Commission urges 'ambitious and transformative' mental health reforms

Published by Professional Social Work magazine, 28 January, 2022

The Scottish government must make mental health a priority and implement "ambitious and transformative" change, according to the chief executive of Scotland’s leading mental health campaigning organisation.

The Mental Welfare Commission safeguards the rights and welfare of some of Scotland’s most vulnerable people including those with mental ill health, learning disability and dementia. It is engaging with the current Scottish Mental Health Law Review and has also advised the Scottish Government on emergency pandemic legislation

Julie Paterson, chief executive of the Commission, said: “With all of the pressures government is under, they must continue to keep mental health as a priority.

“I hope the law review is ambitious and transformative. I hope the Scottish government responds quickly and positively to its calls for change. And I hope that in the meantime they do not lose sight of the day-to-day delivery of services to people who are struggling with mental ill health, and those with learning disability, dementia and other related conditions.”

The Commission campaigned successfully on mental health in women’s prisons after a damning report of Cornton Vale Prison by the European Committee for the Prevention of Torture. And a separate investigation into detention rates revealed the number of people detained due to mental ill health had risen by ten per cent in 2020-21, a doubling of the average 4.5 per cent rise of previous years.

Jule Paterson added: “We are concerned about the year-on-year rise in people being so unwell that they are treated against their will and detained under the Mental Health Act. We also want to pursue the responses to our report Authority to Discharge, which found that on too many occasions staff did not fully understand the law when transferring people from hospital wards to care homes using the Adults with Incapacity Act.”

Speaking of wider issues for the year ahead, she added:  We see continued concerns over waiting times, particularly for children and young people’s services and concerns about community services not returning to pre pandemic levels of support.

“There are concerns about staffing levels, including the critically important social care workforce which supports people to be discharged from hospital, and also supports people to avoid hospital admission. We must not lose sight of maintaining a person-centred focus –remembering that the individual is at the heart of health and care work.”

The Commission gave its response to the first consultation round in The Scottish Mental Health Law Review which is due to publish recommendations on reforms to the law in autumn 2022.

Julie Paterson added: “Whatever the final recommendations, it is vital that changes to legislation have a direct positive impact on individuals, on their human rights, and on the services they receive.”

Mental health detentions

The Commission examined detentions under the Mental Health Act between 1 March 2020 and 28 February 2021 and found rates had doubled during the pandemic, with a 9.1 per cent rise in detentions compared to an average of five per cent in the previous five years. There were 10,059 detentions in 2020-21 compared to 9,222 detentions in the previous year.

Julie Paterson said: “In our Mental Health Act monitoring, we remain very concerned over the way detentions are taking place

“Consent of a mental health officer (a specialist social worker) is an important safeguard and should happen every time a person is detained using the Act. For emergency detentions, consent fell below half of all such detentions in 2020-21, with big variations in different parts of Scotland. This is unacceptable and unfair to patients, who should all receive the protection of this safeguard, no matter where they live in the country.”

Authority to discharge

After concerns were raised about the legality of movement of people from hospitals to care homes in the early stages of the pandemic, the Commission decided to investigate.

Their subsequent report – Authority to Discharge – identified 20 pandemic-related illegal moves of people, and also found gaps in training and in knowledge sharing that were in the system long before Covid-19.

Adults with Incapacity

The Commission raised concerns about proposed emergency legislation to change provisions of the Adults with Incapacity Act (AWI Act). Revisions would allow local authorities to move a person without capacity to a residential setting without recourse to a welfare guardian or person with a power of attorney.

The Commission asked that the proposed system include a formal notification to a scrutiny body each time the powers were used. Scottish Ministers confirmed that the Commission would be involved in the reporting process.

Women in prison

The Commission launched an investigation into care for vulnerable women with mental ill health in Cornton Vale prison following a damning publication from the European Committee for the Prevention of Torture.

The investigation found that women were being segregated as a way of managing their mental ill health, for up to 82 days.

In total, 23 women had been segregated under Rule 45, and a total of 25 episodes were recorded, with average segregation time lasting 32 days.

Sandy Riddell, chair of the Commission, said: “Our investigation confirmed (initial) findings, and raised wider questions about missed opportunities in early intervention, pathways from prison to the community, and the revolving door of prison.”