Young people detained for mental health treatment – self harm is a key characteristic

The Mental Welfare Commission today published a new report analysing the detentions of young people aged 16 and 17 for mental health care and treatment in Scotland, and found self harm to be a key characteristic, particularly with young women.

There has been a rising number of detentions in this age group, and the Commission sought to understand better the characteristics and presentations of those young people detained for their care.

The new report analysed all detention forms for 16 and 17 year olds in Scotland over a five year period from 2014-15 to 2018-19. This amounted to 608 detentions under the Mental Health Act over the five years, relating to 402 young people. 

There are two ways those detentions can take place. Most of the young people (421) were detained using short term detention certificates, which last up to 28 days and 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, were used in 187 cases.

Numbers of 16 and 17 year olds being detained in Scotland under the Mental Health Act have risen from 106 in 2014-15, to 173 in 2018-19 - the five year period cover by the report.

Information reviewed included the reason for the detention and any other underlying mental health conditions noted on the detention forms. Key findings are:

• Over the five-year period, 60% of detained patients displayed self-harming behaviours (suicidality or deliberate self-harm). This was higher in those detained on emergency detention certificates (EDCs) compared to short term detention certificates (STDCs) (74% and 53%, respectively). 
• There has been a rise in the proportion of detentions in which self-harming behaviour is reported over the last five years.  
• There has been an increase in detentions in which self-harming behaviour was reported in girls, whilst detentions reporting self-harming in boys decreased. 
• Most (81%) of the emergency detentions occurred during out-of-hours (weekends and 5pm-9am on weekdays) and 38% of STDCs occurred out-of- hours. 
• Only 51% of emergency detentions had consent of a mental health officer (MHO).
• Most detentions related to concerns about the patient’s own safety, though boys more often presented as a risk to themselves and to other people compared to girls. 
• Psychotic symptoms/disorder was the most common presentation in all detentions (40%), with a higher proportion among boys than girls (54% and 32%, respectively). 
• Mood disorder/difficulties was described in 35% of patients, with an equal distribution in boys and girls (35% and 35%, respectively). 
• Substance use (confirmed or suspected) was indicated in seven percent of detentions, higher among boys than girls (12% and 4%, respectively).

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

‘Mental illness in young people can be short term, or can be the start of a prolonged period of difficulty. It can disrupt education, the development of friendships and the transition into adulthood, significantly affecting both the young person and their family or carers. Getting the right help early can make a major difference.
‘We conducted this analysis because we knew that detentions of young people were rising, and we wanted to understand better the characteristics and presentations of young people who are so unwell that they need treated under the law. Our analysis does not attempt to say why the detentions are increasing, but it does give information on these two key issues.
“We now aim to share these findings and hope they might be a helpful contribution for young people, those important to them and the services and clinicians working with them, in considering who might be supported by developing intensive treatment services in the community and alternatives to hospital admissions. 
“I am really glad to say we have a meeting later this month with clinical leads where this report, and the experience of family and carers, will be discussed.”

Personal experience from a parent

While the report contains detailed research information, the Commission is very aware that each detention relates to an individual. The detention of a young person can be traumatic for that young person and for their family. The Commission sought comment from the parent of a young person who was detained for treatment. That parent, whom we quote anonymously, found the experience very difficult, both due to her daughter’s ill health, and also due to the experience for family in dealing with the system and the way they were treated by professionals. 

The parent welcomed the report, but also said:

“Our daughter struggles with bipolar disorder and anorexia. Sadly, as parents we have supported her through multiple crises, with hospital admissions for her eating disorder and serious near fatal overdoses during the years of her adolescence. 
‘At our most terrified and vulnerable, we have felt utterly alone, despite “on paper” multiple services and agencies involved. Even if we were invited into the room, it often felt “token”, being brought in at the end of a consultation, for example to arrange a review date, after the real discussion had already taken place. Of course we understood and respected our daughter’s need for confidentiality, but there felt no true or meaningful connection with us as her family: we were so aware of every change in her behaviours or moods. Over time, this left us drained, exhausted and took its toll on our own mental health, at the very point we needed support to keep some strength and resilience.
‘If I could distil down something constructive and pour it into all the services we’ve been through, it would be this - we desperately want to get things the best they can be, not waste precious energy battling nor trying to be heard. Your “patient” is our whole world: we’re living this; we’re probably exhausted, scared, at our most vulnerable, and juggling other family or work commitments too. Please connect with us as human beings and take time to listen to what we have to say.”