There has been a ‘clear increase’ in the number of people detained for mental health care during the pandemic, coupled with a reduction in safeguards when people have been detained, new figures from Scotland’s mental health watchdog out today show.

There was also an increase in the number of people who died while being detained.

In the years before covid, detentions had been rising at a rate of around 5% annually, but the latest figures covering 2020-21, show an increase of 9.1% - a rise to 10,059 detentions by the end of February 2021 from 9,222 in the 12 months prior to March 2020.

At the same time the number of emergency detentions that complied with necessary safeguards have also fallen below 50% for the first time in Scotland, down to 43.8%, according to the Mental Welfare Commission.

A mental health officer should be involved when a person undergoes emergency detention, with detention orders being used when someone needs treatment but is unable to consent to being taken into hospital. The safeguard of always having a mental health officer had already been reducing pre-pandemic. It has now dipped below 50% of emergency detentions – meaning more than half are made without a mental health officer’s consent.

The Commission also reports a rise in the numbers of detained patients who died in the period 2020-21 compared to previous years.

The Commission was notified of 147 people last year who died while being detained for treatment compared to an average of 110 people over the previous five years. Of the 147 deaths, 114 (77.6%) were non-covid-19 related, and 19 deaths were due to covid-19. 

The increase in deaths may however be due to improvements in the notification system following the Commission’s work on improving processes that follow any deaths of people who are subject to detention.

There was a particular increase in detentions in May 2020 – while Scotland was still in full lockdown in response to the first wave of covid-19 – which then remained higher than average for all emergency and short-term detentions, the Commission reports.

At around the same time, the Commission published a report calling for the length of time people with serious psychiatric conditions could be detained for to be shortened. The independent representative body said the system for supporting young people experience serious mental health issues in particular was “unwieldy and inefficient, if present at all”.

Mental health legislation in Scotland has been subject to review in recent years, recently through an independent review of the Mental Health Act undertaken by John Scott QC.

Dr Arun Chopra, Medical Director at the Mental Welfare Commission, said: “We do not know the reasons for the increased rise in people being detained under the law for treatment, but it is a concern. There is small but clear increased rise in the use of the Act this year that may be related to the pandemic.

“In checking for a potential link with the pandemic, we looked at whether there were more people detained in an emergency last year who did not have a history of detention in the past, but we found that the proportion of people who had or did not have previous episodes were the same last year, as in previous years.

“We can say that pandemic exacerbated existing problems with the law. We are some years away from any new legislation that may follow recommendations from the independent review into Scottish Mental Health Law.”

The rise reported today was seen on all types of detention from shorter to longer periods of detention.

Increases in the number of detentions occurred mainly within Scotland’s larger health boards, including Lothian, Lanarkshire and Greater Glasgow and Clyde.

The most significant rise was in people being detained for up to 28 days under a short-term detention order. These rose by 9.5% compared to an average rise of 3.9% over previous years.

‘Sharp increases’ in compulsory treatment orders took place in Ayrshire and Arran, Dumfries and Galloway, Fife, and Lothian. Overall, there was a continued downward trend in detentions in Highland.

Dr Chopra added: “In the meantime, best practice is not being realised and we will continue to raise our concerns over the lack of mental health officer consent to detentions. 

“We make recommendations to health and social care partnerships on this issue, and also to the Scottish government, asking government to take account of this report in its review of the mental health officer workforce.

“Further work is underway in the Commission specifically on deaths of people who have been detained for mental health care and treatment, and this will report next year.

“We recognise that while this report presents data at a population level, every incident relates to a person and those important to them.”

Scottish government Minister for Mental Wellbeing and Social Care Kevin Stewart said he accepts more needs to be done to improve mental health officer capacity:

“Mental health officers (MHO) are critically important as they protect and safeguard the rights of vulnerable people with mental health conditions. Covid has increased pressures on this vital workforce, as this report clearly indicates.

“We’re committed to addressing a shortfall in the MHO workforce by 2023 as part of our wider Integrated Health and Social Care Workforce Plan and we are investing £1.5m over three years to support local authorities and Health and Social Care Partnerships in training additional MHOs.

“While it is the responsibility of local authorities to ensure they have the appropriate levels of MHOs in place, we are working closely with COSLA, Social Work Scotland, the Scottish Association of Social Work, the Scottish Social Services Council and others to progress a range of actions to improve workforce capacity and MHO training both in the immediate and longer-term.”

 

Read more: New NHS board advised for forensic mental health care; Rise in teen mental health detentions; Call for mental illness detention times to be cut

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