The first in a series of visits to Child and Adolescent Mental Health Services (CAMHS) Inpatient units has found a mix of concerns for the safety and wellbeing of young people, alongside committed staff and positive initiatives at the Melville Unit in Edinburgh.
The joint unannounced visit was carried out in May 2025 by the Mental Welfare Commission for Scotland together with Healthcare Improvement Scotland, following a commitment from the Minister for Social Care, Mental Wellbeing and Sport to address national concerns about the care of young people in mental health units.
The Commission listened to the experiences of the young people in the unit during the visit. While young people reported feeling listened to by staff and staff were praised for their clear commitment and passion, the visit identified several critical areas requiring immediate action.
Key findings on safety and wellbeing of young people
The report presents a mixed picture of the care provided at Melville. On one hand, the Commission observed positive interactions between staff and young people, who reported feeling listened to by dedicated and passionate staff.
However, there were concerns for the safety and wellbeing of young people. A significant issue was the use of restraint. The report calls for urgent improvement when this highly restrictive response is used, noting a lack of detailed care plans and incomplete records.
Of particular concern is the practice of nasogastric tube feeding under restraint, which requires immediate review to ensure it follows best practice and respects young people’s involvement in decisions about their care.
The unit has also yet to ensure all care is lawful under the Mental Health Act, as our previous recommendations have yet to be fully acted on and embedded. The quality of care planning and communication with parents also requires improvement.
Young people and their families reported a lack of activities, especially in the evenings and on weekends. Some young people said this meant they spent “too much time thinking their own thoughts,” which directly impacts their recovery.
The physical environment was also noted as requiring attention to ensure the safety of both staff and patients.
Julie Paterson, Chief Executive of the Mental Welfare Commission and Robbie Pearson, Chief Executive of Healthcare Improvement Scotland said: “Inpatient care provides intensive support for children and young people experiencing acute mental health crises and it is crucial such care meets both legal requirements and standards for the safe delivery of care.
“This report has identified areas for improvement as well as good practice. It is important the NHS Lothian addresses the recommendations and requirements with appropriate urgency.”
Claire Lamza, Executive Director (Nursing) of the Mental Welfare Commission for Scotland, said: ““The safety and wellbeing of vulnerable young people in specialist inpatient mental health units is a key priority for the Mental Welfare Commission. Several findings from our visit to Melville were concerning as they did not provide the quality of lawful care and treatment every young person has a right to.
“We recognize the dedication of staff at Melville who genuinely advocate for young people. However, decisive action from NHS Lothian is needed to address the issues identified in this joint report and in previous Commission visit reports. This must include honest reflection on why previous action plans and intentions have yet to deliver meaningful change for young people and their families.”
Nicola Killean, Children and Young People’s Commissioner Scotland, said: “I’m deeply concerned about the findings from the Mental Welfare Commission into the care of children at Melville Unit, which highlight potential rights breaches including the safe and lawful use of restraint.
“This is further worrying evidence about the use of restraint on children living in some of the most vulnerable situations. Alongside partners I have been raising my concerns with the Scottish Government about the use of restraint on children in mental health provision for over two years.
“Following my recent letter before action, I am pleased that the Scottish Government has now confirmed that it will revise the statutory code of practice to include human rights-based guidance and put in place mandatory recording and reporting of restraint and seclusion.
“I have also been given assurances that it will designate the Mental Welfare Commission as the appropriate monitoring body. These steps must be taken urgently to protect children from harm.”
NHS Lothian says it is working to improve services for young people at the Melville Inpatient Unit after it accepted a joint report published today (Thursday 23 October) by Healthcare Improvement Scotland (HIS) and the Mental Welfare Commission (MWC).
A robust action plan is already well underway to address the report recommendations and improve care in the specialist Child and Adolescent Mental Health Service (CAMHS) unit which supports up to 12 young people with complex needs.
CAMHS has made significant progress in recruiting and retaining more skilled staff and developing new care pathways, with the report also highlighting positive staff interactions and their commitment and passion for working with young people.
However, Jim Crombie, Deputy Chief Executive for NHS Lothian, said that wider improvements were continuing across the unit. He added: “We want to reassure young people and families that we are committed to delivering safe, high-quality and effective care and we take the findings of the report extremely seriously.
“The safety and care of young people and staff is always our top priority. Restraint is only ever used in the unit as a last resort to prevent harm for young people or to staff or other patients.
“We introduced an initiative to reduce the use of restraint further, which was observed by HIS during the inspection, and has shown positive results. Systems are also in place to improve the recording, monitoring and auditing of restraints.
“We want to thank staff for their ongoing dedication and HIS and MWC for their expertise and guidance in shaping improvements to the mental health care of young people. We will welcome any forthcoming national guidance or best practice from these essential reviews.”
The action plan also includes work underway to improve multidisciplinary team dynamics through enhanced meeting structures, communication, collaboration and decision making to work more effectively with young people.
Since May 2025, a system has been in place to monitor legal authority for treating young people under the Mental Health Act, with enhanced managerial oversight and daily checks by registered nurses to ensure documentation is in place before administrating care.
Work also continues to expand meaningful evening and weekend activities for young people with regular reviews planned. Nurses will also receive refresher training to strengthen their therapeutic skills in individual and group settings.
A review of the physical environment of the Melville Unit, including looking at options for how best to provide care safely while meeting the needs of young people, is also well underway.
A copy of the report is available from Healthcare Improvement Scotland.
