Human rights concern over rising levels of compulsory mental health treatment

The number of new episodes of compulsory treatment for mental ill health in Scotland rose last year to the highest level - at 5,008 new episodes - since the 2003 Mental Health Act was introduced.

Close to half (44%) of emergency detentions initiated by a doctor did not have the support and expertise of a mental health officer at the point when that decision was made.

The new data was released by the Mental Welfare Commission today, in its annual monitoring report examining national and regional use of the law in treating people for mental ill health. This aspect of the data raises concerns in the Commission about patients' human rights.

Other data, particularly the declining use of police stations as places of safety, was more positive.

Emergency detention

There are three forms of certification for compulsory treatment, and the most marked rise was in the use of emergency detention certificates, which are used in crisis situations to detain a person who needs urgent care or treatment for mental ill health.

These certificates can be issued by any doctor, and allow someone to be kept in hospital for up to 72 hours.

The Mental Health Act says that there should be consent from a specialist social worker - known as a mental health officer - wherever practicable when these certificates are used.

But while there was a 10% rise in the use of these certificates last year, only 56% of the total had the consent of a mental health officer.

Dr Gary Morrison, Executive Director (Medical) at the Mental Welfare Commission said:

"People who are very unwell, and need compulsory treatment for their mental ill health, are at their most vulnerable.

"A mental health officer can help explain the process, and can also look at alternative ways of supporting a person without needing compulsory treatment. If there is no mental health officer involved in this critical decision, some people may be detained unnecessarily.

"Others may find the experience of being told they will be detained much more traumatic than they would have done if a mental health officer had been there.

"The Commission's role is to protect and promote the human rights of people with mental health problems, so we take this issue seriously. There are significant variations across the country, and we expect those areas with low levels of mental health officer involvement to develop clear action plans for improvement."

Last year the Scottish Government asked the Commission to examine the reasons for low levels of mental health officer consent. In June 2016, the Commission published an audit which made recommendations for action by Scottish Government, local authorities and NHS Boards.

Following the publication of figures for the full year, the Commission will be following up these recommendations with the bodies concerned.

More people treated in the community
One significant change in recent years is that many more people who are subject to the Mental Health Act are being treated in the community, rather than in hospital. In 2006 only four per cent of people were treated through community based Compulsory Treatment Orders, but by last year that had risen to 40%.

Dr Morrison commented:

"We support treatment in the community wherever possible, and believe that community based Compulsory Treatment Orders have a valuable role to play. However, our recent report on the use of these orders highlighted that more needs to be done to help people plan for a future without the need for compulsory care."

Huge drop in use of police stations as place of safety

There was a rise in the number of people detained by police to a 'place of safety'. This relates to people who are mentally unwell and are removed by police from a public place.

Four years ago there were 591 such incidents, 18% of those detained were in a police station.

Last year there were 795 incidents, but only 1% of those detained were held in a police station.

This is a positive step, as a police station should only ever be used as a last resort.

The Commission plans to investigate in more detail how police officers use this power.

The full monitoring report can be found here.

Mary Mowat 0131 313 8786