharge include inpatient discharge, day-case discharge, day patient discharge, outpatient discharge and discharge from the care of allied health professionals (see AHPs).

Diagnostic and statistical manual of mental health disorders.

early intervention
Detection and treatment of psychosis during the critical early phase of illness.

Electroconvulsive therapy

The study of the performance of a service (or element of treatment and care) with the aim of identifying successful and problem areas of activity.

evidence-based practice
Evidence-based clinical practice is an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits that patient best.

family therapy
Supportive interventions which are intended to help a person and their family cope better with their illness. Family therapy programmes can have several different elements, eg an education programme, analysis of family relationships, family sessions to address problems identified in this analysis, and support groups for relatives.

General practitioner

Systematically developed statements which help in deciding how to treat particular conditions.

See Health Department Letter.

health board
See NHS board.

Health Department Letter (HDL)
A formal communication from the former Scottish Executive Health Department to NHSScotland (previously known as a Management Executive Letter – MEL).

healthcare professional
A person qualified in a health discipline.

HEAT targets
Health Improvement, Efficiency and Governance, Access and Treatment HEAT targets are a core set of Ministerial objectives, targets and measures for the NHS. HEAT targets are set for a 3-year period and progress towards them is measured through the local delivery plan process.

When a healthcare professional obtains an account from a person, and usually a carer/relative, of how an illness or disorder has developed, together with details of the person’s social and personal background. A diagnosis is usually made on the basis of the history that has been obtained, a physical examination and other necessary investigations, eg blood tests.

Health of the Nation Outcome Scale or HONOS65+.

See International Classification of Diseases.

See integrated care pathway.

Integrated Care Pathway Users in Scotland

Putting into practical effect; carrying out a task or project.

informal carer
Informal carers, who may be family or close friends, have a major role in supporting people with mental health difficulties to recover or cope as best they can with the condition. Informal carers are not paid carers. Supporting informal carers to care, while retaining their own life and wellbeing, allows service users to live in their preferred environment for as long as possible and to access support services when needed. This helps to avoid crisis or the need for higher level interventions.

integrated care pathway (ICP)
An explicit agreement by a local group of staff and workers, both multidisciplinary and multiagency, to provide a comprehensive service to a clinical or care group on the basis of current views of good practice and any available evidence or guideline. It is important that the group agree on communication, record keeping and audit. There should be a mechanism to pick up when a patient has not received any care input specified by the pathway so that the omission can be remedied. The local group should be committed to continuous improvement of the integrated care pathway on the basis of new evidence of service developments or of problems in implementation.

International Classification of Diseases (ICD)
A medical reference book which provides information about clinical descriptions and diagnostic guidelines, to assist clinicians in classifying and diagnosing illnesses and disorders.
Website: www.who.int/classifications/icd/en

Healthcare action intended to benefit the patient.

Information Services Division (ISD)
Part of NHS National Services Scotland. Health service activity, manpower and finance data are collected, validated, interpreted and distributed by ISD. These data are received from NHS boards and general practices. Website: www.isdscotland.org

Laws passed by a parliament.

local authority
The governing body of a county, district or region.

Montgomery Asberg Depression Rating Scale

Mental Health (Care and treatment) (Scotland) Act 2003
This law came into effect in October 2005 and deals with how people with a mental illness, learning disability or other mental disorder can be given care and treatment. It says:
• when a person can be taken to hospital against his/her will
• when a person can be given treatment against his/her will
• what rights a person has when they are receiving care and treatment, and
• what safeguards are in place to protect a person’s rights.
The law is based on a set of principles, and these principles should be taken into account by anyone involved in a person’s care and treatment.
Website: www.opsi.gov.uk/legislation/Scotland/acts2003/20030013.htm

Mental Health Collaborative
The Mental Health Collaborative has been established to support NHS boards to make the improvements needed to deliver against key national targets in mental health set out by the Scottish Government.

mental illness
A general term for a wide range of disorders where mental functioning such as perception, memory, emotion or thought is affected.

