Principles and the use of mental health and incapacity law - annual report now online

The Mental Welfare Commission has published its annual report on the use of mental health and incapacity law in Scotland.  The report details how these laws were used to provide care and treatment to around 6,500 people across Scotland. This year's report covers the period from April 2009 to March 2010 and spots longer term trends and differences in the use of the law, paying particular attention to equality issues such as age, gender and ethnicity.
http://reports.mwcscot.org.uk/annual_monitoring/annual_monitoring_intro.aspx.

Headline findings

Existing orders under mental health law

Around 2,000 people are subject to compulsory treatment orders at any one point in time. This is similar to the number of people detained under the previous Act. About a third of these people are treated in the community without the need for detention in hospital. This is in line with the principle of restricting people's freedom as little as possible.

People who have been on a compulsory treatment order for more than two years, are now more likely to be in the community than in hospital. It used to be the other way round. The review by the Tribunal at the two year point might have something to do with this.

New orders granted in 2009-10

There has been a 7% fall in the number of new episodes of detention over the last four years.  There have been fewer new episodes of compulsory treatment. The biggest drop has been in the number of emergency detentions, especially where the person is not detained further after 72 hours. We think one possible explanation for this may be that better crisis services have been put in place. Women are more likely than men to be detained under emergency powers.

While emergency detention from the community is falling, there are still a lot of people who are detained as an emergency when they are already in hospital.

The number of new short-term detentions and compulsory treatment orders are about the same as previous years.

Equality issues

Older people (aged 65 and over) are more likely to be detained under all types of order. The rise appears to be for people with dementia. We think that this is because practitioners are more likely to use the Act and its safeguards, than to admit people with dementia informally when they do not consent and are voicing or showing some resistance. In these circumstances, we think the rise is probably a good thing.

Young people in hospital should receive facilities and services that are appropriate for their age (whether detained or not). The number of young people admitted to non-specialist wards has risen again and has not met the Government's target of a 50% reduction. Our biggest concern is that several young people are in adult wards with no input from younger people's mental health services.

Our data on the ethnicity of people subject to mental health law is not complete and the population of Scotland has changed since the last census. Despite this, our data may suggest that people of black-African origin are more likely to be detained in Scotland. This is similar to findings in some parts of England

Geographical differences in the use of mental health law

Dumfries and Galloway has most emergency detentions per head of population. Greater Glasgow and Clyde has the highest rate of short-term detention.

Tayside and Greater Glasgow and Clyde have high overall rates of long term orders. Lanarkshire and Borders have low rates.

We think much of the variation is due to different practices and service provision, rather than differences between populations, in different geographical areas. High rates could mean that there are too few community services, or that practitioners are too ready to use compulsion. Low rates could mean that services are not responding to people's needs, or that people accept treatment under pressure that should really be subject the safeguards of the Act.

Other findings

There has been an increase in the number of people treated with electro-convulsive therapy who are unable to provide, or have refused to consent this year. This mirrors an increase in the use of ECT this year (see www.sean.org.uk for more information).

The use of welfare guardianship

There are now about 4,500 people subject to welfare guardianship - more than twice the number of people treated under mental health law.

The number of new welfare guardianship orders continues to increase. We have recorded a rise in the appointment of private individuals as guardians. The number of local authority applications has not gone up.

Most guardianship orders are for people with dementia or a learning disability. We are still concerned about indefinite orders for young people with a learning disability where there is no automatic review by a court or tribunal. This is not consistent with human rights law principles.

give your feedback...

The Commission wants to know what people think about the statistics it provides about the use of mental health and incapacity law. Is the information useful, does it answer the kinds of questions you have about how the law is being used overall? Do the statistics provide data that helps you to promote the principles in your service? A link to the survey is available on the annual monitoring reports pagehttp://reports.mwcscot.org.uk/annual_monitoring/
annual_monitoring_intro.aspx.

Get the credit you deserve...

More than ever it feels important for us to identify, share and celebrate best practice in mental health and learning disability services. The news on future budgets and spending is often depressing and we are all going to need us to learn fast to keep individual rights central in service development. We think the Principles into Practice Awards are a great way to give teams, projects and services that have kept their focus on  the principles the credit they deserve. They are also a great way to provide important learning about what works and how others have overcome barriers to provide principles based care and treatment.

More detail on the categories for entries can be found at http://www.principlesintopractice.net/PiP-Awards/PIP-Awards.aspx

Our survey said...

In August and September we carried out a survey to find out what people thought about Scotland's progress in putting the principles of good mental health care and treatment into practice.  We wanted to know whether people thought progress was being made, how far people think there is to go and where we need to focus our efforts.  Over 300 people responded and a report of the results can be found at http://www.principlesintopractice.net/
AboutthePrinciples/Oursurveysaid/whatyoutoldus.aspx

Join the conversation

We are now on twitter http://twitter.com/PIPNetwork. Our twitter page provides a daily roundup of what's in the news and relevant to mental health, learning disability and dementia. It's got a Scottish flavour and - being ready at around 11am - goes well with a cup of tea (The news equivalent to shortbread perhaps?) If you find the whole social networking thing a bit scary, you can also access our posts via the www.principlesintopractice.net homepage.