Mental Health Inpatient Census 2024 - Parts 1 and 2

4. Adult patients treated in NHS Scotland facilities

Adult Patients and Demographics

• There were 3,001 adult patients aged 18 and over in the 2024 Census.
• 79% of adult patients had one mental health condition, and 55% had a long-term physical health condition.
• 89% of adult patients received some form of physical health check.

Specialty of Consultant and Legislation

NHS Boards were asked to record the specialty of every consultant who was responsible for overseeing the treatment of a patient in the Census. 1,260 (42%) adult patients were seen by a consultant with a “General Psychiatry” specialty, while 966 (32%) were seen by a “Psychiatry of Old Age” specialist.

Table 14: Percentage of adult patients by consultant speciality

Psychiatric, addiction or learning disability inpatients NHS Scotland, March/April Census 2016 – 2024.

Main Speciality**	2016*	2017*	2018	2019*	2022	2023	2024
Forensic Psychiatry	12%	13%	14%	15%	13%	12%	14%
General Psychiatry	43%	42%	42%	42%	39%	46%	42%
Learning Disability (non forensic)	5%	5%	4%	4%	4%	4%	4%
Psychiatry of Old Age	39%	38%	38%	36%	29%	31%	32%

*These years’ figures are approximate due to some missing hospital ward data.

**Does not include all consultant specialities due to small numbers

There are various legislations that patients can be subject to, and it is possible for patients to be subject to more than one piece of legislation. Patients can be formally detained under the Mental Health (Care and Treatment) (Scotland) Act 2003.

• 1,114 (37%) adult patients were subject to the Mental Health Act (Compulsory Treatment Order).
• 589 (20%) of adult patients were subject to the Adults with Incapacity (Scotland) Act 2000.

Figure 5: Type of formal detention.

Psychiatric, addiction or learning disability inpatients, NHS Scotland, 2024 census

*Not all legislations are shown due to small numbers.

**Patients may be subject to more than one legislation.

Health and Wellbeing

Mental Health Morbidities

79% of adult patients with known mental health conditions had one mental health condition. 21% of adult patients had two or more conditions. The most common mental health conditions were Schizophrenia (27%), Dementia (21%), and Schizotypal (13%).

Figure 6: Number of mental health conditions.

Psychiatric, addiction or learning disability inpatients, NHS Scotland, March/April Census 2016 – 2024 . Figures prior to 2022 are missing some hospital wards and are approximate

Diagnosis counts include both primary and secondary diagnoses. Additionally, separate questions on autistic spectrum disorder and personality disorder were included. This allows for the cross-comparison with diagnosis codes. This process ensures the identification of any patients missing relevant codes.

Learning Disabilities and Autism

Of the 3,001 adult patients in the 2024 Census, 329 (11%) had a diagnosis for either learning disability or autism. There were 180 (6%) adult patients with a diagnosis for learning disability and 229 (8%) with a diagnosis for autism (80 (3%) patients had a diagnosis for both).

Figure 7: Percentage of adult inpatients with selected mental health conditions

Psychiatric, addiction or learning disability inpatients, NHS Scotland, 2019-2024 census.

* Mental health diagnoses are based on ICD-10 codes. Primary and secondary diagnoses included

** Personality disorders and autistic spectrum disorder counts also rely on respective questions on these disorders

*** Patients may have more than one diagnosis

Physical health co-morbidities

The 2024 Census continued to include a set of Yes/No physical health questions, following the approach used in the 2016 Census.

List of yes/no physical health morbidities questions in the Census:

Hypertension                                       

Diabetes  

Dyslipidaemia                                       

Chronic Obstructive Pulmonary Disease

Coronary heart Disease                     

Chronic Pain

Epilepsy                                                 

Sensory Impairment

Chronic Kidney Disease                     

Liver Disease

Thyroid Disease                                   

Acquired Brain Injury

Cancer                                                   

Stroke / Transient Ischaemic Attack

Alcohol Acquired Brain Injury         

Parkinson's

In the 2024 Census, there were 1,663 (55%) adult patients with at least one physical health co-morbidity based on the Yes/No physical health questions.

