Mental Health Inpatient Census 2023 - Parts 1 and 2
Results of the seventh Mental Health and Learning Disability Inpatient Census and Outwith NHS Scotland Placements Census, 2023.
Adult patients treated in NHS Scotland facilities (additional detail)
Adult Patients and Demographics:
-
there were 3,012 adult patients aged 18 and over in the 2023 Census, which is a 3% increase from 2022.
-
70% of adult patients had one mental health condition, and 56% had a long-term physical health condition.
- 89% of adult patients received some form of physical health check.
Specialty of consultant and legislation
NHS Boards were asked to record the specialty of every consultant who was responsible for overseeing the treatment of a patient in the Census. 1381 (46%) adult patients were seen by a consultant with a "General Psychiatry" specialty, while 947 (31%) were seen by a "Psychiatry of Old Age" specialist.
Table 13: Proportion of adult patients by consultant speciality
Psychiatric, addiction or learning disability inpatients, NHS Scotland, March/April Census 2016 – 2023.
| Consultant Speciality | 2016* | 2017* | 2018 | 2019* | 2022 | 2023 |
| General Psychiatry | 43% | 42% | 42% | 42% | 39% | 46% |
| Forensic Psychiatry | 12% | 13% | 14% | 15% | 13% | 12% |
| Psychiatry of Old Age | 39% | 38% | 38% | 36% | 29% | 31% |
| Learning Disability | 5% | 5% | 4% | 4% | 4% | 4% |
| Addictions | 1% | 1% | < 1% | 1% | 1% | <1% |
* Does not include all consultant specialities due to small numbers
Patients can be formally detained under the Mental Health (Care and Treatment) (Scotland) Act 2003. However, there are various legislations that patients can be subject to. It is possible for patients to be subject to more than one piece of legislation. 1026 (34%) adult patients were subject to the Mental Health Act (Compulsory Treatment Order). While 702 (23%) of adult patients were subject to the Adults with Incapacity (Scotland) Act 2000.
Figure 5: The most common legislation that adult patients were held under was the Mental Health Act (Compulsory Treatment Order).
Psychiatric, addiction or learning disability inpatients, NHS Scotland, 2023 census.
* the data for MHA – Nurse Holding Powers, CPA – Sections 59, 59A and Temporary Compulsion Order, and Regulation of Care (Scotland) Act 2001 have been included in Other Legislation due to small numbers.
** patients may be subject to more than one legislation.
Health and wellbeing
Mental health morbidities
70% of adult patients with known mental health conditions had one mental health condition. 30% of adult patients had two or more conditions, an eight percentage point increase from 2022. The most common mental health conditions were schizophrenia (28%), dementia (20%), and schizotypal and delusional disorder (14%).
Figure 6: The proportion of adult patients with 2 or more mental health conditions in 2023 is nine percentage points higher than 2022. FIGURE 6
Psychiatric, addiction or learning disability inpatients, NHS Scotland, March/April Census 2016 – 2023.
Figures prior to 2022 are missing some hospital wards and are approximate.
For most conditions, the proportion of patients has changed little since 2022. The most significant difference is a three percentage point decrease in the proportion of patients with dementia. All other conditions either remained at the same rates or increased by one percentage point.
Diagnosis counts include both primary and secondary diagnoses. Additionally, separate questions on autistic spectrum disorder and personality disorder were included. This allows for the cross-comparison with diagnosis codes. This process ensures the identification of any patients missing relevant codes.
Learning disabilities and autism
Of the 3,012 adult patients in the 2023 Census, 283 (9%) had a diagnosis for either
learning disabidlity or autism. There were 166 (6%) adult patients with a diagnosis for learning disability and 195 (6%) with a diagnosis for autism (78 patients had a diagnosis for both).
Figure 7: There has been a decrease of 3 percentage points in the proportion of adult inpatients with dementia from 2022 to 2023.
Psychiatric, addiction or learning disability inpatients, NHS Scotland, Census 2022 – 2023.
* 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 and check
The Mental Health Strategy 2017 – 2027 highlights the importance of addressing physical and mental health together as they are interconnected. The 2014 Census identified the need to improve the recording of both mental and physical health conditions. To achieve this, mental health and learning disability services in NHS Boards are striving to routinely record physical health conditions using the International Classification of Diseases. The 2023 Census continued to include a set of Yes/No physical health questions, following the approach used in the 2016 Census.
List of yes/no physical health morbidities questions in the census:
● hypertension
● diabetes
● dyslipidaemia
● Chronic Obstructive Pulmonary Disease (COPD)
● coronary heart disease
● chronic pain
● epilepsy
● sensory impairment
● chronic kidney disease
● liver disease
● thyroid disease
● acquired brain injury
● cancer
● stroke / Transient Ischaemic Attack (TIA)
● alcohol acquired brain injury
● Parkinson
In the 2023 Census, there were 1,694 (56%) adult patients with at least one physical health co-morbidity based on the Yes/No physical health questions. This is a increase of three percentage points compared to the 2022 Census. The figure is also lower than the 59% reported in 2019.
Among adult patients with a physical health co-morbidity, 42% had one long-term condition, w. While 14% had 4 or more physical health co-morbidities. This is the sameThese are slightly down from the 45% with one long-term condition and 15% with four or more in proportion as the the 2022 census. The most common physical co-morbidities in the 2023 Census were hypertension (15%), sensory impairment (12%), and diabetes (12%).
Figure 8: The prevalence of physical health conditions in 2023 remains broadly similar to previous years.
Psychiatric, addiction or learning disability inpatients, NHS Scotland, Census 2022 – 2023.
