Independent Forensic Mental Health Review: final report

Introduction

Background to the Review

In March 2019, the Minister for Mental Health announced an Independent Review into the Delivery of Forensic Mental Health Services.  Derek Barron, Director of Care at Erskine was announced as the Chair to the Review in May 2019 and began work at the end of June that year.

This Review was not being asked to investigate a specific negative event.  Rather, it was set up in recognition that there had been significant changes in the way forensic mental health services were being delivered, over a number of years.  Changes included a decline in the number of people detained in levels of high security at the State Hospital, the development of medium secure services, the introduction of appeals against conditions of excessive security and plans for a National Secure Adolescent Inpatient Service for Scotland.

The Review’s remit and purpose as set down in its terms of reference was to review:

• Strategic direction, ongoing oversight and governance arrangements;
• Demand, capacity and availability across the forensic secure estate;
• High secure provision;
• Community forensic mental health services;
• Forensic mental health services and the justice system; and,
• Forensic mental health services for client groups with particular needs.

The ‘client groups’ were people with a learning disability or neurodevelopmental disorder; women; children and young people; and older adults.  The Review’s full terms of reference can be found at Annex A: Terms of Reference

The Review was supported by a secretariat team that started work in July 2019 and three working groups that were established over the summer of 2019.  The work of the Review was suspended from 17 March 2020 until 20 July 2020 to allow the Chair and its working group members to focus their efforts on responding to the coronavirus pandemic.

As a result of its work, the Review was expected to make recommendations for change or improvements.  It was also expected to identify any legislative issues or the need for any further reviews.

The Review’s working groups

In June 2019, the Chair wrote to organisations representing people receiving, delivering and monitoring forensic mental health services.  He asked them to nominate people who were interested in making a positive difference to these services.  These people had to have the time and expertise to join working groups to support the Review’s work.  In July 2019, 53 people representing over 45 organisations met with the Chair to discuss the work of the Review.  They were then asked to join, or nominate others, to join one of the Review’s three working groups.  There was a hospital working group, a community working group and a criminal justice working group.

The membership of these groups remained fairly constant throughout the work of the Review.  Across the three working groups, there were 67 members representing 49 organisations.  The full list of members and the groups they represented can be found at Annex B: Working group members.

The Review held three meetings with each group.  These took place in person in October 2019 and online in August 2020 and October 2020.  The first meeting focused on the pathways within and around forensic services and the areas of concern within them.  It also agreed the evidence that the Review needed to gather and the ways in which the working group members could support that.  Working group members representing people receiving these services and their family and friends met separately with the Review in September 2019 to discuss the specific ways in which the Review could ensure these groups were reached and their voices were heard.  These working group members then not only facilitated access to group sessions with people for the Review, but organised their own events to collate views on the Review’s behalf.

Meetings of the working groups originally arranged for March 2020 were postponed in response to the coronavirus pandemic.  These meetings subsequently took place online in August 2020 where working group members provided their feedback on the Review’s interim report.

The final meetings were held online in October 2020.  Working group members were asked for their thoughts on priority areas for change and their ideas for the potential solutions.  The Chair also asked the representative for the Scottish Human Rights Commission for an analysis of the issues raised in the interim report, from a human rights perspective.  The Scottish Human Rights Commission published this report in January 2021.^[2]

From August until the end of December 2020, and throughout the earlier work of the Review, members continued to be available to the Review team for additional evidence requests.

The Chair and secretariat of the Review are indebted to the support provided to them by the working group members.

Background to this report

This is the second and final report of the Review.

The Review gathered evidence during its ‘listening phase’ which ran between August 2019 and February 2020.  The Review sought the views of people in two ways.  There was a formal call for evidence that ran from 14 October 2019 until 31 January 2020.  The Review received 103 responses from 56 organisations and 47 individuals.  Alongside these written responses, the Chair went out and met people receiving and delivering forensic mental health services.  He visited 10 secure hospital sites where he met with 88 people with lived experience, 16 family members and 118 staff.  Advocacy workers supported and amplified the voices of people with lived experience at a number of these visits.  He also met with people individually and spoke at a number of conferences.

An analysis of the evidence received by the Review was published in August 2020.  This interim report, What People Told Us, provides an overview of the key issues and challenges in forensic mental health services in Scotland as they are experienced by the people receiving and delivering them.^[3]  Between August and October 2020, the Review invited feedback on the report.  This allowed people another opportunity to bring any issues to the attention of the Review.  A further 20 written responses were made during this period and the Chair arranged and accepted invitations to meet with interested groups and individuals.  The Review team continued to proactively gather further information to address evidence gaps until December 2020.

The full list of engagement activities and organisations who responded to the Review’s public calls for evidence are listed at Annex C: Responses to calls for evidence and Annex D: Engagement activities supporting the work of the Review.  As well as the formal responses to the consultation exercises, the Review has received and considered over 300 other supplementary documents including reports, articles, guidelines and responses to specific requests for information.

This report is informed by the evidence of the interim report and the additional evidence the Review has gathered since its publication.  It identifies the key issues that the Review considers need to be addressed to improve the delivery of forensic mental health services in Scotland.  It also makes a number of specific recommendations as to how this should be done.

In this report the term ‘forensic mental health services’ includes forensic learning disability services.