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Geographical variations in the use of mental health law in Scotland

 

No. and rate per 100k population of compulsory powers granted, by order type and NHS Board 2009-10

 

AR-09-10-Table13

Our interest in this

Most people who are detained under the Mental Health (Care & Treatment) (Scotland) Act 2003 are held for up to 72 hours (emergency detention) or 28 days (short-term detention). 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 more people with severe and enduring mental illness tend to live in inner city areas, we usually find detention rates higher in these areas. Emergency detention can be high in rural areas because it is less easy to get both an approved medical practitioner and a mental health officer for short-term detention. 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. It could also mean that people are being persuaded to be in hospital when they want to leave. In some circumstances, this can mean an individual is, to all intents, "detained" but without the safeguards of the Act.

What we found

We looked at this year's figures and compared them with the previous three years. Our main findings are:

  • Dumfries and Galloway has the highest rate of emergency detention for the third consecutive year. This should be a matter of concern for the NHS Board and the local authority. They should look into the reasons for this. Given that consent from mental health officers is around the national average, it may be that there is low availability of approved medical practitioners. Also, it may be that there are insufficient crisis services in these areas.
  • Greater Glasgow and Clyde has by far the highest rate of short-term detention. This area also has a high rate of emergency detention, especially without mental health officer consent. While we expect to see high use of the Act in inner cities, there has been an increase in this NHS Board area of 9% compared with a 4% fall in other NHS Board areas. The excess in Glasgow appears to be mainly people under 65 (64 per 100k in GG&C, 42 per 100k elsewhere). See figure below.
  • Borders and Grampian had very low use of emergency detention and Borders had the lowest use of short-term detention.

The areas we have identified as especially high or low users should consider the reasons for this. They may wish to consider:

  • Are there distinctive features of the population in areas of high use of EDC and STDC? For example, is drug use, especially in Glasgow and surrounding areas, a particular problem causing or complicating mental illness?
  • Are there distinctive features of mental health services in areas of especially high or low use? For example, do areas with high use of emergency and short-term detention have good enough crisis services?

 

Rates of short-term detention by age for NHS Greater Glasgow & Clyde compared with other NHS Board areas 2009-10

Fig-13c

 

No. and rate per 100k population of short-term detentions and compulsory treatment orders by local authority 2009-10

 

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Our interest in  this

We have an interest in ensuring that people are getting the care and treatment they need regardless of where they may live. We therefore take an interest in variations in the use of civil compulsory orders by NHS Board area.  We also 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 the highest rates of detention. Some of this data may be skewed by "out-of area" placements.

What we found

Glasgow City and Dundee City have very high rates of short-term detention. Argyll and Bute Council has shown a particularly high rate this year, which is a new finding.

CTO rates are also high in Glasgow and Argyll and Bute. Highland Council also has a high rate of CTOs.

Other rural or more affluent areas have low use of mental health legislation.

For number and rates of compulsory orders granted by NHS Boards see compulsory treatment orders by NHS Board.