THE number of detentions for mental health treatment in Scotland are at a 15-year high amid concern over pressures on mental health services.

The sharpest year-on-year rise was in the use of emergency detention certificates, which are considered a last resort for patients whose mental illness has reached crisis point. The Mental Welfare Commission for Scotland said this was particularly worrying since patients detained under an EDC - or "sectioned" - have no right of appeal and the order can be granted by a GP or any hospital doctor without consultation with a psychiatrist or other mental health professional.

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In total, EDCs were used 2,414 times in 2016/17, up 12 per cent on the previous year and 26 per cent on a decade ago. Dumfries and Galloway issued more EDCs as a share of its population than anywhere else, with a rate that was five times higher than that of Grampian.

Overall, there were 5,422 new episodes of compulsory treatment in 2016/17, including EDCs and the preferred short-term detention certificates. This is the highest since 2001/2, when there were 4,849. It echoes similar upward trends in England, which recorded its highest number of detentions for mental health treatment in at least a decade in 2015/16.

Dr Gary Morrison, a psychiatrist and executive director for the Commission said it was unclear what was behind the increase. He said: "We really don't know. It could be that that more people are being diagnosed - more people are coming forward because there's more awareness of mental health.

"It could be because of the drive to keep people at home longer rather than going into hospital, so by the time people need a hospital they're much more unwell than they would have been in the past."

Dr Morrison added that there was also "no way of explaining" why Dumfries and Galloway's rate of EDCs was five times higher than Grampian.

He said: "You could understand it if it was a very rural health board compared to a very urban health board, but Grampian is a bit urban and a lot rural, so we would be very keen to understand why there are these differences. Is it linked to deprivation, is it linked to drug and alcohol misuse, or service provision?

"It would be great to look at how the use of compulsory treatment relates to outcomes, for example suicide rates. Do areas with a high use of compulsory treatment have lower suicide rates? We don't know."

The watchdog is calling on the Scottish Government to pull together various available data sources to make sense of what is driving the increase, the regional variations, and the outcomes for patients.

Dr John Crichton, chair of the Royal College of Psychiatrists Scotland, said: "The rise in the use of mental health legislation needs to be fully understood before any assumptions are made.

"It may reflect, for example, an increase in the use of short term orders for people using novel psychoactive substances who present to A&E experiencing a mental health crisis.

"It could also reflect the better identification of those who need specialist mental health interventions or require long term support in the community. The ability to provide support in the community can prevent relapse and hospital stays."

Minister for Mental Health, Maureen Watt said: “Our mental health law is based on rights and principles and offers protection for patients where compulsory treatment is necessary.

"Any increase in compulsory treatments may represent the effects of more people coming forward for treatment and increased awareness and response to mental ill health.

"It’s also important to note that the largest proportion of people subject to compulsion are for short term orders rather than long term orders.

“We will continue to work with the Mental Welfare Commission and stakeholders both to ensure these orders are used correctly, and to promote patients’ rights more generally.

"Patient rights are a key part of our legislation and the new Mental Health Strategy.”