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Routes into hospital

Forty per cent of the individuals we visited during this monitoring exercise were already in hospital informally before they became subject to a STDC.  29% were admitted from the community on a STDC; 27% of individuals had been on an emergency detention certificate (EDC) first - although there were some regional variations in relation to use of emergency detention.. The proportion of men and women who were on EDCs prior to an STDC was about the same. A small number of the people we visited had been on community CTOs, or subject to English legislation before transferring to Scotland on a STDC.

In many of the cases we looked at, the circumstances which led to an EDC being used initially included:

  • absconding during the assessment process;
  • being found mentally disordered in a public place;
  • being thought at risk of self-harm/suicide; or
  • a threat of harm to others.

In these situations an EDC is likely to be the appropriate option. Occasionally however it was recorded that there had been an awareness of the deterioration in someone's presentation, sometimes for a number of weeks, beforehand. It may be that where services are mainly hospital focussed and lack developed community early intervention procedures there can be an attitude of helplessness in the mental health service, waiting for the inevitable crisis to occur when detention in hospital becomes the only option. We believe that health and social care teams, their out of hours services and the community and social care resources available in an area, should be organised in a way that reduces the impact of these factors on whether an EDC or a STDC is sought.

Relatives can often be the first to notice and report changes and attempt to get assistance, as in this example:

"From reports in the file it was clear that M had been showing increasing symptoms of illness for a number of weeks.It came to a head when he was 'full of grandiose plans'.He was clearly unwell to his parents and they called the CPN service. The parents tried to prevent him going and called the police.When he left the house, the police intervened and took him to hospital, where he was detained on an EDC in the small hours"

In some of these cases, a more pro-active response to the concerns raised by relatives or others might have resulted in avoidance of emergency admission.More and more areas of Scotland now have a community-based response team that can offer intensive support and intervention in a crisis, to avoid this leading to admission. It is acknowledged that despite best efforts hospital admission may still be necessary.