Geographical variations in the use of mental health law in Scotland
Our interest in these figures
Most people who are detained under the Mental Health (Care & Treatment) Scotland Act 2003 are held for up to 72 hours (if on an emergency detention certificate) or 28 days (on a short-term detention certificate). Each year, we look at how these orders are used in different NHS Board areas. We always find large variations and causes are not easy to explain.
Because people with severe and enduring mental illness tend to live in inner city areas, we would expect to find detention rates higher in these areas. Emergency detentions can be higher in rural areas, because it is less easy to get an approved medical practitioner (AMP) and a mental health officer (MHO) that would be required to complete a short-term detention certificate. These differences however do not explain the geographical variations in practice that we see.
We are concerned that areas with high use may be intervening excessively where there may be alternatives to depriving people of their liberty. Low use could mean that people are not being adequately treated or protected. It could also mean that people are being persuaded to be in hospital when they want to leave. This can mean they are effectively being "detained", but without the range of safeguards provided by the law.
What we found
We looked at this year's figures and compared them with those from the previous two years. Our main findings, shown in the table above are:
NHS Dumfries and Galloway and NHS Greater Glasgow and Clyde have highest rates of emergency detention. NHS Dumfries and Galloway was highest last year.
As with the last two years, the highest rate of short-term detention was in NHS Greater Glasgow and Clyde, but this year the rate is 14% higher than any other NHS Board area and 6% higher than last year. Tayside, Lothian and Highland have the next highest rates. This has been a consistent pattern over the last three years.
Lanarkshire and Borders have the lowest rates of all mainland NHS Boards.
The areas we have identified as especially high or low users of the 2003 Act should consider the reasons for this.
We think these differences raise a number of issues for example:
- the potential interaction of drug use with mental illness, especially in Glasgow and surrounding areas and the resulting impact on services there;
- the distinctive features and culture of mental health services in different parts of Scotland;
- the interaction between crisis services provision, crisis planning and individual detentions.
Our interest in these figures
Compulsory treatment orders (CTOs) are used to authorise long-term compulsory treatment. Each year, we look at how these orders are used in different NHS Board areas. We always find large variations and causes are not easy to explain. Because people with severe and enduring mental illness tend to live in inner city areas, we usually find rates higher in these areas. This does not explain the variations that we see. We are concerned that areas with high use may be intervening excessively where there may be alternatives to depriving people of their liberty. Low use could mean that people are not being adequately treated or protected.
We find that numbers and rates differ greatly from year to year, so we looked at the average use in each mainland NHS Board area over the last three years.
What we found
We think that it is best to look at the average figures for the last three years. These show that:
- NHS Lanarkshire and NHS Ayrshire and Arran have low CTO rates
- The highest CTO rates are in NHS Fife and NHS Tayside with NHS Highland and NHS Lothian not far behind
- Despite having high rates of emergency and short-term detention, NHS Greater Glasgow and Clyde has a CTO rate lower than many other areas and closer to the national average.
The NHS Board areas that we have identified should examine this data and look for possible explanations. They should also look at our point prevalence data. NHS Tayside, in particular, has a very high use of long-term compulsory treatment, especially in hospital.
Our interest in these figures
Tables above show the variation in civil compulsory orders by NHS Board area. We also want to look for differences across local authority areas. There are differences and overlaps in boundaries, especially in Glasgow and Lanarkshire. We do not examine figures for emergency detention because so many orders are outside office hours and the MHO may be from a different local authority as part of a regional standby service. For short-term detention and compulsory treatment orders, we usually find that inner city local authorities have highest rates.
What we found
Glasgow City and Inverclyde have very high rates of short-term detention. These are the major reasons why NHS Greater Glasgow and Clyde has such a high rate.
Rates are generally higher in inner cities and large towns such as Aberdeen, Dundee, Perth and Stirling.
Rates are generally low in rural areas such as Moray and Aberdeenshire or relatively affluent areas such as East Dunbartonshire and East Renfrewshire.
Annual reports
- directors introduction
- overview of the Mental Health (Care & Treatment) (Scotland) Act 2003 introduction
- new orders granted in 2008-09
- total numbers of 2003 Act orders in existence
- monitoring our priority areas
- additional findings from our monitoring of mental health law
- our overview of the use of the Adults with Incapacity (Scotland) Act 2000