Compulsory treatment for mental ill health in Scotland – an analysis to inform future law reform

A new research report by the Mental Welfare Commission analyses the growing use of compulsory mental health treatment for people who are very unwell, and calls for changes to the system.

The report has been produced for the Scottish Mental Health Law Review as it nears completion of its work to review Scotland’s mental health act, which is now 20 years old. 

The report focuses on compulsory treatment orders (CTOs) which are one of legal mechanisms for providing care and treatment against the person’s will to someone who is very unwell.

It confirms that, as more people are being treated against their will every year, the way in which that treatment takes place has also changed, with a shift towards treatment in the community (living at home) rather than in hospital.

The new research also shows that minoritised ethnic groups are overrepresented among people on compulsory treatment orders compared to representation in the general population. Around 15% of individuals on both hospital and community CTOs were from minoritised ethnic groups, compared to 4% in the general population.

Dr Arun Chopra, medical director, Mental Welfare Commission, said:

“In this report we looked in detail at information about all CTOs to understand how this type of intervention has been used over the last 14 years in Scotland. 

“We focused on these orders because compulsory treatment orders (CTOs) initially last up to six months, but can be extended further, meaning an individual’s liberty is deprived or restricted for a prolonged period. 

“Our recommendations to the Scottish Mental Health Law Review team include asking them to look at whether duties to review detention and compulsion are currently being met, and to consider strengthening the law related to safeguards in how they are used.

“We are also asking them to review the data in our report that shows inequalities in how these compulsory treatment orders are used.

“For a number of years we have been raising concerns about the increasing use of compulsory treatment for mental ill health in Scotland. With increasing number of people being treated against their will, it is critically important that the law should be updated and kept relevant.”

The Mental Welfare Commission has statutory duties to monitor aspects of the use of mental health law in Scotland.
The research report was submitted to the Scottish Mental Health Law Review team on 31 May 2022.