Mental Health Inpatient Census 2023 - Parts 1 and 2

Table 8: Number of beds and occupancy by ward type NHS Scotland, 2018 – 2023

Psychiatric, addiction or learning disability inpatients, beds and occupancy rates, NHS Scotland, March/April Census 2018 – 2023.

* 2019 is missing some hospital wards and figures are approximate.

¹ Addiction wards are the combination of addiction rehabilitation and addiction detox wards.

² Dementia wards are the combination of dementia assessment and dementia care & treatment wards.

³ Young People/Children wards are the combination of Young people’s units and children’s units.

The bed occupancy rate for NHS Scotland was 89%. This varied between ward types, with Eating Disorder and Addiction wards having an occupancy of 70% and Perinatal wards an occupancy of 100%. Wards also differ in the number of available beds. Around two in five beds in Scotland were in an Acute ward, and just under one in five were in a Dementia ward. Addiction wards in 2019 showed an occupancy rate of 102%, partly due to "On Pass" patients who temporarily free up beds.

Ward Security Levels

Wards have varying levels of security. This can affect unrestricted communication, visitor access, and patient movements. Most patients (63%) were in General Psychiatric Wards, and 20% were in wards with low, medium, or high security levels.

Patients in these wards usually require more attention and higher staff resources. Since 2016, there has been a decrease from 74% to 63% in the proportion of patients treated in general psychiatric wards. Yet, there has not been a corresponding increase in wards with extra security.

In most ward types, "General Psychiatric" is the most common security level and is the only security level for Acute, Addiction, Continuing/Long Stay, Young People/Children, Perinatal, and Eating Disorder wards. However, some ward types have more varied security levels, likely reflecting the complex nature of the cases they deal with. Only Forensic wards included a "High Security" level.

Figure 2: Most wards have a security level of “General Psychiatric”, however some wards have a range of security levels.

Psychiatric, addiction or learning disability beds, NHS Scotland, 2023 census.

*Other security includes: Open Forensic Ward, Community Facility, Intensive Care Psychiatric Unit.

**Excludes a number of cases where ward security returned “Not applicable” (237 inpatients).

Observation level

Wards vary in security levels. These levels are based on patients’ individual needs but can impact staff resources. The observation levels recorded at the time of the Census are:

• "General Observation" – Staff should know the patients' general whereabouts.
• "Constant Observation" – Staff should constantly know the precise whereabouts of the patient.
• "Special Observation" – Patients should be in sight and within arm's reach of a staff member.
• "Enhanced Care Plan For Therapeutic Engagement" – Aims to improve observation through therapeutic engagement with suicidal, violent, or vulnerable patients to prevent harm during their recovery at times of high risk.

During the 2023 Census, the majority of patients (2,719 or 89%) were under general observation. However, some wards, such as Learning Disability wards (both Forensic and Non-Forensic) and Intensive Psychiatric Care wards, had more patients requiring higher levels of observation.

Figure 3: Most patients are under general observation, however some wards have a higher proportion of patients requiring higher levels of observation.

Psychiatric, addiction or learning disability inpatients, NHS Scotland, 2023 census.

Patients under Constant, Special, or Enhanced Observation need a high level of staff resources. Out of the 299 patients under these levels, 73 (24%) required 2 or more staff members for supervision. This varied across ward types. For example, in Acute wards, 88% of patients needed only one staff member for supervision. In Forensic (Non-Learning Disability) wards, 22 patients (63%) required 2 or more staff members for higher levels of observation.

The most common reasons for patients being on Constant, Special, or Enhanced Observation were "risk of harm to others" (36%), "risk of self-harm" (21%), and "risk of absconding" and “physical monitoring” (10%). Note that patients may be under observation for multiple reasons, such as being a risk to themselves or to others.

Formal Status and Length of Stay

Patients can have two types of status under the provisions of the Mental Health (Care and Treatment) (Scotland) Act of 2003:

• Formal status: This refers to patients who have been detained under the Act.
• Informal status: This refers to patients who have been admitted to Mental Health facilities voluntarily.

