Commission calls for consistent standards across Scotland’s child mental health units

A national overview report has been published following a programme of joint unannounced visits and inspections to all four of Scotland’s specialist inpatient mental health units for children and young people.

The report, released on 3 March by Healthcare Improvement Scotland and the Mental Welfare Commission for Scotland, examines the quality and safety of Tier 4 child and adolescent mental health services (CAMHS) across the country.

Tier 4 services provide highly specialised inpatient assessment and treatment for children and young people with complex mental health needs. Over the course of 2025, inspection teams carried out joint visits to the Melville Unit in May; the National Child Psychiatry Inpatient Unit (Ward 4) and Skye House in August; and the Dudhope Unit in October.

Across the four units, inspectors identified a number of areas of good practice. These included the introduction of innovative roles such as care co-ordinators and physical health nurses in several units; positive interactions between staff and young people in all sites; and the development of detailed digital resources for young people and their families.

At Ward 4, all parents spoken to during the visit reported feeling involved in care planning and expressed high levels of satisfaction with the care and treatment provided. Dudhope Unit was commended for its rights-respecting approach to education, with school provision described as integral and available to all patients. Inspectors also found that treatment in some units was fully authorised in line with mental health law, and that accessible, age-appropriate information was available to patients.

However, the report also highlights significant concerns requiring urgent attention. These include issues relating to staff culture and attitudes at Skye House, the need for board-wide seclusion policies to underpin local guidance in three of the four units, and concerns about the practical application and safe use of proportionate restraint as a last resort at the Melville Unit.

Inspectors also identified the need for timely completion of fire safety actions, improved maintenance of care environments across all units, and more robust multidisciplinary workforce models. In particular, the report points to gaps in social work, dietetics and psychology staffing in several units. The timely review and implementation of lessons learned from reported incidents was also highlighted as an area requiring improvement.

All four units were urged to strengthen discussion with young people about their rights, including the right to make an advance statement when well enough to do so, for example as part of discharge planning.

In a joint statement, Robbie Pearson, Chief Executive of Healthcare Improvement Scotland, and Julie Paterson, Chief Executive of the Mental Welfare Commission for Scotland, said the findings showed both positive experiences and areas for improvement, but noted inconsistencies between units.

“All four reports evidence a range of good practice and positive experiences of children, young people, relatives and staff, as well as areas for improvement.

“However, there are inconsistencies across the units, in terms of the areas where units are performing well and the areas for improvement.

“Our overarching recommendation therefore is that learning must take place across all four units. Where there is good practice, this must be replicated where improvement is needed.

“When a child or young person is admitted to hospital because of complex mental health needs, they are at their most vulnerable. They and their families have a right to expect consistent, high quality, compassionate care in a safe environment, no matter where in Scotland they receive this.”

The inspections were commissioned by the Scottish Government in response to national concerns about the care of young people in inpatient mental health units. The full national overview report is available on the Mental Welfare Commission for Scotland’s website.