‘No progress’ on issue of daytime confinement at State Hospital, report finds
A psychiatric hospital has made “no progress” on the issue of daytime confinement for patients, a report has found.
The State Hospital in Carstairs, South Lanarkshire, has been urged to take swift action to reduce and eliminate routine use of daytime confinement arising from staffing or operational pressures as soon as possible.
It is the only high-security psychiatric facility in Scotland, providing secure mental health services for patients from Scotland and Northern Ireland.
The latest report from the Mental Welfare Commission found daytime confinement at the hospital has become “a routine feature of service delivery linked to insufficient staffing”.
The commission undertook an unannounced, enhanced visit to the facility in July to follow up on issues identified in previous visits, particularly the ongoing use of daytime confinement (DTC).
It found “no progress” on the issue.
DTC is defined in the report as periods during the day when a person is required to remain in their bedroom and prevented from accessing the usual ward areas, hub, grounds or therapeutic activities.
It is not a punishment that is imposed because of individual risk or clinical needs, but is linked directly to insufficient staffing and associated operational pressures.
The commission said it had learned the hospital was attempting to maintain ward staffing by drawing staff away from therapeutic services, with Skye Centre staff, allied health professionals and psychologists “repeatedly redeployed to nursing duties”.
The report said: “We heard that this repeated confinement was adversely affecting individuals’ mental state and recovery. Routine DTC therefore raises significant human rights concerns.
“The obvious risks include restriction of liberty, institutionalisation, deterioration in mental state and functioning, reduced rehabilitation, prolonged admission, interference with therapeutic care, cumulative impact on individuals subjected to repeated confinement, and the possibility that an emergency response to staffing pressures is now becoming normalised at the State Hospital.”
Claire Lamza, executive director of nursing for the Mental Welfare Commission for Scotland, said: “The commission has repeatedly highlighted the need to address the issue of daytime confinement at the State Hospital, and it is not acceptable that no progress was found during our latest visit.
“The routine use of daytime confinement because of staffing or operational pressures must be reduced and eliminated.
“We urge the State Hospital to act urgently, with a clear improvement plan and board oversight, and ensure that any restriction is necessary, proportionate and individually reviewed.
“This matters because daytime confinement affects people’s access to therapeutic activity, clinical contact, mental health and wellbeing, rehabilitation and progression to less restrictive settings.”
The commission has recommended the State Hospital board develops and implements an improvement plan to be shared with the commission by November 16, setting out how and when the reduction and elimination of daytime confinement will be achieved.
The commission said it has also alerted Healthcare Improvement Scotland, which has a responsibility to monitor the hospital’s compliance with statutory regulations.
The State Hospital has been contacted for comment.