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Monitoring care and treatment
Quarterly statistics report 1st April to 30th June 2008
Summary statistics are given in the text, please use links at bottom of page to download more detailed statistics.
Emergency and short-term detention
The Code of Practice, which supports good practice under the Act, makes it clear that the preferred route for a person into compulsory treatment is through the use of a short-term detention certificate.This route provides better safeguards for the patient than an emergency admission.For Scotland as a whole, 68% of all emergency detention certificates (EDCs) granted in the quarter had the consent of a mental health officer (MHO). 68% were granted out of hours (Table 80). Just under one third of EDCs in Scotland did not have MHO consent.
The law says that MHO consent for emergency detention should be sought where practicable.Table 79 shows variations between NHS board areas. Ayrshire and Arran show a relatively high proportion granted out of hours where 50% of all EDCs were granted without MHO consent.
There has been an increase - from 209 to 240 - in the total number of detention episodes initiated through emergency and short-term detentions, between the Apr-Jun quarter and the previous quarter (Table 58)This is in the context of an overall rise in the total number of episodes involving emergency or short term detention (from 970 to 1021) (Table 58).There is also an apparent slight increase from previous quarters in the numbers of emergency detentions of people already in hospital on an informal basis (from 507 to 572) and an increase in the number involving people living in the community (from 206 to 270) (Table 59a).
For Scotland as a whole, 68% of all emergency detention certificates (EDCs) granted in the quarter had the consent of a mental health officer (MHO), The law says that MHO consent for emergency detention should be sought where practicable.Just under one third of EDCs in Scotland did not have MHO consent.There has been little change in these proportions over the past 4 quarters and the wide variation between NHS boards persists (Table 79).69% of certificates were granted out of hours (Table 80). Table 80 suggests that Ayrshire and Arran and Lanarkshire have granted more than half of their EDCs in the quarter without MHO consent: the figures are 59% and 62% respectively.
Community-based compulsory treatment orders (CCTOs)
There was a sharp increase in the number of new community-based CTOs in the latest quarter. Numbers of cases of variation from a hospital to a community-based CTO (Table 2) remain unchanged from the last quarter. The number of people subject to community CTOs, who are temporarily recalled to hospital, shows little variation. The same is true for people on community based compulsion orders (Table 3).
Young People
Following a dip in numbers reported in the last quarter of 2007, the number of admissions of young people to non-specialist facilities reported was higher in the first quarter of 2008 (Figure 2). There has been a slight decrease in the under 16 figures in this quarter and a slight increase in the 16-17 group for the 2nd quarter of 2008.The total reported for April to June 2008 is 39. These admissions took place across all NHS areas (excluding island authorities).
Advance Statement over-rides
The number of advance statements being overridden has been decreasing over the last 4 quarters. The Commission has recognised that it is a priority to monitor this aspect of the Act, but, as advance statements have been little used, the number of over-rides tells us little about patient wishes being upheld.Recent analysis of reports of our visits to people subject to compulsory treatment orders suggests that around 10% of people in this sample of the detained population had made advance statements.The number of times advance statements are overridden has varied from 7 – 16 over the last four quarters. We think the potential of advance statements has not been fully realised by practitioners and service users and we would like to see practice develop in this area.
Point prevalence information
On the April 2008 census date, a total of 2538 people were subject to compulsion. Gender and age patterns amongst the census populations have changed little since the last report: 35% of people counted on the census date were women (Table 65).Women who were subject to compulsion on the census date were more likely to be on short-term orders than men. Men who were detained were more likely to be subject to criminal proceedings than women.
As pointed out in earlier reports, the fact that the number of women detained on our census dates has been consistently lower than that of men indicates that women are less likely than men to remain as detained patients. The age distribution on 2 April, as shown in pie charts (Figures 4a and 4b), differs between men and women who are detained. For example, there are proportionately more men in the 25-44 age band than women, and proportionately more women in the 45-64 and 65-84 age bands than men.
The data on CTOs shows that the total numbers of people on CTOs has been stable over the last year. The number of people on community-based orders has risen at the same rate that the number of people detained in hospital has fallen. We think this demonstrates care and treatment delivered in line with the principle of least restriction of freedom.
Adults with Incapacity Act activity
The total number of welfare guardianship applications notified to the Commission in the second quarter of 2008 was 328.250 welfare guardianship interlocutors were received during the quarter (Figure 4) compared with 230 in the previous quarter. The proportion of relative or carer applicants in interlocutors received during the most recent quarter is slightly lower at 53% than in the previous quarter when it was 57% (Table 71).For Scotland as a whole, there are now more private welfare guardianships granted, than where the local authority is the applicant (Table 70).
52% of all orders included both welfare and financial powers (Table 73).Women account for 59% of all interlocutors received in the quarter, although more men than women are made subject to guardianship orders in the under-65 age group.In this quarter, 68% of women subject to welfare guardianship were over 65 years old (Table 74).
The proportion of orders granted for an indefinite duration continues to be very high at 78%. In 96% of orders granted, the power to determine care and accommodation (or where the adult should reside) was included. There is a continued increase in the percentage of orders granted which include the power to give consent to medical treatments, research or supervise medication (Table 76); from 56% in the last quarter of 2007 to 75% and 80% in the first two quarters of 2008.
Criminal Proceedings
No community-based compulsion orders were granted in this quarter.The numbers of orders granted under criminal proceedings are very small by quarter. More detailed information is presented in our annual reports.
Ethnic Monitoring
The proportion of returns of ethnic minority monitoring forms is not yet sufficient for reporting purposes. We continue to be concerned that we are not able to report on this. We will be looking at other options for monitoring ethnicity in relation to the use of mental health legislation this year.
Orders granted by local authority
Admissions of children and young people to non-specialist wards
Emergency detention and short-term detention episode sequences
Quarterly statistics