National Overview Report published following joint visits/inspections of all four children and young people's inpatient mental health units in Scotland

Healthcare Improvement Scotland and the Mental Welfare Commission for Scotland today (Tuesday 3 March) published a national overview report following a programme of joint unannounced visits and inspections to all four of Scotland's Tier 4 children and young people's inpatient mental health units.

Tier 4 services are highly specialised inpatient settings for children and young people who require assessment and treatment for complex mental health needs.

Over the course of 2025, we jointly visited and inspected:

• Melville Unit, NHS Lothian (May 2025)
• National Child Psychiatry Inpatient Unit (Ward 4), NHS Greater Glasgow and Clyde (August 2025)
• Skye House, NHS Greater Glasgow and Clyde (August 2025)
• Dudhope Unit, NHS Tayside (October 2025)

Our overview report highlights:

Areas of good practice

Across the four units, we observed a number of positive developments and areas of good practice:

• Introduction of new innovative roles including care co-ordinators and physical health nurses (Melville Unit, Skye House, Dudhope Unit)
• All parents felt involved and included in the care planning process and were very satisfied with the care and treatment provided (Ward 4)
• Positive interactions observed between staff and young people (all units)
• Introduction of community meetings (Melville Unit, Skye House)
• Commitment to fill longstanding vacancies in social work (Skye House and Dudhope Unit) and to provide additional nursing establishment resource (Skye House)
• Rights-respecting school and education integral and available to all patients (Dudhope Unit)
• Treatment in place was fully authorised by mental health law (Ward 4, Dudhope Unit)
• Available, accessible and age specific information (Ward 4, Dudhope Unit)
• Development of detailed online digital resources for young people and their families (Dudhope Unit, Ward 4, Melville Unit)

Areas for improvement

However, we also identified significant areas for improvement that require urgent attention across the four sites:

• Culture and attitudes of some staff (Skye House)
• To build in discussion regarding the rights of young people to have an advance statement when they are well enough to do so e.g. at the point of discharge planning (all units)
• Board-wide seclusion policies need to be in place to underpin local seclusion guidance (Ward 4, Skye House, Dudhope Unit)
• The practical application and safe use of proportionate restraint as a last resort (Melville Unit)
• Timely completion of fire risk assessment improvement actions and fire safety maintenance (Ward 4, Skye House, Dudhope Unit)
• Safe maintenance of the care environment (all units)
• Need for robust multidisciplinary workforce models including social work, dietetics and psychology (Skye House, Melville Unit, Dudhope Unit)
• Timely review and implementation of lessons learned from reported incidents (Skye House, Melville Unit)

Speaking about the report, Robbie Pearson, Chief Executive of Healthcare Improvement Scotland, and Julie Paterson, Chief Executive of the Mental Welfare Commission for Scotland, said:

“All four reports evidence a range of good practice and positive experiences of children, young people, relatives and staff, as well as areas for improvement.

“However, there are inconsistencies across the units, in terms of the areas where units are performing well and the areas for improvement.

“Our overarching recommendation therefore is that learning must take place across all four units. Where there is good practice, this must be replicated where improvement is needed. 

“When a child or young person is admitted to hospital because of complex mental health needs, they are at their most vulnerable. They and their families have a right to expect consistent, high quality, compassionate care in a safe environment, no matter where in Scotland they receive this.”