Report warns "Backlog" of secure unit patients must be addressed

Concerns have been raised about a “backlog” of patients in Scotland's secure hospital wards who are waiting to be moved to a less-restrictive environment.

The Mental Welfare Commission raised the issue of human rights of patients in medium and low security forensic wards, saying some are “being held in conditions of excessive security due to a lack of suitable places to move on to”.

It comes as the commission published its first-ever Scotland-wide report into medium and low security hospital wards after visiting all 46 of them.

There were 400 patients being looked after in such settings and while many had either been sent there by the courts or transferred from prison, some patients had not committed any offence and were being treated in a secure setting because of difficulties providing care elsewhere.

The commission found six of the cases they examined involved “civil patients” who had spent more than 10 years in a secure environment, with the report stating “not all patients who have spent a long time in conditions of security have necessarily come from the criminal courts”.

Scotland has 14 medium-security and 32 low-security wards which have a combined total of 439 beds.

Some 89 of the 400 patients being cared for when the commission visited were described by ward staff as being “ready to move on”, including 28 people being cared for in medium-secure wards - with most of these waiting for a move to a low-security ward.

“We have particular concerns in relation to patients moving on from higher levels of security and what appears to be a lack of capacity in hospital and community provision,” the report said.

It added: “The reasons given for the delays included the lack of 'step down' facilities, the lack of suitable accommodation, the location of accommodation due to vulnerability or risk, the availability of money for support packages, restrictions with regard to victim issues and patient choice.

“Concerns were also raised by patients about feeling stuck in hospital and not being able to move on.

“These delays are concerning and potentially result in patients remaining in environments in which they are living lives that are excessively restricted.”

Alison Thomson, executive director (nursing) at the commission, said:

“Many of our findings are good, including positive comments from patients about the staff who care for them and good access to advocacy and psychological services. This is welcome.

“We were concerned about the human rights of patients who are being held in conditions of excessive security due to a lack of suitable places to move on to.

“We found that even after they have successfully won appeals at a mental health tribunal, some medium-secure patients were waiting to move on for longer than need be.

“In turn, low-secure units were often finding it difficult to take these patients as they themselves were having difficulty finding suitable places in the community for people ready to leave.

“This backlog in moving people to the least-restrictive situation must be addressed.”

Two patients had been subjected to exclusion - where they were locked alone in a room for about 30 minutes - on “a number of occasions” over the previous month, with the report stating this was “being used to minimise the use of restraint which was felt to be more distressing for them”.

In addition to this, the report revealed one patient is kept in a “state of permanent seclusion due to high levels of violence to staff and issues of serious self-harm”, with a ward adapted to meet their needs and their treatment kept under regular review.

Overall, the commission found the care and treatment for patients in low and medium security wards was “generally good”, with the report highlighting a “level of attention to detail and patient participation in care planning that we often do not see in non-forensic wards”