Inpatient census 2022: parts one and two

4. Adult patients treated in NHS Scotland facilities (additional detail)

• There were 2,830 patients aged 18 and over at the time of the 2022 Census
• 76% of adult patients had one mental health condition while 53% of patients also had a long-term physical health condition
• 89% of adult patients in the 2022 Census received some form of physical health check

This section looks at additional detail for adult patients (18+) occupying a mental health, addiction and learning disability bed in NHS Scotland. At the 2022 Census, there were 2,830 adult patients, a 13% decrease on the 2019 Census.

Specialty of Consultant

NHS Boards were asked to record the specialty of every consultant who was responsible for overseeing the treatment of a patient in the Census. A total of 1,067 (38%) adult patients were seen by a consultant whose speciality was “General Psychiatry” in the 2022 Census, four percentage points lower than the previous three censuses. A further 839 (30%) adult patients were seen by a consultant under the speciality “Psychiatry of Old Age”. This is six percentage points lower than 2019.

Table 12: Proportion of adult patients by consultant speciality, NHS Scotland, 2016 – 2022

Consultant Speciality	2016	2017	2018	2019	2022
General Psychiatry	43%	42%	42%	42%	38%
Forensic Psychiatry	12%	13%	14%	15%	14%
Psychiatry of Old Age	39%	38%	38%	36%	30%
Learning Disability	5%	5%	4%	4%	4%
Addictions	1%	1%	< 1%	1%	1%

* Does not include all consultant specialities due to small numbers

Legislation

Patients can be formally detained under the provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003. However, there is a range of legislation which patients can be subject to, and patients can be subject to more than one piece of legislation.

A total of 853 (30%) patients were subject to the Mental Health Act (Compulsory Treatment Order), while 571 (20%) were subject to the Adults with Incapacity (Scotland) Act 2000. Other legislation patients can be subject to includes the Criminal Procedure Act and the Adult Support and Protection (Scotland) Act 2007.

* MHA – Mental Health Act, CPA – Criminal Procedure Act

** Patients can be subject to more than one piece of legislation

*** Some data has been excluded for disclosure control

Health and Wellbeing

Mental health morbidities

NHS Boards returned diagnosis codes (ICD-10) for any mental health condition with which patients in the 2022 Census had been diagnosed. Approximately 3 out of 4 adult patients with known mental health conditions (unknown data for 163 patients) had one mental health condition recorded in the 2022 Census. The proportion of patients with two or more mental health conditions has decreased from 24% in 2019 to 21% in 2022.

* Excludes patients with unknown diagnosis (2016 - <10, 2017 - 86, 2018 - 124, 2019 – 106)

The most commonly diagnosed mental health condition in the 2022 Census for adult patients was schizophrenia (27%), followed by dementia (23%) and schizotypal and delusional disorder (12%). For most conditions, the proportion of patients has changed little since 2019, with the biggest difference a two percentage point decrease in the proportion of patients with dementia and schizophrenia, and a two percentage point increase in schizotypal and delusional disorders. The only other condition to increase from 2019 was autism spectrum disorder, by one percentage point. All other conditions either remained at the same rates or decreased by one percentage point.

Diagnosis counts include both primary and secondary diagnoses. In addition, separate questions on autistic spectrum disorder and personality disorder allowed for cross-comparison with diagnosis codes to pick up any patients missing relevant codes. It should also be noted that patients may have more than one diagnosis.

Learning Disabilities and Autism

Of the 2,830 adult patients in the 2022 Census, 254 (9%) had a diagnosis for either learning disability or autism, the same as in 2018 but down from 294 for 2019. There were 166 (6%) adult patients with a diagnosis for learning disability and 152 (5%) with a diagnosis for autism (64 patients had a diagnosis for both).

* 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

**** Some diagnoses not included due to small numbers

Physical health co-morbidities

The Mental Health Strategy 2017 – 2027 emphasises the importance of considering physical and mental health together as the outcomes of both are linked. A key outcome from the 2014 Census was the need to improve the recording of both mental and physical health morbidities. Mental health and learning disability services in NHS Boards are working towards routinely recording physical health conditions under the International Classification of Diseases. The 2016 Census included a suite of Yes/No physical health questions and these were retained for the 2022 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

There were 1,510 (53%) adult patients with at least one physical health co-morbidity based on the suite of Yes/No physical health questions at the 2022 Census. This is six percentage points lower than the 2019 Census. It is also lower than the 58% figure reported in 2017 and the same as 53% in 2016.

Most adult patients with a physical health co-morbidity returned one long term condition (45%). However, 14% had 4 or more physical health co-morbidities in the 2022 Census, a decrease of four percentage points from 2019. The most common physical co-morbidity in the 2022 Census was hypertension (13% of all adult patients), followed by sensory impairment (11%) and diabetes (11%).

* Patients can have more than one physical condition

Physical Health Check

The 2017 Census included, for the first time, questions related to physical health checks. These follow on from actions on mental health set out by the Chief Medical Officer (http://www.sehd.scot.nhs.uk/cmo/CMO(2015)19.PDF). An annual health check should be both a physical assessment and delivery of health promotion activity. There are two questions;

• For patients admitted to a mental health bed within the last year: “Did the patient receive a general physical examination by a qualified clinician within a day of admission?”
• For patients admitted to a mental health bed over one year ago: “Has the patient had an annual (physical) check within the last year?”

