Report on Melville Unit finds dedicated staff, highlights need to strengthen safety and wellbeing of young people

The first in a series of visits to Child and Adolescent Mental Health Services (CAMHS) Inpatient units has found a mix of concerns for the safety and wellbeing of young people, alongside committed staff and positive initiatives at the Melville Unit in Edinburgh.

The joint unannounced visit was carried out in May 2025 by the Mental Welfare Commission for Scotland together with Healthcare Improvement Scotland, following a commitment from the Minister for Social Care, Mental Wellbeing and Sport to address national concerns about the care of young people in mental health units.

The Commission listened to the experiences of the young people in the unit during the visit. While young people reported feeling listened to by staff and staff were praised for their clear commitment and passion, the visit identified several critical areas requiring immediate action.

Key findings on safety and wellbeing of young people

The report presents a mixed picture of the care provided at Melville. On one hand, the Commission observed positive interactions between staff and young people, who reported feeling listened to by dedicated and passionate staff.

However, there were concerns for the safety and wellbeing of young people. A significant issue was the use of restraint. The report calls for urgent improvement when this highly restrictive response is used, noting a lack of detailed care plans and incomplete records. Of particular concern is the practice of nasogastric tube feeding under restraint, which requires immediate review to ensure it follows best practice and respects young people's involvement in decisions about their care.

The unit has also yet to ensure all care is lawful under the Mental Health Act, as our previous recommendations have yet to be fully acted on and embedded. The quality of care planning and communication with parents also requires improvement. Young people and their families reported a lack of activities, especially in the evenings and on weekends. Some young people said this meant they spent "too much time thinking their own thoughts," which directly impacts their recovery. The physical environment was also noted as requiring attention to ensure the safety of both staff and patients.

Julie Paterson, Chief Executive of the Mental Welfare Commission and Robbie Pearson, Chief Executive of Healthcare Improvement Scotland said:

“Inpatient care provides intensive support for children and young people experiencing acute mental health crises and it is crucial such care meets both legal requirements and standards for the safe delivery of care. This report has identified areas for improvement as well as good practice.  It is important the NHS Lothian addresses the recommendations and requirements with appropriate urgency.”

Claire Lamza, Executive Director (Nursing) of the Mental Welfare Commission for Scotland, said:

“The safety and wellbeing of vulnerable young people in specialist inpatient mental health units is a key priority for the Mental Welfare Commission. Several findings from our visit to Melville were concerning as they did not provide the quality of lawful care and treatment every young person has a right to.

“We recognize the dedication of staff at Melville who genuinely advocate for young people. However, decisive action from NHS Lothian is needed to address the issues identified in this joint report and in previous Commission visit reports. This must include honest reflection on why previous action plans and intentions have yet to deliver meaningful change for young people and their families.”

Nicola Killean, Children and Young People’s Commissioner Scotland, said:  

“I’m deeply concerned about the findings from the Mental Welfare Commission into the care of children at Melville Unit, which highlight potential rights breaches including the safe and lawful use of restraint.

“This is further worrying evidence about the use of restraint on children living in some of the most vulnerable situations. Alongside partners I have been raising my concerns with the Scottish Government about the use of restraint on children in mental health provision for over two years.  

“Following my recent letter before action, I am pleased that the Scottish Government has now confirmed that it will revise the statutory code of practice to include human rights-based guidance and put in place mandatory recording and reporting of restraint and seclusion. I have also been given assurances that it will designate the Mental Welfare Commission as the appropriate monitoring body. These steps must be taken urgently to protect children from harm.”