Revealed: more than 900 Scots sectioned without safeguards under Mental Health Act

MHOs are vital staff who are supposed to protect patients subject to detention certificates, and preserve their human rights.

The number of people who are subject to the emergency certificate, which allows them to be kept in a specialist hospital facility for up to 72 hours, has risen by 12% in Scotland in the last three years, with the number of people being detained for up to 28 days also rising by 10% in the last year alone across Scotland.

Campaigners have raised concerns about the particularly low number of MHOs involved in detention cases in some areas, specifically the NHS Greater Glasgow and Clyde Health Board. The area has one of the lowest rates of MHO involvement: only 28% of people who were urgently detained between April 2014 and April 2015 in NHS Greater Glasgow and Clyde had the support or approval of an MHO.

The most recent figures show a slight improvement across the area, with 33% of detentions having MHO consent but the overall picture across the country remains unchanged.

These crucial members of staff, who are part of local authorities’ senior social work teams, are supposed to act as a second opinion in crisis situations where people are severely mentally ill.

Those who are detained are usually deemed as posing a risk to themselves or others, and in need of urgent medical attention. They may have harmed themselves already, or are threatening to harm themselves, or refusing crucial medical help.

As any medical professional is able to detain patients, campaigners argue there is a real need for MHOs to be present as much as possible as they have specialist training in mental health issues which other medics who are not specialists may not have. The lack of an MHO leaves open the possibility of patients being wrongly detained and their liberty taken away from them when there could be other options available.

Patients, campaigners, and the mental health watchdog the Mental Welfare Commission have all raised concerns about the lack of MHO involvement in the detention process, and have urged local authorities and the Scottish Government to take action.

Many say there is a problem with recruitment, and attracting people to a role which does not necessarily provide a substantial increase in salary or career prospects. Latest figures show there are 602 MHOs across the entire country.

Colin McKay, Chief Executive of the Mental Welfare Commission, said: “Being detained, being forcibly admitted to the hospital for assessment against your will, is a huge intervention and infringement of your human rights. It needs to be taken really seriously, and it's important that there are checks and balances in place.

“[Detaining someone] is a difficult judgement to make in a pressurised situation and that's why we think, if at all possible, there should be another perspective on it to really check it's absolutely the best way to proceed.”

McKay added: “One of the things we are concerned about is not just overall the number of people without [MHO] consent going up, in some areas it's really bad. Glasgow is one of them, where the stats are really quite concerning.

“Part of [the problem] within the local authority is how to deploy these people…Glasgow has a lot of pressures but we don't think that entirely explains quite how bad the statistics are.”

The watchdog said they will be monitoring Glasgow’s situation particularly closely, and plan to meet representatives from local authorities in the area in March.

Laura Bogucki, Operations Manager at Glasgow-based The Advocacy Project, which has statutory powers to provide help for people who have been detained under the mental health act with support and advice, said: “MHOs are doing their very best under tight circumstances. [Their] role is essential - it’s as important as the psychiatric role.

“Part of their duty is also to think about us as a service, we’re entrenched in law for a reason and we also explain people’s rights and their right of appeal. If an MHO is overworked they may not be considering the other branches that can assist them. There is no doubt an MHO is in a very difficult position.”

Bogucki said the issue highlighted “the importance of retention of good social work staff” and urged the Scottish Government to commit to investing more in social work.

The Sunday Herald contacted the six local authorities covered by NHS Greater Glasgow and Clyde, and asked what action has been taken to improve the access to MHOs for people who are being detained.

West Dunbartonshire council had no MHOs, but says it has now added two to its payroll to help the situation, while East Dunbartonshire, which has nine, said it always has two MHOs on duty during office hours.

Renfrewshire Council, with a staff of 21, said during office hours the local authority has never “been unable to provide a consultation with a Mental Health Officer, either in person or by phone, during office hours.” Inverclyde Council, with eight, said it was currently carrying out a review of MHOs.

Renfrewshire and East Dunbartonshire said outside office hours they rely on support from the Glasgow & Partners Social Work Service to provide MHO cover.

A spokesman from Glasgow City Council, which has 80 MHOs working across the city, said: “There is no absolute requirement that MHOs are always present when emergency detention orders are issued by medical officers, although the presence of an MHO is considered to be the ideal.

“We do always seek to review such decisions within 24 hours to ensure that an appropriate decision has been made. We are currently working with health colleagues to study what impact this has on the care management of those taken into hospital and also where any policy improvements could be made.

“However, in our experience an emergency detention order is issued on a precautionary basis to protect the well-being of individuals affected by mental illness.”

Jamie Hepburn, Scottish Government Minister for Health Improvement, said: “Mental Health Officers make an invaluable contribution towards improving the lives of mental health patients and their friends and families.

“It is the responsibility of local authorities to plan their MHO workforce, ensuring they have the appropriate levels of staff in place to provide services for their residents.

“The Scottish Government has announced an additional £150 million investment in mental health services over the next five years.”

East Renfrewshire Council, which has eight MHOs, did not respond to a request for comment.

'Being detained in a mental hospital strips everything from you. You are at the mercy of other people'

Only those who have been forcibly detained under the Mental Health Act, know the true terror of the experience.

Two women told the Sunday Herald of their experiences.

Sarah, who wishes to remain anonymous, is 45 and from Glasgow. She has spent the last 25 years in and out of hospital for treatment of a recurrent depressive disorder which she said makes it very difficult to lead a normal life.

At one time she spent 53 consecutive weeks in hospital for treatment for her condition, and has been admitted several other times on both a voluntary and involuntary level.

She said "It leaves you feeling completely powerless, and out of control. Anything you thought you did have control over is stripped away from you [when you are detained]. You are at the mercy of other people.

"There is a huge number of people who are not aware of their rights if they are sectioned. At the time of admission or shortly after they usually end up being detained they are at their most unwell, they're not in a position to be thinking abut rights or who to turn to.

"The MHO's role should include an explanation of rights. In my experience, I was assessed by an MHO, but they didn't explain [my rights] to me. They seemed more to be on the medical side than being neutral."

She agreed that increasing the number of MHOs would help to relieve some of the pressure put on those currently in the role, giving them more time to spend with patients explaining what was happening to them and advising them of their rights.

Dianna, a 67-year-old woman, who is currently a patient in a Scottish mental health hospital, has a diagnosis of paranoid schizophrenia. She said when she was last detained in 2014 she did not feel it was the right thing for her.

She said: "I was detained in an older people’s unit. I felt a lot of the people there were detained unfairly. Due to their age lots of people were confused, and this confusion lead to them being detained, but I didn’t think this was the right option.

"When I was detained it was neither by a psychiatrist, nor with a mental health officer - it was by the psychiatric nurse on duty. Later they brought in a psychiatrist and someone else to see me, but I have no idea who the other person was.

"I was very distressed, it was a dreadful incident. I was restrained as it was suggested I had tried to punch and kick, however I had no movement in my legs or arms.

"There is certainly a role for sectioning, but it can be damaging when you are sectioned over and above when you need to be. For me, when you’re sectioned when you shouldn’t be you are being misrepresented."