* Patients can have more than one physical health condition.
Physical health check
In total, 2,533 (89%) adult patients received some form of physical health check in the 2023 Census, the same as 2022, but three percentage points lower than in 2018 and 2019.
In the 2023 Census, out of 1,917 adult patients eligible, 1,710 (94%) are known to have received a general physical examination within a day of admission. This is a decrease of two percentage points compared to the 2022. Additionally, 37 (2%) patients were offered an examination but declined.
Regarding annual physical examinations, out of 942 adult patients eligible, 823 (87%) received a health check within the last year. This is 4 percentage points higher than the 2022 Census. Furthermore, 23 (2%) patients were offered an examination but declined.
Lifestyle Factors
BMI (Body Mass Index)
BMI (Body Mass Index) was calculated for patients with available height and weight data. We excluded 257 patients who didn't provide this information or had extreme values. Patients in eating disorder wards were also excluded.
Among the remaining adult patients, 931 (34%) had a normal BMI, while 61% were classified as overweight or obese. The BMI of adult patients has shown little change over time.
Table 13: Proportion of adult patients by Body Mass Index, NHS Scotland, 2016 – 2023
Psychiatric, addiction or learning disability inpatients, NHS Scotland, March/April Census 2016 – 2023.
|
BMI Category |
2016* |
2017* |
2018 |
2019* |
2022 |
2023 |
|
Underweight |
6% |
6% |
5% |
5% |
5% |
5% |
|
Normal |
36% |
37% |
37% |
36% |
34% |
34% |
|
Overweight |
31% |
30% |
30% |
30% |
30% |
29% |
|
Obese |
28% |
28% |
29% |
30% |
31% |
32% |
* These years are missing some hospital wards and figures are approximate.
** Excludes patients in eating disorder wards
*** 257 patients excluded in 2023 due to missing data or extreme outliers
Smoking, alcohol and drug misuse
The Census collects data on alcohol and substance misuse. It's important to note that not all patients with these issues have a formal diagnosis. This section presents analysis based on responses to specific questions. A minor methodological change was made in 2017 (see Section 7 for details).
In the 12 weeks prior to the 2023 Census, 1,014 (34%) adult patients reported smoking tobacco, an increase of two percentage point from 2022. Smoking rates have remained fairly consistent between 32% and 36% since 2016. The proportion of smokers among adult patients in the 2023 Inpatient Census is higher than the overall smoking rate in Scotland. The 2022 Scottish Health Survey reported that 15% of adults in Scotland were smokers.
Regarding alcohol dependence, 474 (16%) of adult patients had a history of alcohol dependence in the four weeks before admission. Of these patients, 106 (22%) had an alcohol-related diagnosis based on ICD-10 codes. The is three percentage points higher than in 2022.
For substance abuse (excluding alcohol), 528 (18%) of adult patients reported it in the four weeks prior to admission. Of these, 68 (13%) had a diagnosis of drug misuse based on ICD-10 codes. The rate of substance abuse among adult patients in the four weeks before admission was one percentage point lower than in 2022.
NHS Boards provided data on substances used by 528 adult patients with a history of substance misuse (excluding alcohol) in the four weeks before admission. The most common substance was Cannabis, used by 249 patients (47%). This is eight percentage points higher than 2022 but still 14 percentage points lower than 2019. Cocaine (16%) was the next most prevalent, followed by Heroin (10%) and Amphetamine (10%).
Figure 9: The proportion of adult patients with a history of alcohol abuse has fallen for the second year in a row and is the lowest recorded at 16%. Although similar to 2022, the proportion of adults who misused drugs is 18%, 5 percentage points higher than in 2016. The proportion who are smokers, 34%, remains similar to previous years.
Psychiatric, addiction or learning disability inpatients, NHS Scotland, March/April Census 2016 – 2023.
Figures prior to 2022 are missing some hospital wards and are approximate.
Out of the 528 patients with a history of substance abuse, 282 (53%) used only one substance in the four weeks prior to admission. There were only 89 (17%) using multiple substances in 2023. The number of patients using two or more substances increased by three percentage points from 2022. Detailed substance information was not available for 126 of these patients.
Regarding the main route of substance abuse among patients with recorded substance abuse in the four weeks before admission, 265 (50%) used smoke or nasal, 71 (13%) used oral, and 21 (4%) injected. It's important to note that patients may use multiple routes of substance abuse.
Self-harm
NHS Boards provided information on whether patients self-harmed in the week before admission. In the 2023 Census, 269 (9%) adult patients had self-harmed in that week, which is a one percentage point increase from 2022. The most common form of self-harm in the 2023 Census was non-accidental injury (51%).
Out of all adults self-harming in the week prior to admission, 41% were male, and 59% were female. However, it important to note that only 40% of adult patients in the Census are female. This suggests that females are at a higher risk of self-harm compared to males.
Among all adult patients in the 2023 Census, those aged 18 – 39 years make up 28%. However, this age category represents 43% of those who self-harmed in the week before admission. This indicates that individuals that those aged 18 - 39 are most at risk.
Suicidal ideation
NHS Boards provided information on whether patients expressed suicidal ideation on admission. In the 2023 Census, there were 397 (13%) adult patients who expressed suicidal ideation on admission. This is one percentage point higher than in 2022.
Females were more likely to express suicidal ideation on admission, accounting for 53% of those who did so. Additionally, individuals aged 18 – 39 (36%) and 40 – 64 (39%) were more likely to express suicidal ideation compared to other age groups.
Contact
mhic@gov.scot
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