Almost 5500 mental health care orders continues ‘upward trend’ in Scotland, figures show

The number of compulsory mental health treatments in Scotland has hit its highest level in at least 15 years, according to a watchdog report.

In 2016/2017, the Mental Welfare Commission was notified of 5,422 new episodes of the care orders being used – a rise of 8.2% on the previous period.

Its latest report shows just over half of emergency orders were found to have been approved by a mental health officer.

Dr Gary Morrison, executive director at the commission, said: “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.”

In 2001/02 there were 4,849 instances of compulsory treatment orders being used through old legislation.

The commission’s latest Mental Health Act Monitoring Report findings form part of a continued upwards trend, making the number of orders made through the legislation at its highest since it was introduced in 2003.

There are three routes to compulsory treatment. The sharpest rise of these was through emergency detention certificates – used 2,414 times in 2016/17 and up by 12% on the previous year.

Emergency orders are designed for “crisis” situations when a person who needs urgent care or treatment for mental ill health.

They can see someone kept in hospital for up to 72 hours.

Over the last 10 years the use of these certificates increased by 26%, with the most marked rises in Dumfries and Galloway and Greater Glasgow and Clyde Health Board.

The report also shows a continued reduction in the number of times a mental health officer approved an emergency detention order.

Mental health officers are specialist social workers and “should always” be involved in approving emergency detention certificates, said the commission.

In 2016/17, the report found just 54% of these certificates had the consent of a mental health officer.

The commission said the preferred route to compulsory treatment is through short-term detention orders, which “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 increased by 34% over the last 10 years, with the largest rises in Greater Glasgow and Clyde Health Board and Lothian Health Board.

Another method which can be used is through a compulsory treatment order, which increased by 22.9% – from 979 to 1,203 – over the 10-year period.

Mr Morrison added: “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.”

The Mental Welfare Commission has a statutory duty to monitor and publish information on the use of the act.

Maureen Watt, minister for mental health, said: “Our mental health law is based on rights and principles, and offers protection for patients where compulsory treatment is necessary.

“Any increase in compulsory treatments may represent the effects of more people coming forward for treatment and increased awareness and response to mental ill health.

“It’s also important to note that the largest proportion of people subject to compulsion are for short-term orders rather than long-term orders.

“We will continue to work with the Mental Welfare Commission and stakeholders both to ensure these orders are used correctly, and to promote patients’ rights more generally.

“Patient rights are a key part of our legislation and the new Mental Health Strategy.”

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