Director's introduction
Mental health and incapacity legislation - what we've found this year
Each year, we report on the use of the Mental Health (Care & Treatment) (Scotland) Act 2003 and on welfare guardianship under the Adults with Incapacity (Scotland) Act 2000. We look at new orders, existing orders and areas of the Acts that we think are particularly important for us to look at.
We spot trends and differences in the use of the Acts, paying particular attention to equality issues (e.g. age, gender and ethnicity). Here are the main findings from 2009-10.
New orders under the Mental Health (Care & Treatment) (Scotland) Act 2003
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 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.
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 CTO 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.
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.
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.
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).
Adults with Incapacity (Scotland) Act 2000 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.