Mental Welfare Commission for Scotland
An independent organisation working to safeguard the rights and welfare of everyone with a mental illness, learning disability or other mental disorder. The commission’s duties are set out in mental health law. Website: www.mwcscot.org.uk/

The systematic process of collecting information on the performance of clinical or non-clinical activities, actions or systems. monitoring may be intermittent or continuous. It may also be undertaken in relation to specific incidents of concern or to check key performance areas.

multidisciplinary mental health team
A group of professionals from a variety of different disciplines such as medicine, nursing, and social work, who work together to provide a range of mental health services. The composition of such teams varies from area to area. A multidisciplinary mental health team can work in a number of settings, such as in the community, when it is termed a community mental health team.

multi / partner agency
The involvement of different agencies, eg healthcare, social care services, local authorities.

National Institute for Health and Clinical Excellence (NICE)
The independent NHS organisation responsible for providing national guidance on treatments and care for those using the NHS in England and Wales. Its guidance is for healthcare professionals and patients and their carers, to help them make decisions about treatment and healthcare. NICE guidance and recommendations are prepared by independent groups that include healthcare professionals working in the NHS and people who are familiar with the issues affecting patients and carers. Website: www.nice.org.uk

needs assessment
A systematic method for reviewing and recording the health and other needs (eg social, housing, finance) of an individual.

National Health Service

NHS board
There are 22 NHS boards of two types: 14 territorial boards responsible for healthcare in their areas and eight special health boards which offer supporting services nationally. See NHS board (territorial) and special health board.

NHS board (territorial)
There are 14 territorial boards, the mainland being covered by 11 and the island groups (Orkney, Shetland and the Western Isles) by three. They are responsible and accountable for strategic planning, service delivery, performance management and governance within their local areas. Each NHS board uses the organisational building blocks of NHS direct care, such as community health partnerships or operating divisions, in a way which suits its geography and population. NHS boards work together in regional planning arrangements for those services which require that wider perspective.

See NHS Quality Improvement Scotland.

NHS Quality Improvement Scotland (NHS QIS)
NHS QIS was established in 2003 and leads the use of knowledge to promote improvement in the quality of healthcare for the people of Scotland. It performs three key functions: providing advice and guidance on effective clinical practice, including setting standards; driving and supporting implementation of improvements in quality; and assessing the performance of the NHS, reporting and publishing the findings. In addition, NHS QIS also has central responsibility for patient safety and clinical governance across NHSScotland. Website: www.nhshealthquality.org

The National Health Service in Scotland.

See National Institute for Health and Clinical Excellence.

A person who is specially trained to provide services that are essential to or helpful in the promotion, treatment, maintenance, and restoration of health and wellbeing.

occupational therapy
The treatment of mental and physical health problems by encouraging people to participate in specific activities that will help them to reach their maximum level of function and independence in all aspects of their daily life. An occupational therapist is a person specially trained to provide such assessment and treatment.

The end result of care and treatment and/or rehabilitation. In other words, the change in health, functional ability, symptoms or situation of a person, which can be used to measure the effectiveness of care and treatment, and/or rehabilitation.

patient journey
The pathway through the health services taken by the person who is receiving treatment, and as viewed by that person.

A qualified professional who understands the nature and effect of medicines and how they are produced and used to prevent and treat illness, relieve symptoms or assist in the diagnosis of disease. Pharmacists use their expertise for the wellbeing and safety of users and the public.

One of the screening tools recommended in the quality and outcomes framework of the General medical Services contract. It may be used to give a relative measure of the extent of the patient’s depression. It is a simple to use self-report, diagnostic tool for depression consisting of nine questions. The answers to these questions are used to calculate an overall ‘score’ for depression. This score, together with the GP knowledge of the patient’s circumstances, helps to facilitate a decision regarding the best course of action for this particular patient.

See the Psychiatric Inpatient Clinical Discharge Summary Information Set.

