SHETLAND spends nearly 10 times as much per head on young people's mental health as Orkney and considerably more than most other health boards, a report shows.
The figures, contained in Audit Scotland's newly released Children and young people's mental health, show a wide disparity in spending per head between health boards, with the three most expensive treating mental health patients in-house.
Shetland, the report shows, spent £66,077 on children and adolescent mental health services (CAMHS) per 1,000 people under 18 years old in financial year 2016/17.
This compares with a meagre £6,649 in Orkney and £1,410 in Highland region. By contrast the regions with inpatient facilities – Lothian, Greater Glasgow and Tayside - spent £75,188, £86,583 and £86,674 respectively.
The Western Isles spends almost as much as Shetland at £60,086 per 1,000 young people.
NHS Shetland director of nursing and acute services Kathleen Carolan could not account for the disparity in spending between Shetland and Orkney as she did not "know what resources they have allocated to CAMHS services there for comparison purposes".
In an email response to the report, Carolan said that changes to the CAMHS team had been made after listening to families' experiences of accessing CAMHS in Shetland.
It emerged that having a point of contact while waiting for an assessment and reducing the time to treatment were priorities for users.
Carolan added: "In 2016, CAMHS put in place a named nurse system so that families have a point of contact and introduced a referral prioritisation process, so that children with the greatest priority would been seen more quickly.
"CAMHS now also offers access to group therapy. With these changes and more time for the clinicians to see children, we have been able to provide a better, more responsive service resulting in lower than (national) average waiting times for treatment in Shetland and consistently meeting the 18 week referral to treatment time target. This is against a backdrop of increasing referrals, again as reflected in the national report."
The CAMHS team got a small funding increase via national allocations, enabling the appointment of a second community psychiatric nurse and an increase in time available for the CAMHS consultant psychiatrist and consultant psychologists.
Carolan said the CAMHS team was looking to identify and support those who "experienced adverse childhood events" and prioritised referrals for young people who have experienced care or who are looked after by statutory services.
CAMHS had a key role in supporting very young children and had links with specialist services on mainland Scotland such as perinatal care.
The team also works closely with adult mental health and learning disabilities to ensure that when a young person is ready to move to adult services, then the necessary work has taken place for this to be as smooth a transition as possible.
The report cautions that the figures are far from comprehensive, owing to inconsistencies in reporting criteria and even in mental health referral criteria.
It adds that the "current system is complex and fragmented, making it difficult for children and young people to get the support they need".
The Audit Scotland report says that nationally crucial early intervention is being hindered by "a lack of oversight of the whole system" and "boundaries between services" which stems from "services at different tiers" being "funded and provided by different organisations".
CAMHS patients in Shetland and the other islands have the shortest waiting times in Scotland, averaging five weeks between referral and first appointment against a national average of 11 weeks. Five health boards rank above the average, with the worst being Grampian, where children wait on average 21 weeks.
Over the past five years, overall referral to CAMHS has risen 22 per cent, from 27,271 to 33,270, with a 24 per cent increase in rejected referrals to 7,199. NHS Shetland was the only board not to see an increase in referrals in 2017/18 compared with 2013/14.
The Scottish Government committed to spending more than £1 billion on mental health services in the last financial year, but it is unclear how much of that exactly went to CAMHS owing to poor data.
Some health boards do not include expenditure on psychology or treatment of ADHD among their figures.
It is especially difficult to pinpoint local authority spending on young people's mental health as often the cost is spread across various budgets.