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Mental Health (Emergency Detention)

– in the Scottish Parliament on 19th January 2016.

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Photo of Richard Simpson Richard Simpson Labour

1. To ask the Scottish Government how it will increase protection for people subject to emergency detention under the Mental Health (Care and Treatment) (Scotland) Act 2003. (S4T-01282)

Photo of Shona Robison Shona Robison Scottish National Party

Emergency detention under the 2003 act is permissible only where it is necessary as a matter of urgency because of a significant risk to the health, safety or welfare of the patient or the safety of others. Medical practitioners are required to seek agreement from a mental health officer, unless it is impractical for them to do so, for example, where there is immediate, serious or life-threatening danger to the patient and/or others around the patient.

I am concerned by low levels of involvement by mental health officers in some areas, as identified by the Mental Welfare Commission for Scotland in its annual monitoring report in September 2015. Consent by mental health officers is an important safeguard, and it is essential that local authorities ensure that they have the appropriate levels of staff in place to meet statutory duties.

I am pleased to note that the Mental Welfare Commission has plans to meet one health board where this appears to be a particular issue, and I look forward to hearing the outcomes of that engagement. I have also asked the Mental Welfare Commission to undertake analysis of the reasons why the medical practitioner has reported that it was impractical to consult a mental health officer. Separately, I have asked the Scottish Government’s chief social work adviser to investigate issues to do with the shortfall in mental health officers in local authorities with chief social work officers, and I expect him to report back by the end of April.

Photo of Richard Simpson Richard Simpson Labour

I thank the cabinet secretary for her helpful reply. According to the Mental Welfare Commission’s most recent report, 45 per cent of the people who were detained under emergency detention system in 2014-15 did not have the consent of an MHO, which was an increase from 42 per cent in the previous year and 37 per cent in the year before that. We are in a deteriorating situation, to which the Mental Welfare Commission has drawn attention in repeated reports. Given that new funding is coming forward, will the cabinet secretary consider allocating additional funds to local authorities to recruit more mental health officers?

Photo of Shona Robison Shona Robison Scottish National Party

I recognise Richard Simpson’s interest in the matter. As he pointed out, the Mental Welfare Commission highlighted such issues in its report “Mental Health Act Monitoring 2014-15”. For example, it noted that the increase in emergency detention is “largely due” to an increase in use of the 2003 act to admit older people to hospital but said that the reasons for the rise in compulsory treatment are “unclear”.

The commission made the important point that, wherever possible, a short-term detention certificate should be granted in preference to an emergency detention certificate, given the additional protection for the patient that a short-term detention certificate provides.

There are therefore a number of issues that we need to consider and understand better. That is why, as I said, I have asked for a number of pieces of work to be done to look at the issues, identify the reasons for them and, more important, consider what action we can take.

Richard Simpson asked about the resources that have been allocated to health. Over the next five years, additional resources of £150 million have been allocated. Richard Simpson will be aware that there is a clear separation between the role of mental health officer, who is employed by the local authority, and the national health service, for the good reason that an MHO might investigate issues in the NHS. Although I would normally point to integration joint boards as the territory on which issues can be resolved, the issue is more complex, because of the potential for conflict of interest, about which we need to be quite careful.

If, when we have the reports, they point to specific action that needs to be taken and which requires an element of resourcing, I will of course consider whether further work is needed in that domain. We should wait and see what the issues are first.

Photo of Richard Simpson Richard Simpson Labour

I commend the cabinet secretary for both her replies, which indicate her concern about a problem that has been getting worse.

Another aspect, which I always raise in this context, is variation between boards, to which the cabinet secretary alluded in her first answer. The Mental Welfare Commission said:

“It concerns us that in Greater Glasgow and Clyde, the area with the highest use of emergency detention in Scotland ... the proportion of EDCs with consent is even lower this year (28%) than last year (37%).”

We should remember that emergency detention certificates tend to be used more in deprived areas. When 72 per cent of people are not getting an MHO, the matter requires fairly urgent attention. I understand from the cabinet secretary’s first answer that the commission will have a close look at that issue.

Photo of Shona Robison Shona Robison Scottish National Party

Yes. A number of local authorities responded to inquiries, which were in newspaper reports at the weekend, about their number of MHOs and how their services are organised. Richard Simpson is right to highlight the particular concern about local authorities in the NHS Greater Glasgow and Clyde area, which is why the Mental Welfare Commission plans to meet the board to consider what lies behind the figures and, more important, what action can be taken to overcome some of the concerns that he raised. I will be happy to keep Richard Simpson informed of the discussions and, more important, their outcome.

Photo of Mary Scanlon Mary Scanlon Conservative

The shortage of mental health officers has been an increasing problem for some time. It is not a legal requirement for a mental health officer to be present for a patient to be sectioned, but it is an important safeguard and best practice. Will the Government consider making input and support from a mental health officer a legal requirement to ensure that there is such input when a patient is sectioned? Will it ensure that the number of fully trained and suitably qualified officers is increased to fill the gap?

Photo of Shona Robison Shona Robison Scottish National Party

I understand Mary Scanlon’s concern. On the shortage of mental health officers, there are issues around the requirements in relation to skill level and qualifications that immediately reduce the pool of people who are available. There are some issues there with the ability to recruit mental health officers. We need to look at that, and I am keen to look at what more can be done to expand the interest in that career.

We have to be cautious about the legislative suggestion that Mary Scanlon made because, as I set out in my original answer, where there is immediate, serious or life-threatening danger to the patient or others around them, it would be wrong to have to wait for a mental health officer’s involvement. In such a situation there are immediate concerns about welfare and safety and we can understand that, sometimes, things have to move quickly. However, it is best practice to involve a mental health officer. It is about getting the right balance so that we do not restrict action from being taken that is required for the immediate safety of the patient and, potentially, others around them, but we encourage the best practice of involving a mental health officer.

Again, I am happy to keep Mary Scanlon informed about the discussions that will be taken forward with the Mental Welfare Commission and the chief social work adviser.