Short-term detention under the Mental Health (Care & Treatment) (Scotland) Act 2008-09
Our interest in these figures
One of the intentions of the Mental Health (Care & Treatment) (Scotland) Act 2003 is that short-term detention certificates (STDCs) should be the usual starting point for an episode of compulsory treatment for a mental illness or disorder. Being detained under a STDC provides better individual safeguards than admission under emergency detention; an STDC involves examination by an approved medical practitioner (AMP) and consent from a mental health officer (MHO). Short term detention can last for up to 28 days.
We are interested in whether this power is equally applied across geographical areas, across genders and for people of different ages. We also compare our data from 2008-09 with previous years to see if there are any emerging trends in the use of detention.
What we found
Unlike our findings for the use of emergency detention, we found the gender balance in the use of STDCs roughly equal and with very little change over the past few years.
Slightly fewer people under 18 were detained on STDCs - 56 this year compared with 66 and 67 in the previous 2 years.
The use of STDCs for older people has fluctuated in the last few years but we have seen a rise in the use of short-term detention for people aged 65-84. 706 people in this age group detained under STDCs this year, compared with 621 in 2006-07 and 675 in 2007-08. This is a rise of 14% over 2 years. The use of short-term detention appears to be similar for men and women and cannot be explained by a rise of that size in the number of older people in Scotland. We think this reflects a greater use of mental health legislation for people with dementia.
We have had concerns that many people with dementia are kept in hospital and deprived of their liberty without the law being used properly. Also, we have found cases where we thought a person with dementia should have been detained earlier in order to safeguard their rights and well-being. We will continue to monitor this and are visiting people in acute older people's wards across Scotland to make sure they are getting the care they need.
Our interest in these figures
We are required to monitor the use of the 2003 Act. We need to know on what grounds people are being detained, to ensure individual detention is consistent with the letter and the principles of the law.
What we found
The majority of people subject to short-term detention have a mental illness diagnosis.
The number of people with a diagnosis of personality disorder receiving care and treatment under a STDC appears to have fallen slightly since 2007-08, from 133 to 111, although it is still higher than 2006-07 when only 42 people were recorded as having a personality disorder.
A small number of people who have a learning disability are detained under a short-term order. While the number is small we have recorded a significant increase in numbers of STDCs since 2007-08 (from 88 to 144 this year). Although the change in monitoring forms that took place in 2007 may have led to better recording and hence higher numbers, it is nevertheless a significant increase. Additional information regarding the use of mental health legislation for people with a learning disability will be available from our 2 yearly census. We will continue to monitor the use of mental health legislation for this group of people to ensure that people with a learning disability have the same freedoms, benefits and protections as other individuals under the law.
Our interest in these figures
People frequently present with more than one diagnosis. It is important to recognise the relative contributions of each category of mental disorder in order to ensure that they are getting the appropriate care and treatment.
What we found
The revised STDC forms allow us to determine more clearly the number of people receiving more than one diagnosis. The number of people receiving a diagnosis of personality disorder alone is little changed from the previous year; in combination with mental illness or learning disability there are small increases.
The main finding is the doubling of those with a diagnosis of learning disability and mental illness, from 45 in 2007-08 to 99 this year. Overall, there has been a 64% increase since 2007-08 in the number of people with a learning disability detained under STDC. As we said above, some of this increase may be due to new monitoring forms. More information will be provided through our our 2008 census report on the use of mental health legislation for people with a learning disability.
Our interest in these figures
The provision for individuals with a mental illness, learning disability or other mental disorder to have a named person was an important aspect of the 2003 Act. The appointment of a named person, trusted by the service user to take a specific interest in his or her care and treatment,was intended to provide a means by which a person's past and present views could be represented and could influence care and treatment decisions. Named persons should be consulted when an STDC is issued. We are aware that the implementation of this aspect of the 2003 Act has been less than complete.
What we found
There is a slight improvement in the consultation and recording of named persons. Nevertheless, as a clear requirement of the 2003 Act, it is disappointing that in 50% of cases, people treated under short-term detention received this treatment without the benefit of input from their named person. We will have more information about this aspect of the implementation of the 2003 Act in our 2009 monitoring report on short-term detentions.
Figure 2: Episodes of detention initiated by emergency and STD within and outside office hours 1st April 2008 to 31st March 2009
Our interest in these figures
The 2003 Act is clear that short-term detention should be the usual order used for compulsory admission. In previous years, we have found this is more likely to happen during office hours. At evenings, weekends and public holidays, emergency detention is more often used. We wanted to see if there was any change this year.
What we found
This year, around 80% of compulsory admissions during office hours are short-term detentions. Outside office hours, 80% are emergency detentions. As MHOs give consent for most out-of-hour emergency detentions, it appears that NHS Boards are not securing out of hours availability of AMPs who are required to carry out emergency assessments. We think that ensuring good availability of AMPs to review people within 24 hours of emergency admission is very important. NHS Boards that are not achieving this should look to see how the availability of AMPs can be extended.
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