Positive & Innovative Resources. A Mental Health Interactive Database Scotland. A national multidisciplinary database of positive and innovative practice in mental health which will allow users to share practice or access the innovations of others in mental health care.

plan of care
A written document which is developed with the user, and which details the roles and responsibilities of all individuals involved in the person’s care and when their care arrangements are to be reviewed. The plan of care developed when a person is diagnosed is termed the initial plan of care. The plan of care developed when a person is admitted to hospital is termed the inpatient plan of care. The plan of care developed when a person is discharged from hospital is termed the discharge plan of care.

The highest level statement of intent and objectives within an organisation. A policy can also be a required process or procedure within an organisation.

A set of written instructions from a doctor to a pharmacist regarding the preparation and dispensing of a drug, etc for a particular patient. The term can also be used to describe the drug, etc prescribed in this way, or a set of written instructions for an optician stating the type of lenses required to correct a patient’s vision.

primary care
The conventional first point of contact between a patient and the NHS. This is the component of care delivered to patients outside hospitals and is typically, though by no means exclusively, delivered through general practices. Primary care services are the most frequently used of all services provided by the NHS. See acute sector and secondary care.

process mapping
A formal scoping exercise and graphic representation examining all the steps, actions, handovers and decision points of a process. In this instance, documenting the whole journey of care.

Operational instructions to regulate activity. Protocols may be national, or agreed locally to take into account local requirements.

Psychiatric Inpatient Clinical Discharge Summary Information Set (PIC-DSIS)
A data standard developed to provide a summary of care received during an inpatient psychiatric stay.

A branch of medicine concerned with the diagnosis, care and prevention of mental illnesses.

Relating to human behaviour.

psychological interventions
A range of interventions based on identified psychological concepts and theory, which have been acquired through training and maintained through supervision. This type of service is provided by a wide range of professionals, for example: clinical/counselling psychologists; counsellors; psychiatrists; specialist and mental health nurses; psychotherapists; members of primary care teams; social workers; voluntary organisation workers with special skills, and a wide range of other mental health and non-mental health professionals working in a variety of services and settings.

See clinical psychologist.

The scientific study of human behaviour and the corresponding mental processes.

A type of major mental illness associated with loss of insight. The signs and symptoms of psychosis may include hallucinations, delusions and agitated behaviour. Episodes of psychosis may be shortlived or recurring. Schizophrenia is one type of psychosis.

Relating social conditions to mental health.

quality and outcomes framework (QOF)
A system to remunerate general practices for providing good quality care to their patients and to encourage further improvement of the quality of healthcare delivered. It is a fundamental part of the General medical Services contract, introduced on 1 April 2004, and measures achievement against a range of evidence-based indicators, with points and payments awarded according to the level of achievement.

See quality and outcomes framework.

Quick reference guide

Scientific/objective reason for taking specific action.

See Royal College of General Practitioners.

See Royal College of Psychiatrists.

The process by which a patient is transferred from one professional to another, usually for specialist advice and/or treatment.

The worsening of symptoms which a person is experiencing, or the return of symptoms associated with an illness.

risk assessment
The systematic process of identifying risks and evaluating their potential likelihood and consequences.

risk management
A systematic approach to the management of risk, staff and patient/client/user safety, to reducing loss of life, financial loss, loss of staff availability, loss of availability of buildings or equipment, or loss of reputation. Risk management involves identifying, assessing, controlling, monitoring, reviewing and auditing risk.

Royal College of General Practitioners (RCGP)
Professional and advisory body overseeing education and qualifications of general practitioners.
Website: www.rcgp.org.uk

Royal College of Psychiatrists (RCPsych)
Professional and advisory body overseeing education and qualifications of psychiatrists.
Website: www.rcpsych.ac.uk

A psychotic illness. It is a complex mental illness which affects different people in different ways. The first symptoms of schizophrenia usually develop in early adulthood.

Social Care Institute for Excellence

Scottish Executive
Formerly the name of the Scottish Government. See Scottish Government.

