A process, based on a system of external peer review using written
standards, designed to assess the quality of an activity, service
Hospital-based health services which are provided on an inpatient
or outpatient basis. See secondary care.
Adults with Incapacity (Scotland) Act
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
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
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.
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.
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
See allied health professions.
A set of agreed or binding routines by which a process can be
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
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
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
Use of a standard or point of reference for the purpose of
comparison, usually in the context of improving performance.
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
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
See borderline personality
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.
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.
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
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
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 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
Community Care and Health (Scotland) Act
The Act makes further provision for social care provision in
relation to arrangements and payments between NHS bodies and local
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
A qualified doctor who has completed special advanced training in
diagnosing and treating mental illnesses.
Clinical outcomes for routine
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
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
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
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.
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:
• 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
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.
Detection and treatment of psychosis during the critical early
phase of illness.
The study of the performance of a service (or element of treatment
and care) with the aim of identifying successful and problem areas
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
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
Systematically developed statements which help in deciding how to
treat particular conditions.
See Health Department Letter.
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).
A person qualified in a health discipline.
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
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
See integrated care pathway.
Integrated Care Pathway Users in Scotland
Putting into practical effect; carrying out a task or project.
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
International Classification of Diseases
A medical reference book which provides information about clinical
descriptions and diagnostic guidelines, to assist clinicians in
classifying and diagnosing illnesses and disorders.
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
The governing body of a county, district or region.
Montgomery Asberg Depression Rating Scale
Mental Health (Care and treatment) (Scotland) Act
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
• 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
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
A general term for a wide range of disorders where mental
functioning such as perception, memory, emotion or thought is
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
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
A systematic method for reviewing and recording the health and
other needs (eg social, housing, finance) of an individual.
National Health Service
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
See NHS Quality Improvement
NHS Quality Improvement Scotland (NHS
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.
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.
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
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
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.
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
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.
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
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
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
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.
The systematic process of identifying risks and evaluating their
potential likelihood and consequences.
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
Royal College of General Practitioners (RCGP)
Professional and advisory body overseeing education and
qualifications of general practitioners.
Royal College of Psychiatrists (RCPsych)
Professional and advisory body overseeing education and
qualifications of psychiatrists.
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
Formerly the name of the Scottish Government. See Scottish
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
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/
Care provided in an acute sector setting. See acute sector and
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
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
An effect of treatment in addition to its desired therapeutic
effect. A side-effect is usually unpleasant and unwanted.
See Scottish Intercollegiate
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
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.
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
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
A reported feeling or observable physical sign of a person’s
condition that indicates a physical or psychological
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.
Protocol of care which specifies what should be done, by whom, when
and with what aim.
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
Active observation and regular monitoring of a patient without
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
Young Mania Rating Scale