Mental Welfare Commission annual report 2019-20

The Mental Welfare Commission today published its annual report for 2019-20, with visits to wards and services, monitoring the use of legislation, and law reform amongst the year’s highlights.

In March, the Commission also began publishing Covid-19 advice notes for health and care professionals, and for families and carers, as services sought to adapt to pandemic restrictions.

During 2019-20, the Commission conducted 127 local visits to hospitals, secure units, specialist units and prisons, and three national themed visits. Reports are published after each visit, highlighting findings and giving recommendations for improvement where needed.

Delayed discharge from hospital

One of the Commission’s national themed visits was to rehabilitation wards. People often remain on these wards for long periods of time, averaging 582 days compared to 40 days on an acute mental health ward. Findings were mixed, with more access for patients to local communities than in the past, but a third of individuals were reported as being recorded as ‘delayed discharge’, waiting to leave hospital. The Commission recommended that integrated joint boards (IJBs) across Scotland review the circumstances of all those whose discharge had been delayed by over three months.

Eating disorders

The Commission undertook its first themed visit looking at care, treatment and support for people with eating disorders in Scotland and heard positive comments about inpatient care, but not enough support for families as they tried to manage at home.
The report also found confusion and conflict over responsibility for physical health monitoring between GPs and psychiatrists, and concerns about the focus on BMI (body mass index) alone as a criteria for referral and as an indicator of recovery.

Monitoring the use of the law in care and treatment

In monitoring the use of the Adults with Incapacity Act, the Commission found that the number of guardianship orders (15,973) was the highest ever recorded, continuing a trend of recent years. Seventy four per cent of granted guardianship orders were private, from relatives or friends, and the remainder from local authorities. 

Law reform 

The Commission welcomes the Scottish Government’s commitment to reforming the Adults with Incapacity Act, which will be considered alongside the review of the Mental Health Act and adult support and protection legislation. 

Law reform was one of the recurring issues of the year, as the Commission engaged with a number of reports and consultations, including the Strang review into mental health services in Tayside, and the review of forensic mental health services.

The overarching piece of legislative reform remains the Scott review which published its first consultation in February 2020.

Sandy Riddell, Chair, Mental Welfare Commission, said: 

“This 2019-2020 annual report confirms the range of work that the Commission undertook last year, with every activity aimed at protecting and promoting the rights of individuals.

“For the future, I believe the Scott review is an opportunity to truly reform and update our legislation and we will do all we can to support the team in its work.

“When the pandemic hit, I was hugely impressed with the way in which staff at all levels adapted and developed new ways of supporting services, immediately publishing advice notes covering a wide range of questions related to the new situation.

“We are very aware of the need to properly understand the impact that pandemic restrictions had, and continue to have, on care and treatment for patients and people in the community. Lessons must be learned by all, and we will play a role in that process”.

Julie Paterson was appointed chief executive of the Commission in August 2020, and said:

“This annual report confirms my earlier view where I was hugely impressed by the range of roles the Commission undertook, and by the way it operated across the country. There is so much good work in this report, and issues I will ensure we follow through.

“Coming to the Commission with a fresh eye, I also feel that while its work is well known by some, there are areas of the health and care sector who are maybe less aware of the Commission than perhaps they should be. 

“And there are parts of that external world that the Commission has the ability and powers to influence more than it is perhaps aware of.

“For me, taking on the role at this time is a fantastic opportunity and a privilege”.