Mental Health and Wellbeing Strategy: Initial Monitoring Report and Monitoring Framework

Short-term outcome 10: Where there may be limits on the decisions people can make (due to the setting, incapacity or illness), they are supported to make choices that reflect their will and preference and feel that their views and rights are respected.

Short Term Outcome 10 (STO10) of the Mental Health and Wellbeing Strategy describes that where there may be limits on the decisions people can make (due to the setting, incapacity or illness), they are supported to make choices that reflect their will and preference and feel that their views and rights are respected.

Metrics for monitoring STO10 are grouped under two core components of the outcome:

1. People are supported to make choices that reflect their will and preferences

2. People feel that their views and rights are respected

Table 26 presents the specific metrics grouped under each component.

Table 26: Metrics for Monitoring Short-term Outcome 10

The following sections present each of these components and associated metrics in detail, offering insight into baseline measures and observed changes related to STO10.

1. People are supported to make choices that reflect their will and preferences

The first component of STO10 outlines that where there may be limits on the decisions people can make, they are supported to make choices that reflect their will and preferences. There are five metrics used to monitor this component.

Number of people with advance statements registered per year with the Mental Welfare Commission for Scotland

Mental Welfare Commission (MWC) publishes an annual report which provides a detailed analysis of how the Mental Health Act was used across Scotland, including advance statements. 

Advance statements are written statements made by a person when they are well, setting out the care and treatment they would prefer or would dislike should they become mentally unwell in the future. Since 2017, each time someone either writes a statement or withdraws a statement, health boards should notify the MWC for Scotland.

In 2023/24, there were 150 new advance statements registered with the MWC for Scotland. This compares with 161 new statements in 2022/23.

Number of emergency detention certificates per 100,000 population

Emergency detention certificates (EDCs) are a type of compulsory treatment under the Mental Health (Care and Treatment) Scotland Act 2003.

EDCs are designed to be used only in crisis situations to detain a person who requires urgent care or treatment for mental ill health. An EDC can be issued by any doctor, with the consent of a mental health officer (MHO) unless impracticable, which allows someone to be kept in hospital for up to 72 hours

Monitoring the use of EDCs shows how often individuals are subject to urgent detention and whether safeguards are in place to ensure their views are considered wherever possible. This data is available from PHS’s Mental Health Quality Indicators.

In Scotland in 2023/24, the number of emergency detention certificates per 100,000 population was 66.9, an increase from 60.6 in 2022/23.

Number of inpatients under mental health and incapacity legislation

The Scottish Government’s Mental Health Inpatient Census reports annually on the number of people receiving inpatient care under various mental health and incapacity laws. It provides a snapshot of patients on a specific day each year, rather than a total count across the full year.

Some patients are subject to legal frameworks that limit their ability to make decisions about their treatment or care. In some cases, individuals may be covered by more than one piece of legislation at the same time.

The legislations listed in Table 27 are included because they provide legal frameworks that may limit an individual’s decision-making due to illness or incapacity, while embedding safeguards and supported decision-making processes to ensure that their will, preferences, and rights are respected.

Table 27: Number and percentage of adult patients by other legislation, NHS Scotland, 2023 and 2024

Source: Mental Health Inpatient Census

Table 27 shows that from 2023 to 2024:

• The proportion of inpatients under a Compulsory Treatment Order (Mental Health Act) increased from 34% to 37%.
• The proportion under the Adults with Incapacity (Scotland) Act 2000 decreased from 23% to 19%.
• Use of the Short-Term Detention Certificate (Mental Health Act) rose slightly from 6% to 7%.
• The proportion under a Compulsory Order (Section 57A) of the Criminal Procedure Act increased from 3% to 4%.
• The proportion under a Community Based Treatment Order (Mental Health Act) remained stable at 1%.
• The proportion under an Emergency Detention Certificate (Mental Health Act) remained at <1%.

Number of individuals subject to guardianship orders in Scotland

The Mental Welfare Commission Annual Monitoring Reports include data on the number of people subject to welfare guardianship orders in Scotland. These are legal orders granted by a sheriff court, appointing one or more guardians — often a family member, friend, or the local authority — to make decisions on behalf of an adult who lacks capacity.

The powers granted under a guardianship order vary depending on the individual's needs. They may include:

• Welfare powers (e.g. decisions about healthcare or accommodation)
• Financial and property powers (e.g. managing money or paying bills)

The Commission reports the number of individuals subject to a welfare guardianship order on a specific date each year — 31 March.

On 31 March 2024, there were 19,078 individuals subject to a guardianship order in Scotland. This represents a 6.9% increase compared to 17,849 individuals in 2023.

In 2024, over 80% of individuals who were subject to a guardianship order had a learning disability or dementia/Alzheimer's disease.

Percentage of welfare guardianship care plans considered person-centred

The Mental Welfare Commission for Scotland (‘the Commission’) monitors the use of welfare guardianship orders [1] under the Adults with Incapacity (Scotland) Act 2000, as part of its safeguarding role for adults with mental illness, learning disability, dementia, and related conditions. The Commission defines person-centred care plans as those that reflect each individual’s hopes and aspirations.

In 2023/24, 19,078 individuals were subject to a welfare guardianship order. The Commission visited 327 of these individuals, reviewing care plans for 295. Of those, 80.4% (n=263) were considered person-centred. This is a slight decrease from 2022/23, when 83% of 196 care plans met this standard.

2. People feel that their views and rights are respected

The second component of Short-Term Outcome 10 focuses on ensuring that, where there are limits on the decisions people can make, they still feel their views and rights are respected. Currently, there are no identified metrics to monitor this component, highlighting a gap in available data on patient experience.

Reflections on Short-Term Outcome 10

Short-Term Outcome 10 of the Mental Health and Wellbeing Strategy focuses on ensuring that where people may face limits on decision-making—due to setting, incapacity, or illness—they are supported to make choices that reflect their will and preferences and feel that their views and rights are respected. Much of the data is from 2023 and 2024, providing insight into early changes across the identified metrics.  

The number of advance statements registered remained relatively stable, showing that a small proportion of individuals are documenting their care preferences in advance. Meanwhile, the rate of emergency detention certificates increased slightly, reflecting continued use of urgent detention measures under the Mental Health Act.

Inpatient data under mental health and incapacity legislation highlights variation in the use of legal frameworks. Compulsory Treatment Orders increased as a proportion of inpatients, while the proportion under the Adults with Incapacity Act decreased, and other categories showed only minor changes. Guardianship orders rose, potentially indicating a growing number of individuals requiring appointed decision-makers.

The proportion of person-centred care plans remained high of those that were reviewed but showed a slight decline from the previous year.

Data gaps

There is one overarching data gap that limits the ability to fully monitor STO10.

• Data on a range of supports and services: Lack of patient experience data on whether people feel their views and rights are respected. Limited data on other settings where there may be limits on the decisions people can make, such as prison.