News

Last October, when mental health professionals met Scottish executive officials at a conference, there was a sense of unease about the imminent introduction of the Mental Health (Care and Treatment) Act 2003.

Although the act is seen as a benchmark in social care, there was concern that Scotland was not ready for it.
Not only did independent advocacy, the training of mental health officers and mental health tribunals all have to be put in place, but there were also grave doubts about whether Scotland's facilities were up to the job.

The act explicitly expects health boards to provide specialised facilities for specific groups of patients: children and adolescents, and mothers suffering from perinatal mental disorder and their babies.

Also, from May 2006 those held in "excessive security" have a right to appeal to a tribunal to consider whether they should be placed in medium rather than high-security units.

In January health minister Rhona Brankin decided to put back the act's implementation to this October to give local authorities, health boards, the Mental Health Tribunal for Scotland, and Carstairs Hospital in Lanarkshire - which houses a number of patients in a high-security setting - more time to identify facilities.

But doubts still remain over infrastructure. Faced with the possibility of appeals against levels of security, Carstairs is considering moving patients to England or moving the hospital fence so that some of its buildings fall outside the perimeter and can be classed as medium-secure.

Although two new medium-secure facilities are due to be built in Paisley and Glasgow, with a possible third for the Highlands, these won't be ready until the end of the decade. The only existing medium-secure facility is the 50-bed Orchard Clinic in Edinburgh.

Andreana Adamson, chief executive of Carstairs, says: "It has not been considered whether it will be appropriate or acceptable to the tribunals that the fence is moved or for moving patients to England."
But she added that a "scoping exercise" was about to start.

In the meantime, councils and health boards are busy identifying the delivery of services in joint local implementation plans to deal with the different client groups.

In 1994, there were 125 in-patient places for children and adolescents in Scotland, but by 2004 the number had fallen to 44, mainly because of a move towards community mental health support.

The Mental Welfare Commission for Scotland has long been concerned about the lack of in-patient places for young people. Its director, Donald Lyons, says: "We have for some time reported on young people being inappropriately admitted to adult wards. This is a major concern. Admission facilities and crisis services for young people are in urgent need of attention."

The Scottish executive's child health support group has recommended a phased increase in the number of beds to 60 for the new act's implementation and a spokesperson said that additional work was being undertaken at a regional level to take the support group's recommendations forward.

In the interim, she added, the executive expected health boards to make provision for "age-sensitive services" and that shared (cross-authority) facilities might be necessary.

While places have to be available in principle by this October for children, and May next year for adults, in the absence of new builds being ready, cross-authority arrangements will be inevitable. The new act is so specific in its expectations that inappropriate placements may be open to legal challenge.

The mental health tribunals - most of which will be housed in hospital or local authority buildings - will hear appeals by individuals who may argue they have been inappropriately placed, and it will no longer be acceptable under the new act to say that a place was simply not available. CC Last October, when mental health professionals met Scottish executive officials at a conference, there was a sense of unease about the imminent introduction of the Mental Health (Care and Treatment) Act 2003. Although the act is seen as a benchmark in social care, there was concern that Scotland was not ready for it.

Not only did independent advocacy, the training of mental health officers and mental health tribunals all have to be put in place, but there were also grave doubts about whether Scotland's facilities were up to the job.

The act explicitly expects health boards to provide specialised facilities for specific groups of patients: children and adolescents, and mothers suffering from perinatal mental disorder and their babies.

Also, from May 2006 those held in "excessive security" have a right to appeal to a tribunal to consider whether they should be placed in medium rather than high-security units.

In January health minister Rhona Brankin decided to put back the act's implementation to this October to give local authorities, health boards, the Mental Health Tribunal for Scotland, and Carstairs Hospital in Lanarkshire - which houses a number of patients in a high-security setting - more time to identify facilities.

But doubts still remain over infrastructure. Faced with the possibility of appeals against levels of security, Carstairs is considering moving patients to England or moving the hospital fence so that some of its buildings fall outside the perimeter and can be classed as medium-secure.

Although two new medium-secure facilities are due to be built in Paisley and Glasgow, with a possible third for the Highlands, these won't be ready until the end of the decade. The only existing medium-secure facility is the 50-bed Orchard Clinic in Edinburgh.

Andreana Adamson, chief executive of Carstairs, says: "It has not been considered whether it will be appropriate or acceptable to the tribunals that the fence is moved or for moving patients to England."

But she added that a "scoping exercise" was about to start.

In the meantime, councils and health boards are busy identifying the delivery of services in joint local implementation plans to deal with the different client groups.

In 1994, there were 125 in-patient places for children and adolescents in Scotland, but by 2004 the number had fallen to 44, mainly because of a move towards community mental health support.

The Mental Welfare Commission for Scotland has long been concerned about the lack of in-patient places for young people. Its director, Donald Lyons, says: "We have for some time reported on young people being inappropriately admitted to adult wards. This is a major concern. Admission facilities and crisis services for young people are in urgent need of attention."

The Scottish executive's child health support group has recommended a phased increase in the number of beds to 60 for the new act's implementation and a spokesperson said that additional work was being undertaken at a regional level to take the support group's recommendations forward.

In the interim, she added, the executive expected health boards to make provision for "age-sensitive services" and that shared (cross-authority) facilities might be necessary.

While places have to be available in principle by this October for children, and May next year for adults, in the absence of new builds being ready, cross-authority arrangements will be inevitable. The new act is so specific in its expectations that inappropriate placements may be open to legal challenge.

The mental health tribunals - most of which will be housed in hospital or local authority buildings - will hear appeals by individuals who may argue they have been inappropriately placed, and it will no longer be acceptable under the new act to say that a place was simply not available.