Mental Health and Wellbeing Strategy: Initial Monitoring Report and Monitoring Framework

Summary outcome 6: Comprehensive support and services that promote and support people’s mental health and wellbeing are available in a timely way that meets and respects individual needs

Summary Outcome 6 (SO6) of the Mental Health and Wellbeing Strategy focuses on whether comprehensive support and services that promote and support people’s mental health and wellbeing are available in a timely way that meets and respects an individual’s needs. Evidence highlights that timely care that aligns with individual needs is an important factor for effective recovery (Green et al., 2013). 

Metrics for monitoring SO6 are grouped under two core components of the outcome:

1. Timely access to support and services

2. Support and service meeting an individuals need

Table 12 presents the specific metrics grouped under each component.

Table 12. Metrics for Monitoring Summary Outcome 6

Core Components	Metrics
Timely access to support and services	Length of time patients waited to see a GP for urgent mental health support 90th percentile call answer time for NHS 24 mental health calls Number of referrals to Distress Brief Intervention (DBI) services Percentage of patients who started treatment within 18 weeks of referral to CAMHS and PT Percentage of adults who started treatment within 3 weeks of referral for community drug and alcohol services Number of delayed discharge days spent in inpatient mental health settings Percentage of all discharged psychiatric inpatients followed up by community mental health services within 7 calendar days
Support and services meeting an individual’s needs	Percentage of GP patients reporting improvements in mental health symptoms after a GP appointment Number of community mental health and wellbeing funded projects aimed at supporting at-risk population groups Percentage of welfare guardianship care plans considered person-centred Percentage of GP patients with a mental health condition who felt people took account of the things that mattered to them Percentage of GP patients with a mental health condition who were given the opportunity to involve people who mattered to them Percentage of carers with a mental health condition that felt supported to continue in their caring role Percentage of community-based mental health service users reporting improved outcomes

The following sections present each of these components and associated metrics in detail, offering insight into baseline measures and observed changes related to SO6.

1. Timely access to support and services

The first component of Summary Outcome 6 is timely access to support and services. Long wait times for treatments often indicate a lack of availability and are associated with worsened mental health outcomes (Royal College of Psychiatrists, 2020). There are seven metrics used to monitor this component.  

Length of time patients waited to see a GP for urgent mental health support

The HACE survey asks GP patients how long they waited the last time they needed to see or speak to a doctor or a nurse from their GP quite urgently.

In the 2023/24 survey, of patients attending their GP for a mental health reason:

• 49% of patients reported seeing a doctor or nurse on the same day
• 16% of patients reported waiting more than two working days for contact

90th percentile call answer time for NHS 24 mental health calls

The NHS 24 Mental Health Hub is a dedicated telephone service in Scotland that offers urgent mental health support via the 111 number. It provides access to trained mental health professionals 24 hours a day, seven days a week.

NHS 24 Operational data on the time taken to respond to mental health-related calls can be used to assess the responsiveness of the service during times of crisis. One key metric is the 90th percentile call answer time, which represents the maximum time within which 90% of callers had their call answered.

Data on weekly 90th percentile call answer times to NHS 24 for mental health calls from week ending 5th May 2024 to week ending 10th August 2025 show that call answer times varied across the year, with calls in the winter months typically experiencing longer wait times compared to summer months.

The shortest 90th percentile wait time was just over 4 minutes (week of 9 June 2024). The longest wait time peaked at over 19 minutes (week of 9 March 2025). Nearly half of the recorded weeks had 90th percentile wait times exceeding 10 minutes.

Number of referrals to Distress Brief Intervention

The Distress Brief Intervention (DBI) programme aims to offer timely, compassionate support in non-clinical settings within 24 hours of referral. Referrals to the DBI Level 2 service [1] have steadily increased over time, reflecting its national expansion and growing role in supporting people experiencing emotional distress.

As of 30 September 2024, there had been 73,926 referrals to the DBI Level 2 service (face-to-face support following an initial contact), including 21,949 via NHS 24 and 1,393 via the Scottish Ambulance Service. This compares to 40,280 referrals as of 31 March 2023.