Among adult patients with a physical health co-morbidity, 46% had one long-term condition, while 11% had 4 or more physical health co-morbidities. The most common physical co-morbidities in the 2024 Census were Hypertension (14%), and Diabetes (12%).

Figure 8: Inpatients Physical Health conditions

Psychiatric, addiction or learning disability inpatients, NHS Scotland, 2019 - 2024 census

Physical Health Check

In the 2024 Census, out of 1,854 adult patients eligible, 1,658 (89%) are known to have received a general physical examination within a day of admission. 29 patients (2%) were offered an examination but declined.

Regarding annual physical examinations, out of 836 adult patients eligible, 743 (89%) received a health check within the last year. 26 patients (3%) were offered an examination but declined.

Lifestyle Factors

BMI (Body Mass Index)

BMI (Body Mass Index) was calculated for patients with available height and weight data. 232 patients who did not provide this information or had extreme values were excluded. Patients in eating disorder wards were also excluded.

Among the remaining adult patients, 967 (35%) had a normal BMI, while 60% were classified as overweight or obese, and 5% of patients were classified as underweight.

Table 15: Percentage of Adult patients in different BMI bands, 2016 – 2024.

Psychiatric, addiction or learning disability inpatients, NHS Scotland, 2024 census.

BMI	2016	2017	2018	2019	2022	2023	2024
Healthy Weight	36%	37%	37%	36%	34%	34%	35%
Obese	28%	28%	29%	30%	31%	32%	33%
Overweight	31%	30%	30%	30%	30%	29%	28%
Underweight	6%	6%	5%	5%	5%	5%	5%

*     These years figures are approximate due to some missing hospital ward data.

**   Excludes patients in eating disorder wards

*** 13 patients excluded due to missing data or extreme outliers

Smoking, alcohol and drug use

The Census collects data on alcohol and substance use. Not all patients with these issues will have a formal diagnosis so reported numbers may be underestimated.

This section presents analysis based on responses to specific questions. A minor methodological change was made in 2017 (see Section 7 for details).

In the 12 weeks prior to the 2024 Census, 970 adult patients (33%) reported smoking tobacco.

515 adult patients (17%) had a history of alcohol dependence in the four weeks before admission. Of these patients, 114 had an alcohol-related diagnosis, based on ICD-10 codes.

616 of adult patients (21%) reported using substances other than alcohol in the four weeks prior to admission. Of these, 105 (17%) had a diagnosis of substance use based on ICD-10 codes.

NHS Boards provided data on substances used by 432 adult patients with a history of substance misuse (excluding alcohol) in the four weeks before admission. The most common substance was Cannabis, used by 264 patients (42% of drug users).

Figure 9: History of Substance Use

Psychiatric, addiction or learning disability inpatients, NHS Scotland, March/April Census 2016 – 2024 .

* Figures prior to 2022 are missing some hospital wards and are approximate.

Out of the 878 patients with a history of substance abuse, 336 (55%) used only one substance in the four weeks prior to admission. There were 104 (17%) using multiple substances in 2024.

Detailed substance information was not available for 210 (7%) of these patients.

Among patients with recorded substance use in the four weeks before admission, 277 (45%) used "smoke" or "nasal" as the main route and 125 (20%) "oral". Patients may have recorded multiple routes of substance use.

Self-harm

NHS Boards provided information on whether patients self-harmed in the week before admission. In the 2024 Census, 326 adult patients (11%) had self-harmed in that week. The most common form of self-harm was non-accidental self-injury (68% of those reporting self-harm). Patients can self-harm in more than one way.

Of all adults self-harming in the week prior to admission, 47% were male, and 53% were female.

Of adult patients who self-harmed, those aged 18 – 39 years account for 41% of adult patients, those aged 40-64 accounted for 40%, and those aged 65+ accounted for 19%.

Suicidal Ideation

NHS Boards provided information on whether patients expressed suicidal ideation on admission. In the 2024 Census, there were 451 adult patients (15%) who expressed suicidal ideation on admission.

Females were more likely to express suicidal ideation on admission, accounting for 53% of those who did so. Of those who expressed suicidal ideation, 37% were aged 18-39, 39% aged 40-64 and 24% aged 65+.