Concern over rising compulsory mental health treatment
New figures show Scotland has highest rates of compulsory mental health treatment in 15 years. This is part of a continued upwards trend, and means the number of new episodes of compulsory treatment using the Mental Health Act is the highest it has been in at least 15 years.
The new report includes a broader range of figures, and comparisons over the last 10 years, and shows wide variations across the country.
Dr Gary Morrison, Executive Director (Medical) at the Mental Welfare Commission, said: “In recent years the number of times the Mental Health Act has been used to give people compulsory treatment for mental illness in Scotland has risen steadily.
“We are once again concerned at the overall continued upwards trends, particularly in the use of one specific category of compulsory treatment – emergency detention, which has risen steeply. We are concerned because it was designed to be used only in times of crisis, and it affords fewer safeguards for the individual, yet the figures are showing that it is fast catching up on the more expected route to compulsory treatment.
“While we don’t know the causes for the rising figures, they could indicate a general increased pressure on mental health services, and possibly increased distress amongst patients as more people are being given compulsory, rather than voluntary, treatment.
“There are wide variations across the country. Higher levels in our most urban areas may be expected, but they don’t account for all of the differences.
“We hope to work with the Scottish Government and health authorities to get a better understanding of why these figures are increasing, and what they are telling us about services.”
Emergency detention certificates
There are three routes to compulsory treatment. The sharpest rise was in the use of emergency detention certificates, which was up by 12% on the previous year, and were used 2,414 times in the year. These certificates are designed to be used only in crisis situations to detain a person who needs urgent care or treatment for mental ill health. They can be issued by any doctor and allow someone to be kept in hospital for up to 72 hours.
The use of emergency detention certificates has increased by 26% across Scotland in the last 10 years, with the most marked rises in Dumfries and Galloway and Greater Glasgow and Clyde Health Board.
Short term detention certificates
The preferred route to compulsory treatment is through short term detention orders. They should only take place if recommended by a psychiatrist and a mental health officer. These certificates were used 2,905 times in 2016-17, an increase of 5% on the previous year.
The use of short term detention certificates has increased by 34% in the last 10 years, with the most marked rises in Greater Glasgow and Clyde Health Board and Lothian Health Board.
Compulsory treatment orders
The number of compulsory treatment orders completed each year has increased by 22.9% (979 to 1203) over the 10 year period.
The national rate for compulsory treatment orders has been rising steadily over the past 10 years (from 18.9 to 22.3 per 100,000). The rate of increase is slower than for emergency detention certificates (EDCs) or short term detention certificates (STDCs). The proportion of compulsory treatment orders which are community based has increased steadily over the last 10 years.
The report also shows a continued reduction in the number of times an emergency detention order is used with the approval of a mental health officer. Mental health officers are specialist social workers and they should always be involved in approving emergency detention certificates. In 2016-17 we found that 54% of these certificates had the consent of a mental health officer. The figures vary widely across health boards, with only 33% of emergency detention certificates in Greater Glasgow and Clyde being used with the consent of a mental health officer.
The Mental Welfare Commission has a statutory duty to monitor and publish information on the use of the Mental Health Act.
A full copy of the report can be found here.