The average monthly referrals rose from 1,244 for the period from 1st October 2022 to 31st March 2023 to 1,913 in the first nine months of 2024.

Percentage of patients who started treatment within 18 weeks of referral to CAMHS and PT

NHS Scotland has set a standard that 90% of patients referred to PT and CAMHS, should begin treatment within 18 weeks of referral. This standard is a key indicator of timely access to specialist mental health and substance use services.

Quarterly data from PHS, covering the period from January – March 2023 to Jul–Sep 2025, show variation in performance across services:

• CAMHS: Performance has steadily improved, rising from 74.2% of patients starting treatment within 18 weeks in Jan-Mar 2023 to 91.5% in Jul-Sep 2025. The 90% target was first met in Oct–Dec 2024 (90.6%) and has been sustained since.
• Psychological Therapies (all ages): Performance remained consistently below target, fluctuating between 78.3% and 80.6%. The highest level over the period was recorded in Jul–Sep 2025 (80.7%), following the lowest level in Apr–Jun 2025 (78.3%).

Figure 6: Percentage of patients starting treatment within 18 weeks of referral to CAMHS and Psychological Therapies, Scotland, Jan–Mar 2023 to Jul–Sep 2025

Waiting times performance statistics, Public Health Scotland 2025

Percentage of adults who started treatment within 3 weeks of referral for community drug and alcohol services

In 2011, the Scottish Government set a Standard that 90% of people referred for help with problematic drug or alcohol use should wait no longer than three weeks to start specialist treatment that supports their recovery.

PHS reports that community-based drug and alcohol services have met or exceeded the 90% Standard in every quarter from quarter ending March 2023 (92.1%) to quarter ending June 2025 (94.2%), maintaining timely access throughout this period. Hospital-based and prison-based services have also exceeded the Standard over the same reporting period.

Number and percentage of delayed discharge days spent in inpatient settings

The Scottish Government’s Mental Health Inpatient Census reports on the percentage of inpatients who had a delayed discharge. Delayed discharges happen when a hospital patient, who is ready for discharge, continues to occupy a bed. Timely discharge from the hospital is crucial for quality care.

In 2023, 11% of patients experienced a delayed discharge, up slightly from 10% in 2022. During the same period, the average delayed discharge days rose from 68 in 2022 to 87 in 2023. The reasons for delayed discharges are not reported.

Percentage of all discharged psychiatric inpatients followed up by community mental health services within 7 calendar days

Timely follow-up after discharge from psychiatric inpatient care is a key quality indicator. It supports continuity of care, reduces the risk of relapse or readmission, and is a recognised measure of safe, person-centred care.

Quarterly data from the PHS Mental Health Quality Indicators report show the percentage of psychiatric inpatients who were followed up by community mental health services within 7 calendar days of discharge.

As of the quarter ending March 2025, follow-up rates varied considerably across NHS health boards (Table 13). Performance ranged from 100% in NHS Borders to 11.3% in NHS Dumfries and Galloway. Data for NHS Greater Glasgow and Clyde were missing in this quarter, although the quarter ending December 2024 reported a follow-up rate of 72.0%. No data were returned for NHS Lanarkshire across any quarter. Patient data for NHS Orkney and NHS Shetland are included in NHS Grampian figures.

Compared with the quarter ending March 2023, which serves as a baseline from when the Strategy was published, NHS Grampian showed the largest increase (+18.4%), while NHS Dumfries and Galloway showed the largest decrease (-46.33%).

