Detentions for mental health care during the pandemic – new report

The Mental Welfare Commission today published a report analysing the use of detention of people for mental health care and treatment during the pandemic.

The Commission wanted to compare detentions in the first phase of the pandemic (1 March to 31 August, 2020) with the same period over the previous five years to see if there were any significant rises or falls in numbers. 

The Commission also sought to understand which forms of detention were used and how well each detention adhered to the law and best practice, and to do so both nationally and by health board. 
The report also records numbers of detained patients who died during this period compared to previous years, and whether there were any deaths linked to Covid-19.

Key findings

• There were 333 more detentions beginning in the period March to August in 2020 compared to the previous year. This is an increase of seven per cent, which is in line with rises in previous years.  Total numbers of detentions in the period was 5,057.
• Within that, the overall number of detentions dropped in March and April, followed by a sharp increase in May and stayed higher during the summer. This varied by type of detention. The drop and rise coincide with the first lockdown weeks and the immediate aftermath.
• There was a concerning reduction in emergency detentions that had the consent of a mental health officer (MHO) – all such detentions should have this safeguard. Overall, 45% had MHO consent, compared to the previous five years’ average, which was 53%. 
• There were great differences in number of detentions compared to average between health boards. There were higher-than-average emergency detentions of individuals with no previous detention episode in Lothian and Highland, while mental health officer consent for emergency detentions was lower than average in Borders, Fife, Forth Valley, Grampian, Greater Glasgow and Clyde, and Highland. 
• We were informed of 60 deaths of individuals who were detained for treatment in this period. This was higher than average for previous years (52 deaths), with evident impact of Covid-19, as eight deaths were due to Covid-19. 
• Significantly more deaths reported were of women and individuals aged 45-64 years and over 85 years. 

Dr Arun Chopra, medical director, Mental Welfare Commission, said:

“Our analysis of rates of detention is mostly reassuring. We found a rise in detentions of people for care and treatment, but this was in line with rises over recent years. This differs at the health board level, and we found that in some health board areas, there was a notable rise in the numbers of people being detained for the first time during the time period. 
“The lack of involvement of a mental health officer (MHO) in emergency detentions was even more apparent than usual. Fewer than half of emergency detentions involved a mental health officer; a specialist social worker who should be involved each time a patient is detained. The mental health officer safeguard is vital, as it allows for a different professional group to take part in the decision making process at point of detention. We continue to raise our concerns about this. 
“We will also work with the Scott review of the Mental Health Act team to discuss how to open up the debate about strengthening the mechanisms for this safeguard. In the Commission’s view, the law is not working as was intended when the Act was passed. 
“We found a rise in deaths of people in detention at this time, with eight deaths attributed to Covid-19. 
“We recognise that while this report presents data at a population level, every incident relates to a person. Further work is underway in the Commission on deaths of people who have been detained for mental health care and treatment.
“We will also continue to monitor and report on the number of detentions and activity in later phases of the pandemic.”
 

Note

There are two ways in which detentions can take place. Short term detention certificates, which last up to 28 days, are the usual route into hospital care under the law as there are more safeguards. 
Emergency detention certificates, which allow for a person to be held in hospital for up to 72 hours while their condition is assessed, are used only in emergencies.