In the 2023 Census, around 61% of patients had a Formal status, which has been steadily increasing since the 2016 Census (44%). This status can change during their stay. On the day of the Census, 62% of patients had a Formal status, slightly higher than on admission.
There are large differences in the lengths of stay between patients with Formal and Informal status. Current patients with Formal status had an average (median) stay of about 8 months (245.5 days). Patients with current Informal status had an average stay of about 2 months (66 days).

The proportion of Formal patients varies across different ward types. Forensic Wards and Intensive Psychiatric Care Wards mostly have Formal patients. In most ward types, the proportion of Formal patients is increasing. Since 2022, Acute wards for have more Formal than Informal patients. Addiction and Dementia Wards tend to have more Informal patients due to voluntary admissions.

Table 9: Percentage of inpatients with a “Formal” status at time of Census by ward type

Psychiatric, addiction or learning disability inpatients, NHS Scotland, March/April Census 2016 – 2023.

* These years are missing some hospital wards and figures are approximate.

Hospital Based Complex Clinical Care (HBCCC):

At the 2023 Census, patients receiving HBCCC had longer stays compared to those without HBCCC. HBCCC patients had an average (median) length of stay of about one year and eight months (615 days). Patients without HBCCC had an average stay of about three and a half months (104 days).

There were 509 (17%) patients receiving HBCCC in mental health or learning disability inpatient beds at the 2023 Census. Most of these patients (35%) were being treated in Dementia wards. Although most HBCCC patients are in wards with longer lengths of stay, 5% are in Acute wards.

Table 10: Number of HBCCC patients by selected ward type, and the percentage of inpatients in that ward type who are receiving HBCCC.

Psychiatric, addiction or learning disability inpatients, NHS Scotland, March/April Census 2017 – 2023.

* These years are missing some hospital wards and figures are approximate.

¹ Dementia wards are the combination of dementia assessment and dementia care & treatment wards.

c – data suppressed due to small numbers. Secondary suppression also applied.

Delayed discharge 

Timely discharge from the hospital is an indicator of quality care. It reflects person-centred, effective, integrated, and harm-free treatment. Delayed discharge happens when a hospital patient who is ready for discharge continues to occupy a bed.

In the 2023 Census, there were 321 patients experiencing delayed discharge. Most of them were in Acute wards (27% or 86 inpatients), Dementia wards (26% or 83 inpatients) and Learning Disability units (Non-Forensic) (16% or 50 inpatients).

The length of delay at the 2023 Census varied significantly across different ward types. Patients in Dementia wards (43 days), Admission & Assessment (36 days), and Acute wards (57 days) had shorter delays. However, delays were longer for patients in Forensic units. There was an average (median) delay of 153 days for patients in Forensic units (excluding learning disability).

The longest delays were observed in patients in Forensic Learning Disability units (442.5 days). Delays in Non-Forensic Learning Disability units have decreased from 760 days in the 2019 Census to 155 days in 2023.

The proportion of patients experiencing delayed discharge ranged across health boards from 6% in NHS Lanarkshire to 25% in NHS Dumfries and Galloway. This may reflect a number of factors including ward type and treatment.

Male patients (60%) were more likely to experience delayed discharge than female patients (40%). Most of these patients were also over 65 (42%), however those aged 18-39 had the longest length of delay (149 days). The most common diagnosis for delayed discharged patients was dementia (30%), followed by learning disability or autism (21%) and schizophrenia (19%). 

Table 11: Delayed Discharges by Health board

Psychiatric, addiction or learning disability inpatients, NHS Scotland, 2023 census.

Length of Stay in Different Wards

The average (median) length of stay for patients in the country is 140 days. However, this duration varies across different ward types. For instance, patients in Forensic Learning Disability units have the longest average stay, at 3 years and 11 months (1,434 days). This is followed by patients in Non-Forensic Learning Disability wards (1,217 days) and Forensic (non-LD) wards at 890 days.

Patients in Rehabilitation (722 days) and Continuing Care/Long Stay wards (735 days) also experience longer stays, at around 2 years. On the other hand, patients in Addiction wards have a much shorter average (median) stay of 10 days.

Table 12: Average (median) length of stay (days) by ward type.

Psychiatric, addiction or learning disability inpatients and beds, NHS Scotland, March/April Census 2016 – 2023.

* These years are missing some hospital wards and figures are approximate.