Scottish Government
The devolved government for Scotland, with responsibilities including health policy and the administration of NHSScotland. Until September 2007, the devolved government was named the Scottish Executive. Website: www.sehd.scot.nhs.uk/

Scottish Intercollegiate Guidelines Network (SIGN)
To help improve the quality of healthcare SIGN develops national clinical guidelines aimed at reducing variations in clinical practice and in outcomes for patients. Founded in 1993 by the Academy of Royal Colleges and Faculties in Scotland, SIGN became part of the national clinical effectiveness body, NHS QIS, on 1 January 2005. The evidence base for many of the clinical standards developed by NHS QIS has been drawn from SIGN guidelines. For further information relating to SIGN guidelines or the methodology by which SIGN guidelines are developed, contact:
SIGN Secretariat, Elliott House, 8-10 Hillside Crescent, Edinburgh, EH7 5EA. Website: www.sign.ac.uk

Scottish Recovery Network
The Scottish Recovery Network exists to help promote and support the process of recovery from long-term mental health problems. It is comprised of a loose affiliation of organisations and individuals, from varied backgrounds, who all share an interest in efforts to promote recovery. SRN was formally launched as an initiative within The National Programme for Improving Mental Health and Wellbeing in late 2004. Website: www.scottishrecovery.net/

secondary care
Care provided in an acute sector setting. See acute sector and primary care.

Assessment of performance against standards by the individual/clinical team/NHS operating division/ NHS board providing the service to which the standards are related. See assessment.

service user
A person receiving the services of a health authority or voluntary or independent organisation is called a service user. Some people do not identify with the term ‘user’ and may instead prefer ‘patient’ or ‘client’.

An effect of treatment in addition to its desired therapeutic effect. A side-effect is usually unpleasant and unwanted.

See Scottish Intercollegiate Guidelines Network.

SIGN guideline
Scottish Intercollegiate Guidelines Network guideline. See guidelines and Scottish Intercollegiate Guidelines Network.

Directing people to other sources of information and support. These may be other services provided by the NHS, local authorities, voluntary sector, private sector or others. Signposting may include supporting service users to make initial contact with these other service providers.

single outcome agreement
An agreement between the Scottish Government and the entirety of the public sector to be signed up to the same national outcomes/shared set of policy priorities.

single shared assessment (SSA)
A person-centred, streamlined assessment overseen by a single professional with other specialist involvement as appropriate. The SSA takes a more holistic approach to assessment, with benefits for people who use services. The results should be acceptable to all professionals in social work, health and housing.

social inclusion
Helping people to feel and be part of the society in which they live.

social work services
Provide advice and practical help for problems resulting from social circumstances. A social worker is a person who has obtained a professional qualification in social work. A social worker supports vulnerable people and their informal carers with the aim of enhancing the quality of all aspects of their daily lives.

special health board
The name given to health boards with a national remit. These boards are focused on specific areas, for example NHS Education for Scotland, or NHS Quality Improvement Scotland. Special health boards match regional NHS boards in terms of administrative grading.
Website: www.show.scot.nhs.uk/organisations/special_hbs.html

Selective serotonin reuptake inhibitor

Agreed level of performance.

Required or created by law.

A high-level document indicating a framework for achieving objectives and perhaps incorporating a plan.

A reported feeling or observable physical sign of a person’s condition that indicates a physical or psychological abnormality.

Methodical, according to plan and not casually or at random.

A system whereby a group of casualties or patients is sorted according to the seriousness of their injuries or illnesses so that treatment priorities can be allocated between them.

treatment plan
Protocol of care which specifies what should be done, by whom, when and with what aim.

variance analysis
The reflection and analysis of causes of any deviation from the planned care (in an integrated care pathway) with the aim of rectifying any missed items of care and for improving the quality of care in future cases.

watchful waiting
Active observation and regular monitoring of a patient without actual treatment.

workforce development plan
A tool to assist an organisation in focussing on its priorities and identifying funding and solutions for the development, education and training of a workforce to ensure the right skills and competencies needed to deliver new and improved services are identified.

Young Mania Rating Scale