Mental Health Inpatient Census 2024 - Parts 1 and 2

6. Patients receiving forensic services

Forensic Services Patients:

• 447 patients (15%) in the Census were receiving Forensic Services.
• Patients receiving Forensic Services are mostly males of working age.
• 82% of forensic patients were either overweight or obese.

Forensic mental health services specialise in the assessment, treatment and risk management of people with a mental disorder who are currently undergoing, or have previously undergone, legal or court proceedings. Some other people are managed by forensic mental health services because they are deemed to be at a high risk of harming others or, rarely, themselves under civil legislation.

In this section’s analysis, forensic patients were identified based on the answer to the following Census question: “Is the patient being primarily managed by forensic services?”.

Health Boards returned data for every forensics ward in all censuses from 2014 onwards. There were 447 patients (15%) primarily managed by Forensic Services in the 2024 Census.

Forensic Regional Units in NHS Greater Glasgow & Clyde, NHS Lothian, and NHS Tayside, serve patients from other NHS Boards. NHS Fife also provides a low security Learning Disability (Forensic) Regional Unit for patients from other NHS boards. The State Hospital (a Special NHS Board) provides a National Service, including for Northern Ireland.

Table 16: Number of forensic patients by NHS Board, 2014 – 2024.

Forensic inpatients, NHS Scotland, 2024 census.

NHS Board	2014*	2016*	2017*	2018	2019*	2022	2023	2024
NHS Ayrshire & Arran	c	c	16	18	19	18	19	20
NHS Borders	0	c	0	0	0	0	0	0
NHS Dumfries & Galloway	0	c	0	c	c	0	c	c
NHS Fife	31	34	39	35	39	27	25	23
NHS Forth Valley	20	c	c	c	c	12	15	14
NHS Grampian	42	42	40	41	37	44	42	49
NHS Greater Glasgow & Clyde	128	122	119	123	119	117	111	112
NHS Highland	c	c	c	c	c	6	c	c
NHS Lanarkshire	19	15	20	25	28	25	30	31
NHS Lothian	65	47	56	51	72	41	36	34
NHS Tayside	65	55	64	62	49	47	50	58
NHS Western Isles	0	0	0	0	0	0	0	0
State Hospital	121	117	111	108	109	113	109	99
Scotland	507	458	484	475	488	450	447	447

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

c - Suppressed due to small numbers. Secondary suppression also applied.

Age and sex

Working age males aged 18-64 make up the majority of patients receiving forensic services in the 2024 Census (90%). Patients aged 65 and over represent only 6 % of forensic patients. There were no female forensic patients aged 65 or over.

Figure 10: Percentage of patients in different age / sex bands.

Forensic inpatients, NHS Scotland, 2024 census.

Ward Type

Most forensic services patients were treated in Forensic (non-LD) ward, (304 patients, 68%), 53 patients (12%) patients were in a Rehabilitation (non addiction) ward, 49 patients (11%) were in an Forensic (LD) ward and 41 in other wards.

Ward Security Level

Forensic Services Patients in Different Security Wards:

• Low Security Ward: 137 patients (31%)

• Medium Security Ward: 125 patients (28%)

• High Security Ward: 99 patients (22%)
• General Psychiatric Ward: 10 patients (2%)

Specialty of Consultant

A total of 407 patients (91%) receiving forensic services were seen by a forensic psychiatrist.

3% of patients were seen by a general psychiatrist and 2% by a psychiatrist specialising in Learning Disabilities.

Length of Stay in hospital.

Patients receiving forensic services tend to have longer average (median) lengths of stay. Average (median) time since admission at 2024 Census:

• Patients receiving forensic services: Around 2 years, 0 months
• Non-forensic services patients: Around 3 months

Table 17: Average (median) length of stay for forensic and non-forensic patients, 2024

Forensics inpatients, NHS Scotland, 2024 census.

Forensic Patient	Average (Median) Days since MH Admission	Median Stay (in Months/Years)
Non-forensic Services Patients	98	0 years, 3 months
Forensic Services Patients	721.5	2 years, 0 months
All	132	0 years, 4 months

316 patients had been in hospital for over a year (71% ). Only 7 patients (2%) had been in hospital for less than two weeks .

Table 18: Banded length of stay for forensic patients, 2017 – 2024.

Forensic inpatients, NHS Scotland, 2017-2024 census.

Days since admission	2017	2018	2019	2022	2023	2024
Less than 2 weeks	13	13	17	11	6	7
2 weeks - 1 month	15		10	6	9	6
1 -3 months	36		21	34	21	39
3 - 6 months	34	43	33	23	37	32
6 months - 1 year	58	43	37	36	53	47
1 - 5 years	203	226	234	195	169	185
Over 5 years	125	114	136	145	152	131
All	484	475	488	450	447	447

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

c - Suppressed due to small numbers

Health and Wellbeing

Mental Health Morbidities

NHS Boards provided diagnosis codes (ICD-10) for any mental health condition diagnosed in patients during the 2024 Census. 143 patients (37%) receiving forensic services had 2 or more mental health conditions. Schizophrenia was the most common condition (58% of patients).

Figure 11:  Psychiatric conditions.

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

* All 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 in Patients Receiving Forensic Services

At the 2024 Census, 214 patients (48%) receiving forensic services had at least one physical health co-morbidity based on the Yes/No physical health questions (as described in Chapter 4 – Adult patients). This percentage is lower compared to all adult patients who had a long-term physical health condition (55%).

Among patients receiving forensic services with a physical health co-morbidity, 63% had only one condition and 2% had 4 or more conditions. The most common physical condition among forensic patients was Diabetes, affecting 14% of all forensics patients, followed by Dyslipidaemia and Hypertension (9% each).

Figure 12: Forensic inpatients, Number of physical health comorbidities.

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

Physical Health Check

Of the patients receiving forensic services and admitted within the last year, 79% received a general physical examination. For those admitted over one year ago, 92% had also received an annual physical health check.

In the 2024 Census, a total of 354 (79%) forensic patients with available information received some form of physical health check.

Lifestyle Factors

BMI (Body Mass Index)

BMI (Body Mass Index) was calculated for patients whose height and weight information was provided. No data was provided for 16 forensics patients.

Of the patients receiving forensic services, 234 (54%) were classified as obese, while 120 (28%) were classified as overweight. Overall, 82% of forensic patients were overweight or obese, compared to 60% for all adult patients (excluding those in eating disorder wards).

Smoking, alcohol and other substance misuse

This section analyses patients with alcohol dependence and/or substance misuse based on a combination of questions. Please note that a minor methodological change was made in 2017 (see Methodology for further detail).

Out of all forensic patients, 123 (28%) reported smoking tobacco in the 12 weeks before the Census. In the 2024 Census, 17 forensic patients (4%) had a dependence on or harmful use of alcohol. A total of 55 of forensic patients (12%) had used substances (excluding alcohol).

Self-harm

Information on self-harm was available for 397 forensic patients (89%). Among them, 39 (10%) had self-harmed in the week prior to admission. Among those 39 patients, 28 had self-harmed by non-accidental injury.

Patients can self-harm in more than one way.

Suicidal Ideation

Information on suicidal ideation was available for 399 forensic patients (89%). Among them, 46 (12%) had expressed suicidal ideation on admission to the hospital.