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Scotland's medium and low security forensic wards - good on care, but concerns over human rights

Publication date: 30 Aug, 2017

The Mental Welfare Commission today published its first Scotland-wide report on medium and low security forensic wards.

The report has positive findings related to staff and to patient care, but it highlights concerns over delays in patients moving on from medium and low security wards.

The Commission visited all 46 wards across the country - 14 of which are for medium secure patients, the remainder being low secure - and reviewed the care of 165 patients.

The report found that risk assessment, care planning, and access to advocacy was good. Most patients spoke well of their care and treatment, and of the staff who cared for them.

However, the Commission also found that there were patients in Scotland's medium secure units who had successfully appealed against the level of security in which they were held and were waiting to move on, but there were frustrations at the length of time this takes.

Sixty one patients in 24 of the wards in low security units were also waiting to move on, either to a rehabilitation bed or to a community setting.

The report identified variations across the country in the use of restrictions for patients, with no clear reason as to why some wards kept this to a minimum, whilst others did not.

One in five patients said they felt unsafe, or partially unsafe, at times in the ward.

Alison Thomson, Executive Director (Nursing) at the Mental Welfare Commission said:

"Many of our findings are good, including positive comments from patients about the staff who care for them, and good access to advocacy and psychological services. This is welcome.

"But we were concerned about the human rights of patients who are being held in conditions of excessive security due to a lack of suitable places to move on to. We found that even after they have successfully won appeals at a Mental Health Tribunal, some medium secure patients were waiting to move on for longer than need be.

"In turn, low secure units were often finding it difficult to take these patients, as they themselves were having difficulty finding suitable places in the community for people ready to leave.

"This backlog in moving people to the least restrictive situation must be addressed."

The full report contains recommendations for the Scottish Government, Health Boards/Integrated Joint Boards and the Scottish Patient Safety Programme Mental Health.

Note to editors

  1. All patients in Scotland's three medium secure units - Rowanbank Clinic in Glasgow, the Orchard Clinic in Edinburgh, and Rohallion Clinic in Perth - are detained in hospital under legislation.
  2. All of the patients we visited in low security wards were detained under legislation. On our visits we found that almost half of those patients were there due to detention under the Mental Health Act, and not criminal courts. Some will not have an offending history. The report refers to this issue.
  3. Since 2006, patients in the State Hospital - Scotland's only high security forensic hospital - have been able to contest their level of security with the Mental Health Tribunal. In November 2015, this option was extended to patients in Scotland's three medium secure units. We wanted to see if this change in legislation was having an effect on services. The report found (page 50) that successful appeals were putting pressure on services.
  4. This report focused on medium and low secure units only, as the Commission visits the State Hospital twice a year, and reports separately on these visits.

Mary Mowat: 0131 313 8786