Consultation on Updates to the Code of Practice for the Mental Health (Care and Treatment) (Scotland) Act 2003

Introduction and purpose of this consultation

The Scottish Government is consulting on proposed updates to parts of volume 1 of the Code of Practice made under section 274 of the Mental Health (Care and Treatment) (Scotland) Act 2003 (“the Act”), focusing specifically on the use of restraint and seclusion.

This consultation seeks views on proposed guidance that would be included in a new chapter to volume 1 of the Code of Practice to support safe and rights‑based practice when restraint and seclusion are used. The responses will inform revisions to the Code of Practice, with the aim of strengthening protections for individuals receiving care and treatment, while supporting staff and services to deliver high‑quality care in challenging circumstances. The consultation also seeks views on updates to chapter 14 and a new chapter 17 of the Code, which focus on cross-border transfers and excessive security.

We note that this is a limited update to certain chapters within volume 1 of the Code of Practice, and we anticipate there will be further, more comprehensive revisions to the Code in the future.

The Code of Practice is a published document which provides guidance to practitioners discharging functions under the Act. The guidance in the Code of Practice applies to any practitioner, such as a doctor, nurse, social worker or mental health officer who is carrying out a function or exercising a duty under the Act in relation to a patient.

Why change is needed around restraint and seclusion

The current Code of Practice was first published in October 2005 and has not been updated since. During this time, both the legislative framework and the wider rights landscape have evolved significantly.

In recent years, the use of restraint and seclusion, particularly with children and young people, has been an increasing area of concern. Although the principles of the Act are clear that any intervention should involve the minimum restriction on a patient’s freedom that is necessary in the circumstances, we recognise that guidance is required on the use of restraint and seclusion and the proposed update to the Code of Practice aims to provide this. We have drafted a new chapter with a specific focus on restraint and seclusion.

We have heard that guidance around restraint and seclusion is particularly important for people subject to compulsory care and treatment and for children and young people, where the potential impact of restraint and seclusion can be profound. Similarly, we recognise that autistic people and people with learning disabilities are more likely to experience restraint and seclusion when accessing care and treatment under the Act, and the use of these interventions should be carefully considered and monitored to ensure that their use is appropriate. As such, the new chapter includes specific advice on the use of these practices for practitioners providing care and treatment for these groups.

We recognise that nasogastric tube feeding, particularly when conducted under restraint, can be distressing, invasive and traumatic. We have included guidance on best practice for practitioners, to ensure that the use of this intervention is carefully considered and conducted appropriately.

The human rights framework has also developed substantially since 2005. In particular, the enactment of the United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Act 2024 places duties on public authorities to not act incompatibly with UNCRC requirements. The new chapter aims to support practitioners and health boards to ensure that the use of restraint and seclusion respects the rights protected under the UNCRC, the European Convention on Human Rights (ECHR), and the UN Convention on the Rights of Persons with Disabilities (UNCRPD).

Following the BBC documentary on Skye House broadcast in 2025, the Minister for Social Care, Mental Wellbeing and Sport asked the Mental Welfare Commission for Scotland and Healthcare Improvement Scotland to undertake a programme of joint visits and inspections across all Child and Adolescent Mental Health Services (CAMHS) inpatient units in Scotland. These visits highlighted both areas of good practice and areas where further clarity, consistency and safeguards are needed, such as the use of restraint and seclusion. The new chapter is informed by the findings and recommendations from these visits.