Table 13: Percentage of community mental health services who follow up seven days after discharge by NHS Health Board, June 2023 – March 2025

NHS Health Board	Quarter ending June 2023	Quarter ending March 2025	Change in % of patients seen within 7 days of discharge
NHS Ayrshire and Arran	87.25%	77.78%	-9.47
NHS Borders	89.29%	100%	+ 10.71
NHS Dumfries and Galloway	57.66%	11.33%	-46.33
NHS Fife	29.46%	32.21%	+ 2.75
NHS Forth Valley	94.16%	84.08%	-10.08
NHS Grampian	41.33%	59.73%	+ 18.40
NHS Greater Glasgow and Clyde	66.37%	72.03% (quarter ending December 2024)	+ 5.66
NHS Highland	14.88%	13.08%	-1.80
NHS Lanarkshire	NA	NA	NA
NHS Lothian	59.51%	66.35%	+ 6.84
NHS Tayside	41.53%	24.29%	-17.24
NHS Western Isles	69.23%	70%	+ 0.77

Source: Mental Health Quality Indicators

2. Support and services meeting individual needs

The second component of Summary Outcome 6 is support and services meet individual needs. There are seven metrics used to monitor this component.

Percentage of GP patients reporting improvements in mental health symptoms after a GP appointment

The HACE survey asks GP patients how they would describe the effect of the treatment or advice they received on the symptoms they were experiencing.

In the 2023/24 survey, among patients whose most recent GP appointment was for a mental health reason, 40% reported that their symptoms improved, 29% said symptoms stayed the same, and 12% reported worsening. An additional 14% indicated it was too soon to assess the impact.

Number of community mental health and wellbeing funded projects aimed at supporting at-risk population groups

The 2023/24 Monitoring and Reporting Summary of the Scottish Government’s Communities Mental Health and Wellbeing Fund provides data on the number of community-based projects that supported at-risk groups. These at-risk groups were identified by the Fund as priority populations. TSI areas were asked to record up to three at-risk groups that were supported by each project

In 2023/24, the Community Mental Health and Wellbeing Fund supported a wide range of projects aimed at improving mental health and wellbeing across different population groups. The most commonly supported groups were:

• People facing socio-economic disadvantage (554 projects)
• Families with a disabled family member (548 projects)
• People with a long-term health condition or disability (537 projects)
• Lone parents (511 projects)

Other commonly supported groups included older people aged 50 and above (427), people experiencing severe and multiple disadvantage (401), families with 3 children (386), people with diagnosed mental illness (363), minority ethnic families (316), mothers aged less than 25 (314), families where the youngest children are under 1 year old (312), and people affected by psychological trauma including adverse childhood experiences (280).

In comparison, the most commonly supported groups in year two (22/23) were people facing socio-economic disadvantage (684 projects), people with a long-term health condition or disability (548 projects), older people (479 projects), people with diagnosed mental illness (406 projects), and people disadvantaged by geographical location (particularly remote and rural areas) (277 projects).

Analysis of project returns shows that 56% of projects in year three (845 projects) supported people from at least one of the six priority at-risk family groups identified in the Best Start, Bright Futures: Tackling Child Poverty Delivery Plan 2022 to 2026. This compares to 24% of projects in 2022/23. The table below compares the percentage of projects that support people from the six priority at-risk family groups between year two and year three.

Table 14: Percentage of funded community mental health and wellbeing projects who supported people from at least one of the priority at-risk family groups, year two and year three

Priority at-risk group	2022/23	2023/24
Families with a disabled member	18%	44%
Lone parents	19%	41%
Families with three or more children	15%	31%
Minority ethnic families	14%	25%
Mothers under the age of 25	14%	24%
Families with children under age one	13%	23%

Source: Community Mental Health and Wellbeing Fund

Percentage of welfare guardianship care plans considered person-centred

The Mental Welfare Commission for Scotland monitors the use of welfare guardianship orders [2] under the Adults with Incapacity (Scotland) Act 2000, as part of its safeguarding role for adults with mental illness, learning disability, dementia, and related conditions. The Commission defines person-centred care plans as those that reflect each individual’s hopes and aspirations.

In 2023/24, 19,078 individuals were subject to a welfare guardianship order. The Commission visited 327 [3] of these individuals, reviewing care plans for 295. Of those, 80.4% (n=263) were considered person-centred. This is a slight decrease from 2022/23, when 83% of 196 care plans met this standard.

