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, as it allows us to look at the total number of people who are detained.
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 2003 Act has been used since its introduction (October 2005). We found that, after an initial fall, the number of people on long-term compulsory treatment orders has risen to the same level as the 1984 Act. The big difference, however, is that a third of people now receive long term compulsory care and treatment outside hospital.
The number of people on criminal procedure orders has stayed stable over this time.
Number of people subject to compulsory powers by type at quarterly census dates, 2009-10
*In these cases, we have made improvements to the way forms are validated, resulting in a much higher rate of confidence in results hence a substantial reduction where status is indeterminate.
** 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.
Point prevalence of compulsory treatment orders on four quarterly dates 2009-10
Our interest in this
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. 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 subject to compulsory treatment orders (CTOs) has been remarkably steady over the past four quarters. There are just under 2000 CTOs in existence at any one time. About a third of these orders are community-based.
The total number is about the same as the number of "section 18" long-term detentions under the old Act. More people are now treated in less restrictive ways, through the provision of compulsory treatment in the community. We are visiting as many people as we can on community CTOs this year to make sure that the orders are being used appropriately and reviewed often enough.
Number of people subject to compulsory powers on 6 January 2010, rate per 100,000, by NHS Board in rank order*
*Including indeterminate orders
Our interest in this
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. 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
What we found
- The high numbers of new orders in Greater Glasgow and Clyde is also reflected in the number of total orders in existence. This year, GG&C has the joint highest number of orders along with NHS Tayside.
- NHS Borders has the lowest number of orders in existence this year. Lanarkshire, always an area of low prevalence, is second lowest.
Trend in prevalence of compulsory treatment per 100,000 population by NHS Board 2007-8 to 2009-10
We looked at the point prevalence of compulsory treatment over the last three years and compared the ten mainland NHS Board areas. There is a striking consistency to these figures. There are areas that always have a high or low use of the Act. We recommend that NHS Boards with either very high, or very low, use of the legislation examine their practice. High using areas might be using legislation too often and may need to do more to intervene and engage people earlier in treatment. Low using areas may be failing to detain people who need care and treatment or may be using excessive persuasion, rather than formal detention.
Some of the variations and changes in the use of the 2003 Act may reflect the numbers of people detained in regional units. For example, the Ayr Clinic and the low secure learning disability forensic unit in Lynebank Hospital, Fife will have significant numbers of detained patients, enough to skew the numbers per head of population in a small NHS Board area.
The increasing use of the Act in Greater Glasgow and Clyde is a matter of concern. While some of the increase may be due to the opening of Rowanbank Medium Secure Unit, this only explains a small fraction of the increased use of the Act. We will be discussing these figures with representatives of NHS Greater Glasgow and Clyde and will continue to report on geographical variations.
