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Scotland's mental health rehabilitation wards - new report

Publication date: 30 Jan, 2020

The Mental Welfare Commission today published a new report on its visits to all 22 of Scotland’s NHS rehabilitation wards. 

Patients on these wards are likely to have severe and complex mental health needs and will have been in hospital for a long time. In comparison with acute mental health wards, where the average length of stay is 40 days, the length of stay for patients in rehabilitation services is much longer, averaging 582 days.

Given the impact of being in hospital for a prolonged period of time, the Commission wanted to review standards of care, and hear from patients and families/carers about their experience.

Commission staff visited 130 patients and spoke to 26 carers/family members. 


The overall findings in the report are mixed.

There were some improvements since the Commission’s last visit, such as patients regularly getting access to their local communities, and in assessment, care planning and reviews for patients, but this varied.

While 99 of the 130 patients were subject to compulsory treatment, the Commission found all such treatment was properly authorised.

Most patients were aware of advocacy, and 107 were actively in contact with advocacy services, saying they found advocacy to be helpful in supporting them on ward meetings and in a number of other general ways.

Families/carers were mostly positive about staff and services. Their main complaint was a lack of meaningful activity on the wards.

Only one service – in Greater Glasgow and Clyde – was accredited with the Royal College of Psychiatrists’ good practice standards for rehabilitation services.

A third of all patients were on delayed discharge, waiting to leave hospital. 
Forty three per cent of patients had at least one long term physical health problem, the most common being diabetes. Of 74 patients interviewed, the majority (45) smoked.

A significant number of patients said they had difficulties with the management of their money. Many managed their own money with support, others had their money managed for them.

Mike Diamond, executive director (social work), Mental Welfare Commission, said:

“We are keenly aware that there is always a risk that this group of patients fall by the wayside, as services focus on people whose needs present as more urgent or dynamic. Maintaining hope and a focus on recovery over a long period is vital.

“Rehabilitation should be seen as a highly skilled area, with expert staff and appropriate resources to help people who have often had difficult lives.

“While we see improvements since our last visit, this is not universal. One of our main recommendations from this report is to ask services to consider seeking accreditation with the Royal College of Psychiatrists’ national standards for mental health rehabilitation services. Currently only one health board – Greater Glasgow and Clyde – has such accreditation.

“We are concerned about the level of delayed discharge on these wards, and recommend that Integrated Joint Boards across Scotland review patients whose discharge has been delayed by over three months. 

“Services could be doing more to encourage patients to have a healthy active lifestyle, which in itself promotes recovery.”

The report includes comment from patients and from families/carers. Families described the negative impact of their relative’s illness on family relationships, and most families had not been directed to any support for themselves.