Rise in numbers of people being detained for mental health care during the pandemic

The Mental Welfare Commission today (Thursday 29 July) published a report analysing the use of detention of people for mental health care and treatment during the pandemic.

The report finds that while detentions had been rising pre-pandemic, there was 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, finding a rise in deaths of which it was notified.

Almost 150 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 Commission noted that the increase in numbers reported may also be due to improvements in the notification system because of its 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.

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. 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.

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%.

Dr Arun Chopra, Medical Director at the Mental Welfare Commission, said the reasons for the increase in detentions were not known, but that it was 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.”

As a result of the findings, The Commission is urging Health and Social Care Partnerships, supported by local authorities, to seek to understand the reasons why important safeguards – such as Mental Health Officer consent for emergency detentions; and preparation of social circumstances reports by those officers – under the Mental Health Act are not being realised in practice.

It is also asking the Scottish Government to take account of the content of this report as part of its current review of the mental health officer workforce.