Everyone has a right not to make a hospital their home

The Mental Welfare Commission today published Hospital is not home, a report on the circumstances of people with learning disability and complex needs who have been in hospital for 10 years or more.

We considered the circumstances of 55 people who were identified as having been in a learning disability or mental health hospital for over 10 years. 

We found that people are staying in hospital for too long; on average 18 years and two months. 

One of the key actions identified in the Scottish Government’s 2022 Coming Home Implementation report was the establishment of a Dynamic Support Register. This Register is to help to ensure that people remain in hospital only for as long as they need assessment and treatment. 

Whilst we found some evidence of commitment to inclusive and active discharge planning from hospital, there was also reluctance and concern regarding the availability and capacity of community care resources to safeguard the person and meet their needs. We also found that there is inconsistent interpretation across Scotland as to who should or should not be on the Register. We are therefore also concerned about those people in hospital for many years who have not made it onto the Register.

Background

It is well documented that people who remain in long-term hospital placements are adversely impacted, including the loss of independent living skills which often results in the person’s inability to manage or cope with day to day living outside of an institutionalised setting.  

Every person in Scotland has the qualified Article 8 human right to respect for their private and family life, home and correspondence. This right includes “a right to identity and personal development, and the right to establish and develop relationships with other human beings and the outside world”.  

Julie Paterson, chief executive, Mental Welfare Commission, said:

“The Scottish Government asked the Commission to review the care and treatment of people with learning disabilities and complex care needs who had remained in either a learning disability or mental health hospital for more than 10 years. 

“We found that the implementation of the Dynamic Support Register has yet to ensure the right to live independently and the right to be included in the community for a small but significant group of people on that register. 

“We also found that there may be people who are in hospital for long periods of time and who are not on any lists or register and are not subject to any legal safeguards. We want to ensure that they are not hidden nor forgotten”.

Dr Lesley Sawyers, Scotland Commissioner, Equality and Human Rights Commission (EHRC) said:

“The Equality and Human Rights Commission (EHRC) is deeply concerned by the findings of this new report by the Mental Welfare Commission for Scotland, which gives much-needed insight into the experiences of people held in hospital for over 10 years.

"Proper compliance with the equality legal framework is critical in all health and social care settings to ensure people have the support they need to make decisions about their care and independent living.

"The use of ‘informal’ arrangements, noted in this report, rather than procedures prescribed under Mental Health or Incapacity Legislation, is of particular concern. This was highlighted in the legal action we took in 2020 against NHS Greater Glasgow and Clyde for facilitating unlawful detention. 

"The Mental Welfare Commission’s findings that there are high numbers of unrecorded patients ‘living’ in hospitals for over 10 years, and in some cases more than 25 years, raises questions as to whether the public bodies involved are failing to meet their obligations under the Public Sector Equality Duty. 

"As Britain’s equality regulator, we are also concerned by the limited attempts made to provide specialist advocacy support to people in hospital for extended periods in Scotland, as this suggests the public bodies involved may be failing to act in the ‘anticipatory’ way required to meet the Equality Act’s reasonable adjustments duty.

"It is evident from these findings that the Scottish Government’s ‘Coming Home’ Strategy has not yet succeeded in its aim to ensure that people are only in hospital for as long as they require treatment. 

"We urge the Scottish Government and all health and social care agencies to pay close attention to these findings and take urgent action to ensure proper compliance with equality legal requirements.”