Scottish adult mental health services are still largely based in hospitals, according to an Accounts Commission for Scotland study.
Most trusts lack the financial and management information they need to manage the shift from institutional to community- based care, the report says. It points out that 80 per cent of the pounds214m spent on adult mental health services in Scotland goes on inpatient care.
Many trusts 'cannot readily identify in a meaningful way how this money is spent'. The commission tried to calculate service costs, but found that only seven of 15 major providers could provide the information requested.
'Without this information on the costs of services, it is difficult to see how, at a local or national level, the development of community services for adults with mental health problems can be achieved in a planned and managed way,' the report says.
The result is that services vary widely across Scotland, and are not related to local needs. Access to intensive psychiatric care is poor, while many people are still being admitted to hospital when they could be treated effectively in the community.
In a second report from the study, service users and their carers said they are not consulted over services, which should be available in the evenings and at weekends. Only one-third of Scottish trusts provide an out-of-hours service.
Adult Mental Health Services Bulletins 1 and 2, available free from the Accounts Commission for Scotland, 18 George Street, Edinburgh EH2 2QU. They can also be accessed via the commission's web site: http://www.scot-ac.gov.uk.