Mental Health Inpatient Census 2023 - Parts 1 and 2

Patients receiving Forensic Services (additional detail)

Forensic Services Patients:

• 447 (15%) patients in the Census were receiving forensic services.
• patients receiving forensic services are mostly males of working age.
• 84% of forensic patients were either overweight or obese.

Forensic psychiatry is a specialised branch of clinical psychiatry. It relates to mentally disordered offenders and individuals with similar problems. In this section's analysis, forensic patients were identified based on the answer to the following Census question: “Is the patient being primarily managed by forensic services?”.

Health Boards returned data for every forensics ward in all censuses from 2014 onwards. There were 447 patients (15%) primarily managed by Forensic Services in the 2023 Census, a decrease from 16% in 2022.

Forensic Regional Units in NHS Greater Glasgow & Clyde, NHS Lothian, and NHS Tayside serve patients from other NHS Boards. NHS Fife also provides a low security Learning Disability (Forensic) Regional Unit for patients from other NHS boards. The State Hospital (a Special NHS Board) provides a National Service, including for Northern Ireland.

Table 14: Number of forensic patients by NHS Board, 2014 – 2023

Forensics inpatients, NHS Scotland, March/April Census 2014 – 2023.

NHS Board	2014*	2016*	2017*	2018	2019*	2022	2023
NHS Ayrshire & Arran	c	c	16	18	19	18	19
NHS Borders	0	c	0	0	0	0	0
NHS Dumfries & Galloway	0	c	0	c	c	0	c
NHS Fife	31	34	39	35	39	27	25
NHS Forth Valley	20	c	c	c	c	12	15
NHS Grampian	42	42	40	41	37	44	42
NHS Greater Glasgow & Clyde	128	122	119	123	119	117	111
NHS Highland	c	c	c	c	c	6	c
NHS Lanarkshire	19	15	20	25	28	25	30
NHS Lothian	65	47	56	51	72	41	36
NHS Tayside	65	55	64	62	49	47	50
NHS Western Isles	0	0	0	0	0	0	0
State Hospital	121	117	111	108	109	113	109
Scotland	507	458	484	475	488	450	447

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

c -  Suppressed due to small numbers. Secondary suppression also applied.

Age and sex

Working age males make up the vast majority (91%) of patients receiving forensic services in the 2023 Census. This percentage has decreased by two percentage points since 2022. Patients aged 65 and over represent only 6% of forensic patients.

Figure 10: Working age males made up 91% of all forensic patients in the 2023 Census, while males in general made up 96%.

Forensics inpatients, NHS Scotland, 2023 census.

Ward Type

Most forensic services patients were treated in a forensic ward, (352 patients, 79%), of which 42 were in a learning disability ward. A further 58 (13%) patients were in a rehabilitation (non addiction) ward, while 21 (13%) were in an intensive psychiatric care unit.

Ward Security Level

Forensic Services Patients in different security wards:

• Low Security Ward: 122 patients (27%)
• Medium Security Ward: 120 patients (27%)
• High Security Ward: 109 patients (24%)
• General Psychiatric Ward: 13 patients (3%) (Compared with 63% in of all mental health, addiction, or learning disability patients)

Specialty of Consultant

A total of 339 (76%) patients receiving forensic services were seen by a forensic psychiatrist. There were less than 1% of patients being seen by a consultant whose specialty was Psychiatry of Old Age.

Length of Stay in hospital

Patients receiving forensic services tend to have longer average (median) lengths of stay. Average (median) time since admission at 2023 Census:

• patients receiving forensic services: Around 2 years and 5 months
• non-forensic services patients: 3 months

Table  15: Average (median) length of stay for forensic and non-forensic patients, 2023

Forensics inpatients, NHS Scotland, 2023 census.

Group	Average (median) number of days since admission	Approx. number of years / months
Forensic Services Patients	878	2 years, 5 months
Non-forensic Services Patients	103	3 months

72% had been in hospital for over a year (321 patients). Only 1% had been in hospital for less than two weeks (6 patients).

Table  16: Banded length of stay for forensic patients, 2017 – 2023

Forensics inpatients, March/April Census 2017 – 2023.

