Mental Health Inpatient Census Part 3: Hospital-Based Complex Clinical Care and Long Stay

Methodology and further information

The eighth Mental Health Inpatient Census was carried out on 10th April 2024 by the Scottish Government and NHS Boards. The census covered three parts: 

Part 1: Every patient occupying a psychiatric, addiction, or learning disability inpatient bed in an NHS Scotland facility on the census date. 

Part 2: Every mental health, addiction, or learning disability patient whose care is funded by NHS Scotland but is being treated in a facility outwith NHS Scotland. 

Part 3: Every patient who was in receipt of Hospital Based Complex Clinical Care (HBCCC) in general acute inpatient beds on the census date. 

All 12 NHS Scotland territorial boards with psychiatric, addiction, or learning disability inpatient beds provided a return. The State Hospital (Special NHS Board) does not provide a return for Parts 2 or 3. 

The Scottish Government’s Digital Acquisition Services provide data collection and validation support for a number of statistical returns. Digital Acquisition Services provided secure data collection software (procxed.net) and first stage data validation checks. Further information about the data collection software can be found in the Data Privacy Impact Assessment which can be obtained on request from MHIC@gov.scot 

The data collection, analysis and reporting of the census has been overseen and produced by Scottish Government statisticians. All statisticians in the Scottish Government are part of the Government Statistical Service (GSS) which comprises the statistics divisions of all major departments in the UK Government, and the devolved Governments of Scotland, Wales and Northern Ireland plus the Office for National Statistics, which has a coordinating role for the GSS. 

Data confidentiality

A Data Protection Impact Assessment was undertaken prior to the census which outlines how patient confidentiality is maintained. The Data Protection Impact Assessment can be obtained on request from MHIC@gov.scot 

In addition, statistical disclosure control has been applied to the analysis. Statistical Disclosure Control (SDC) covers a range of ways of changing data which are used to control the risk of inadvertent disclosure of sensitive information about a person or unit (such as a household or business). This publication has used the following methods where there are under 5 patients in a particular category: 

• Suppression of possibly disclosive cells (e.g. where the value is small) which means that the value for that cell in the table is not given and secondary suppression of cells which means at least one other value in the row or column is also not given to ensure that disclosive cells cannot be deduced through subtraction. 

• Table redesign and recoding, where cells are grouped together to protect small value cells. 

• Rounding – as an alternative to secondary suppression, but preserving some information about the relative size of the categories. 

Further information about Statistical Disclosure Control is available here: Statistical disclosure control - Office for National Statistics (ons.gov.uk) 

Implementation of sex and transgender questions

In 2023 the questions used to collect data in this area were aligned with the Scottish Government, Office of the Chief Statistician’s guidance on sex, gender identity and trans status: Sex, gender identity, trans status - data collection and publication: guidance - gov.scot (www.gov.scot) 

This improved the language, design and consistency of the questions being used and has enabled people to be more appropriately represented in the survey. 

The change to reporting of sex instead of gender and the introduction of extra questions here also brings the Census questions into alignment with other Health and Social Care surveys such as the Scottish Health Survey, and the National Records of Scotland population census. 

The change in the questions are described below: 

Prior to 2023 the following question was asked: 

Q - Gender of patient: 

• Male
• Female
• Other
• [for coding only] Not known 

From 2023 onwards, the following questions are now asked: 

Q - Sex of patient: 

• Female
• Male
• Prefer not to say
• [for coding only] Not known 

Q - Does the patient consider themselves to be trans, or have a trans history? 

• Yes
• No
• Prefer not to say
• Not known 

Q - If the patient would like to, how would they describe their trans status (for example, non-binary, trans man, trans woman)?

• Answer can be supplied as free text response. 

This means that from 2023 onwards data on sex that is reported in the census is not directly comparable with data collected on gender for prior years. Notes have been added to the relevant sections of the publication to make this clear. 

The census is one of the data collections that is part of the Equalities Data Improvement Programme (EDIP). The EDIP was a commitment to expand and make improvements to protected characteristics data. This was part of the wider Equality Evidence Strategy, published in March 2023. More details on this are provided here: Scotland’s Equality Evidence Strategy 2023-2025 - gov.scot 

Health Conditions

The International Classification of Diseases (10th Revision) has been used in the analysis for specific health conditions. The health condition and relevant ICD-10 code can be found in the following table:

Autism

For the purpose of this report, the autism cohort is defined by the patient meeting at least one of the following criteria: 

 Alcohol misuse cohort

For the purpose of this report, the alcohol misuse cohort is defined by the patient meeting at least one of the following criteria:

Drugs misuse cohort

For the purpose of this report, the drug misuse cohort is defined by the patient meeting at least one of the following criteria: 

Forensic Patients

Forensic patients were identified if NHS Boards indicated ‘yes’ to the following Census question: is the patient being managed primarily by forensic services?

Access to the data for further research

To enable further research and statistical analysis, extracts of the Inpatient Census data may be made available for approved researchers.

Academic researchers must initially apply to the ‘Statistics Public Benefit and Privacy Panel’ or the ‘Public Benefit and Privacy Panel for Health and Social Care’ to gain access to the census data. 

Once an application has been approved, a copy of the original application form and a copy of the approval letter should be emailed to the following address MHIC@gov.scot for approval by the Scottish Government (Health & Social Care Analysis Division and the Principal Medical Officer for Mental Health). 

NHS Boards will have a version of their own census dataset which contains information about patients for whom they are responsible for providing treatment or are responsible for funding. NHS boards will have their own arrangements in place for researchers to access health data. 

All boards have a Caldicott Guardian who is responsible for assuring confidentiality and enabling appropriate data sharing, and a director responsible for research and development.