Total number of orders in existence
This section of our report deals with the "prevalence" of orders under the Mental Health (Care & Treatment) Scotland Act 2003. For long term orders, this can be more meaningful than looking at new orders. We have worked hard over the last year to improve our knowledge of all long-term orders and have revised previous years' data to give an accurate picture of how the new Act has been used since its introduction. We found that, after an initial fall, the number of people on long-term compulsory orders has risen to the same level as the previous Act. The big difference is that a third of people are now treated outside hospital. The number of people on criminal procedure orders has stayed stable over this time.
** For the 1984 Act, "Transfer for Direction with Restriction Orders" were originally interpreted as "Hospital Directions". This error was noticed in April 09 and they should have been interpreted as "Transfer for Treatment Direction". This explains changes to the figures.
Our interest in these figures
Here we show all the orders that are in force on four dates throughout the year. This is known as "point-prevalence" data. We think this is very important information, especially for long-term orders. It helps us to see how community compulsory treatment is used over time. We thought the numbers of people on community based orders under the 2003 Act would rise, at least for a while, when the Act was introduced in 2005. We thought that this might correspond with a fall in the number of people detained in hospital under long-term orders.
What we found
The graph shows that the total number of people on compulsory treatment orders (CTOs) has been remarkably steady over the past four quarters. The number of people detained in hospital is falling at the same rate that community compulsory orders (CCTOs) are rising. We saw little change in the number of people treated under long-term orders after being convicted of a crime.
We looked back to see what happened from the introduction of the 2003 Act. This is shown in the graph. We worked hard to get this data as accurate as possible, so this will look a bit different from the numbers we published last year.
Key points are:
- The number of people on CTOs fell sharply during the first year. Some orders may have been revoked because people did not meet the stricter criteria of the new Act. Others may have ended because practitioners were unfamiliar with new procedures.
- Over 2006 and 2007, the total number of people on CTOs climbed back to the previous level of just over 1800 at any one time. This number has been remarkably stable from mid 2007 until now.
- Long-term detention in hospital has fallen by around one third (about 600 people) since the 2003 Act was introduced. It appears that these 600 people would now be treated under community orders. We think this is in line with the principle of least restriction of freedom.
- The number of people on CCTOs rose sharply from the introduction of the 2003 Act and continues to rise. The increase has been slowing down and looks as if it will stabilise at around 600 people.
- We need to keep monitoring this. It is important that responsible medical officers remember their duty to review the need for the orders regularly. We don't think they do this often enough.
Our interest in these figures
We comment on the number of new orders in different NHS Board areas in other parts of this report. This table shows the total number of people in each area who are subject to compulsory treatment on one date during the year. In our experience, this is a good guide to the overall use of compulsion in each NHS Board area. We look to see which are the highest and lowest areas and try to explain the differences.
What we found
We consistently find that NHS Tayside has the highest use of compulsory treatment of all NHS Board areas in Scotland. This year is no exception. NHS Tayside's use of compulsion is 23% higher than the Scottish average. NHS Lanarkshire's use is 34% below the average, with NHS Borders also being low. These NHS Boards need to look at reasons for this. We have had useful discussions with NHS Lanarkshire. Factors which appear to affect use are:
- Urban versus rural populations
- Culture and attitudes of practitioners
- Availability of early intervention, treatment and support
- Use of alcohol and drugs
This is an area that needs more research. We need to understand why someone in NHS Tayside is more than twice as likely to be given compulsory treatment than someone in NHS Lanarkshire.
