The final report of the Scottish Mental Health Law Review has called for changes beyond legal reform alone, including a major expansion of the powers and responsibilities of the Mental Welfare Commission.

Among the 995-page report, recommendations highlight that ministers strengthen the voices of people using the system and carers, reduce the need for coercion and fulfil human rights.

Established by the Scottish government to review current mental health and capacity laws – the first major review of mental health law in Scotland in more than two decades – the Scottish Mental Health Law Review (SMHLR) has published its final report after three years of work.

Significant changes and repeals of existing legislation are needed to better align service aims, with stronger duties placed on ministers and an expansion of the role and powers of the Mental Welfare Commission (MWC) to better support and protect people in Scotland’s mental health services, according to the report.

John Scott KC, the Chair of the Review, says:

“Our recommendations will bring Scotland in line with thinking and practice internationally as assessed against developing human rights standards, like the United Nations Convention on the Rights of Persons with Disabilities.”

The SMHLR says greater resources and improved staffing, as well as coordinated government action, will be necessary for positive change within the system.

Many recommendations concern expanding the MWC’s role, including in issuing guidance on, and monitoring and auditing, the use of force, detention and covert medication and the use of supervision and treatment orders.

The Scottish government should commission and resource the MWC to support the ‘reduction of coercion across health and social care settings which serve people with mental or intellectual disability’, according to the report.

This comes as the MWC calls for “urgent” action from health and social care partnerships to deliver on mental wellbeing and addiction strategies.

As part of delivering better services, the report states the powers and responsibilities of the MWC should be ‘strengthened in legislation’, including changes its core remit to ‘protect and promote the human rights of people with mental or intellectual disabilities’ – for individuals and by promoting systemic change.

One direct recommendation is for a ‘substantial increase in the statutory requirement to include people with lived experience’ on the board of the MWC, with greater involvement in management and engagement.

Julie Paterson, Chief Executive of the MWC, says the organisation agrees that Scotland’s mental health and capacity laws need to be updated to focus much more on the individual and their rights, as she welcomed suggestions the MWC could receive more responsibility and a stronger role:

“The Commission is increasingly concerned about the capacity and ability of our health and social care services to provide the care and treatment that is needed in Scotland. If we can assist this work by doing more to support and challenge services, and in so doing improve the legal and delivery landscape for people with mental ill health, we will do it.

“This review report is a major opportunity to get it right for the future.”

The MWC currently carries out visits to mental healthcare settings – in which they recently highlighted staffing shortages in a number of units – and monitors existing legislation. This report proposes that he MWC should also take a lead role in reviewing health board’s psychiatric emergency plans.

There is currently no single scrutiny body with oversight across all mental health services, but the SMHLR proposes that the MWC leads in this capacity.

In its recommendations, the SMHLR says the MWC should lead a network of bodies – including Public Health Scotland, Healthcare Improvement Scotland, the Care Inspectorate, and Audit Scotland – involved in the scruitiny of mental health services.

This formalised network to scrutinise services should be developed with and work alongside the Scottish government, with a duty to fully involve people with lived experience.

The Minister for Mental Wellbeing and Social Care, Kevin Stewart, says the Scottish government will take time to carefully consider the report’s many recommendations.

Mr Scott KC says that action to tackle stigma and culture change can “begin at once”, to move toward ensuring people’s rights are respected, protected and enabled within the system:

“This will not be easy but is consistent with the developing picture in Scotland of human rights for everyone which should be clarified in the Scottish Government’s forthcoming Human Rights Bill.”

Read more: Early intervention in youth suicidality often missed; Suicide prevention to be about ‘creating hope’; Call to prioritise psychological therapies

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