Uneasy welcome

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.