Of the 1,717 adult patients for whom data on a general physical examination was returned, 1,570 (91%) received a general physical examination within a day of admission. This is one percentage point lower than the 2019 Census but three percentage points higher than in 2017. A further 24 (1%) patients were offered an examination but declined.

Of the 881 adult patients for whom data on an annual physical examination was returned, 730 (83%) received a health check within the last year. This is 7 percentage points lower than the 2019 Census. A further 13 (1%) patients were offered an examination but declined.

Overall, 2,300 (89%) adult patients received some form of physical health check in the 2022 Census, three percentage points lower than 2018 and 2019.

Lifestyle factors

BMI (Body Mass Index)

BMI (Body Mass Index) was calculated for patients whose height and weight information was returned. A total of 338 patients were excluded because height and weight information was either not provided or were extreme outliers. Patients in eating disorder wards are also excluded.

Of the remaining adult patients, 847 (34%) had a normal BMI, while 61% were overweight or obese. There has been little change over time in the BMI of adult patients.

Table 13: Proportion of adult patients by Body Mass Index, NHS Scotland, 2016 – 2022

BMI Category	2016	2017	2018	2019	2022
Underweight	6%	6%	5%	5%	5%
Normal	36%	37%	37%	36%	34%
Overweight	31%	30%	30%	30%	30%
Obese	28%	28%	29%	30%	31%

* Excludes patients in eating disorder wards

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

Smoking, alcohol and drug misuse

The Census includes a number of questions around alcohol and other substance misuse. It is known that not all patients with alcohol dependence or substance abuse will have a formal (ICD-10) diagnosis. This section contains analysis of patients with alcohol dependence and/or substance misuse based on responses from a combination of questions. A minor methodological change was made in 2017 (see Section 7 for further detail).

A total of 874 (33%) adult patients smoked tobacco in the 12 weeks prior to the 2022 Census. This is a three percentage point decrease on the 2019 Census. The proportion of adults smoking has remained between 32 and 36 percent since 2016. The proportion of adults smoking in the 2022 Inpatient Census is much higher than the number of adults that smoke in Scotland (11%), as reported in the 2021 Scottish Health Survey.

In the 2022 Census, 481 (18%) of adult patients had a history of alcohol dependence in the four weeks prior to admission. Of these patients, 89 (19%) had an alcohol related diagnosis based on ICD-10 codes. The 18% of adult patients with a history of alcohol dependence in the four weeks prior to admission is three percentage points lower than in 2019.

A total of 516 (19%) of adult patients had abused substances (excluding alcohol) in the four weeks prior to admission. Of these, 56 (11%) had a diagnosis of drug misuse based on ICD-10 codes. The rate of adult patients who had abused substances (excluding alcohol) in the four weeks prior to admission was one percentage point higher than in 2019.

Substances used prior to admission

NHS Boards returned data on the substances used by the 516 adult patients with a history of substance misuse (excluding alcohol) in the four weeks prior to admission. The most prevalent substance was Cannabis, 204 (40%), the lowest since 2016 and 21 percentage points lower than 2019. Heroin (12%) and Cocaine (11%) were the next most prevalent, followed by Amphetamine (10%).

Of the 516 patients with a record of substance abuse (excluding alcohol) in the four weeks prior to admission, 258 (50%) patients used only one substance. 77 (15%) patients used two or more which is an 14 percentage point decrease from 2019. Detailed information on substances used was not returned for 181 (27%) patients.

Table 14: Number of substances used by adult patients in 4 weeks prior to admission, NHS Scotland, 2016 – 2022

Number of substances	2016		2017		2018		2019		2022
One	291	56%	316	59%	334	55%	350	60%	258	50%
Two	79	15%	70	13%	92	15%	91	15%	55	11%
Three	41	8%	34	6%	34	6%	25	4%	15	3%
Four	19	4%	16	3%	22	4%	20	3%	c	c
Five or more	13	2%	24	4%	16	3%	14	2%	c	c
Not known	79	15%	79	15%	106	18%	88	15%	181	35%

c – denotes data suppressed to protect patient confidentiality.

Of the patients with recorded substance abuse in 4 weeks prior to admission, 213 (41%) used smoke or nasal as the main route of substance abuse, 80 (16%) used oral and 33 (6%) injected (patients can use more than one route and data was not returned for all patients).

Self-harm

NHS Boards returned information on whether patients self-harmed in the week prior to admission. At the 2022 Census, 236 (8%) adult patients had self-harmed in the week prior to admission. This proportion is a three percentage point decrease from 2019. Non-accidental injury was the most common form of self-harm in the 2022 Census.

Of all adults self-harming in the week prior to admission, 44% were male and 56% female. However, given only 41% of adult patients in the Census are female, this suggests females are at a higher risk of self-harm compared with males.

While patients aged 18 – 39 years make up 26% of all adult patients in the 2022 Census, this age category represents 46% of those self-harming the week prior to admission, suggesting this age category are most at risk.

Suicidal ideation

NHS Boards returned information on whether patients expressed suicidal ideation on admission. There were 328 (12%) adult patients who expressed suicidal ideation on admission at the 2022 Census, one percentage point higher than 2019.

Females were more likely to express suicidal ideation on admission (58%), as were those aged 18 – 39 (38%) and 40 – 64 (39%).