Percentage of GP patients with a mental health condition who felt people took account of the things that mattered to them

The HACE survey asks GP patients if people took account of the things that mattered to them. This metric provides insight into holistic support by measuring whether people feel their priorities and preferences are taken into account. This data is available from PHS’s Mental Health Quality Indicators.

In the 2023/24 survey, 56% of patients with a mental health condition agreed that people took account of the things that mattered to them.

Percentage of GP patients with a mental health condition who were given the opportunity to involve people who mattered to them

The HACE survey asks GP patients whether they were given the opportunity to involve people who mattered to them. A whole-person, holistic approach involved supporting and including patients’ interpersonal relationships in their healthcare decisions.

In the 2023/24 survey, 47% of patients who contacted a GP for a mental health reason reported being given this opportunity. This was broadly consistent with the 49% of patients who attended for another reason.

Percentage of carers with a mental health condition who felt supported to continue in their caring role

The HACE survey asks carers whether they felt supported to continue in their caring role. Supporting carers is an important part of holistic, whole-person care, as enabling carers to continue in their role helps maintain the wellbeing of both the carer and the person they support. This data is available from PHS’s Mental Health Quality Indicators.

In 2023/24, 27% of carers with a mental health condition agreed that they felt supported to continue in their caring role.

Percentage of community-based mental health service users reporting improved outcomes

The Scottish Government collects data from local authorities on access to community-based mental health support for children, young people and their families. The latest report covers an interim nine-month period (July 2023 to March 2024), as reporting transitions from six-monthly to annual cycles aligned with the financial year. This change limits direct comparison with previous years.

Recovery-focused support also includes access to and impact of community-based services, which can help people maintain wellbeing and manage mental health in everyday life.

Data from local authorities for the interim nine-month period July 2023 to March 2024 show that 82,938 people used community-based supports and services, including 10,120 family members and carers.

• 78% of users accessed positive mental wellbeing services, which are generally preventative and may include self-guided or educational supports, such as digital cognitive behavioural therapy or wellbeing training.
• Of these service users, 24,425 (58%) reported an improved outcome. Among users of emotional distress services, 7,106 (58%) reported an improved outcome.
• For at-risk groups, 5,409 (71%) of positive mental wellbeing service users reported improvement, and 2,863 (52%) of emotional distress service users reported improvement.

Reflections on Summary Outcome 6

Summary Outcome 6 of the Mental Health and Wellbeing Strategy focuses on ensuring comprehensive support and services that promote, and support people’s mental health and wellbeing are available in a timely way that meets and respects individual needs.

Available data spans 2022 to 2025, providing a baseline around the time the Strategy was launched and early indications of emerging changes in access and provision

Metrics indicate a mixed picture for timely access to mental health support. Urgent GP appointments for mental health reasons are available to some patients on the same day, while others experience delays. NHS 24 call response times vary across the year, with longer waits in winter months. Referrals to Distress Brief Intervention services show an expansion in reach. Child and adolescent mental health services have improved in meeting waiting time standards, whereas adult psychological therapies continue to fall below national targets. Community follow-up after hospital discharge varies widely across health boards, and delayed discharges from inpatient care have increased slightly, highlighting ongoing challenges in ensuring consistent and timely access across services.

Metrics on service responsiveness and person-centred care indicate mixed outcomes. Mental health outcomes following GP appointments show that improvements are experienced by some patients, while others report little or no change. Community Mental Health and Wellbeing Fund projects address a broad range of targeted groups, demonstrating efforts to reach diverse populations, though the impact on individual outcomes requires ongoing monitoring. Person-centred care plans and consideration of patients’ priorities show that most, but not all, individuals experience care tailored to their needs. Opportunities to involve family and carers are provided to some patients, and a portion of carers report feeling supported in their role. Community-based supports show positive outcomes for many service users, including those in at-risk groups

Data gaps

There is one overarching data gap that limits the ability to fully monitor SO6.

Data on a range of support and services: While there is substantial information on timely access to mental health services, including waiting times and referral pathways, less is known about whether these services consistently respond to individual needs. Evidence on patient experience, person-centred care, and responsiveness remains limited.