Rising numbers, falling safeguards - new report shows a rise in numbers of people being detained for mental health care during the pandemic

The Mental Welfare Commission today published a report analysing the use of detention of people for mental health care and treatment during the pandemic.

While detentions had been rising pre-pandemic, the new report shows a 9.1% rise in detentions in year 2020-21, which is a clear increase on the average 5% rise over the previous five years.

The report also shows a drop in safeguards when people were detained. A mental health officer should be involved when a person undergoes emergency detention, and while that safeguard had been reducing pre-pandemic, for the first time, the percentage of emergency detentions without a mental health officer’s consent dropped below 50%.

The report also records numbers of detained patients who died during this period compared to previous years, and whether there were any deaths linked to Covid-19. 

The Commission found a rise in deaths that we were notified of – 147 people died while detained for treatment compared to an average of 110 people over the previous five years. Of the 147 deaths, 114 (77.6%) were non-Covid-19 related, and 19 deaths were due to Covid-19.  The increase in numbers reported may also be due to improvements in the notification system because of the Commission’s current work on improving processes that follow any deaths of people who are subject to detention. 

The report compares data from 1 March 2020 to 28 February 2021 with averages over the previous five years, and gives information at national and health board level. 

Key findings

• There were 9.1% more detentions in 2020-21 compared to 2019-20, with 10,059 detentions in the year, compared to 9,222 detentions in the previous year. This 9.1% rise compares to an average year-on-year rise of 5% for the previous five years, so this is a clear increase.
• The rise was seen on all types of detention from shorter to longer periods of detention*. Increases in number of detentions was mainly in the larger health boards. The most significant rise was in people being detained for up to 28 days under a short term detention order. These rose by 9.5% compared to an average rise of 3.9% over previous years.
• There was a particular increase in detentions in May 2020 which then remained higher than average for all emergency and short term detentions.
• Reducing numbers of detentions that had the consent of a mental health officer (a specialist social worker) had been a concern pre-pandemic but became more so during the pandemic. The percentage of detentions involving a mental health officer dropped from 51.7% to 43.8%.
• There were a total number of 147 deaths among people who were detained that we were notified of within the reporting year, compared to an average of 110 deaths per reporting year in the last five years.
• At local levels, there were more emergency detentions in Greater Glasgow and Clyde, Lothian and Lanarkshire, and sharp increases in short term detentions in Ayrshire and Arran, Fife, Forth Valley, Greater Glasgow and Clyde, and Lothian. 
• There were sharp increases in compulsory treatment orders in Ayrshire and Arran, Dumfries and Galloway, Fife, and Lothian. Overall there was a continued downward trend in detentions in Highland.

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

“We do not know the reasons for the increased rise in people being detained under the law for treatment, but it is a concern. There is small but clear increased rise in the use of the Act this year that may be related to the pandemic. 
“In checking for a potential link with the pandemic, we looked at whether there were more people detained in an emergency last year who did not have a history of detention in the past, but we found that the proportion of people who had or did not have previous episodes were the same last year, as in previous years. 
“We can say that pandemic exacerbated existing problems with the law. We are some years away from any new legislation that may follow recommendations from the Independent review into Scottish Mental Health Law. In the meantime, best practice is not being realised and we will continue to raise our concerns over the lack of mental health officer consent to detentions.  
“We make recommendations to health and social care partnerships on this issue, and also to the Scottish Government, asking government to take account of this report in its review of the mental health officer workforce. 
“Further work is underway in the Commission specifically on deaths of people who have been detained for mental health care and treatment, and this will report next year.
“We recognise that while this report presents data at a population level, every incident relates to a person and those important to them.”
 

Note to editors

1. *There are two ways in which detentions in hospital can take place. Short term detention certificates, which last up to 28 days, are the usual route into hospital care under the law as there are more safeguards. 
   Emergency detention certificates, which allow for a person to be held in hospital for up to 72 hours while their condition is assessed, are used only in emergencies.
   People can also be detained under a compulsory treatment order, which can last for up to six months and can mean they can be treated in the community.
2. This is the second such report produced by the Commission, this one covering a full year from 1 March 2020 to 28 February 2021, and the previous one covering the first six months of the pandemic.