Banded days since admission	2017*	percentage of forensics patients	2018	percentage of forensics patients	2019*	percentage of forensics patients	2022	percentage of forensics patients	2023	percentage of forensics patients
Less than 2 weeks	13	3%	13	3%	17	3%	11	2%	6	1%
At least 2 weeks, less than 1 month	15	3%	c	c	10	2%	6	1%	9	2%
At least 1 month, less than 3 months	36	7%	c	c	21	4%	34	8%	21	5%
At least 3 months, less than 6 months	34	7%	43	9%	33	7%	23	5%	37	8%
At least 6 months, less than 1 year	58	12%	43	9%	37	8%	36	8%	53	12%
At least 1 year, less than 5 years	203	42%	226	48%	234	48%	195	43%	169	38%
5 years or more	125	26%	114	24%	136	28%	145	32%	152	34%

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

c - Suppressed due to small numbers

Health and Wellbeing

Mental Health Morbidities

NHS Boards provided diagnosis codes (ICD-10) for any mental health condition diagnosed in patients during the 2023 Census. 196 (44%) of patients receiving forensic services had 2 or more mental health conditions. Schizophrenia was the most common condition (64% of patients). Patients receiving forensic services are much more likely to have a personality disorder (1 in 4) compared to all adults (1 in 10).

Figure 11: Certain mental health conditions are more prominent in patients receiving forensic services compared to all adults, for example Schizophrenia (64% compared to 28%), while only 1% of forensics patients have dementia compared to 20% in the census as a whole.

Forensics inpatients, NHS Scotland, 2023 census.

*All 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 in patients receiving forensic services

At the 2023 Census, 219 (49%) patients receiving forensic services had at least one physical health co-morbidity based on the Yes/No physical health questions described in Chapter 4 – Adult patients. This percentage is lower compared to all adult patients who had a long -term physical health condition (56%). However, forensic patients tend to be younger, which might explain the difference.

Among patients receiving forensic services with a physical health co-morbidity, the majority had only one condition (57%). The most common physical condition among these patients was diabetes, affecting 66 (15%) of all forensics patients, followed by hypertension at 13%.

Figure 12: 29% of patients receiving forensic services had one long-term physical condition, while 2% had 4 or more.

Forensics inpatients, NHS Scotland, 2023 census.

Physical Health Check

Of the patients receiving forensic services and admitted within the last year, the majority (88%) received a general physical examination. For those admitted over one year ago, 88% had received an annual physical health check.

In the 2023 Census, a total of 368 (88%) forensic patients with available information received some form of physical health check.

Lifestyle Factors

BMI (Body Mass Index)

BMI (Body Mass Index) was calculated for patients whose height and weight information was provided. Only a few patients were excluded due to extreme height and weight values. No data was provided for 33 forensics patients.

Of the patients receiving forensic services, 232 (56%) were classified as obese, while 115 (28%) were classified as overweight. Overall, 84% of forensic patients were overweight or obese, compared to 61% for all adult patients (excluding those in eating disorder wards).

Smoking, alcohol and other substance misuse

This section analyses patients with alcohol dependence and/or substance misuse based on a combination of questions. A minor methodological change was made in 2017 (see Methodology for further detail).

Out of all forensic patients, 138 (31%) reported smoking tobacco in the 12 weeks before the Census. This is the same as in 2022 but lower than the 34% reported for all adult patients.

In the 2023 Census, 93 (22%) of forensic patients had a dependence on or harmful use of alcohol. There were 15 forensic patients with an alcohol-related ICD-10 code. The proportion with alcohol dependence or harmful use remains similar to previous years and is higher than for all adult patients (16%).

A total of 79 (18%) of forensic patients had abused substances (excluding alcohol) in the four weeks prior to their admission. There were 61 patients with a drug-related ICD-10 code. The proportion of forensic patients who had abused substances (excluding alcohol) is seven percentage points higher than in 2022. It is also 18 eight percentage points higher than for all adult patients (10%). However, the percentage of forensics patients that had abused both drugs and alcohol fell from 24% in 2022 to 17% in 2023. The most commonly used substance among forensic patients was cannabis (49%), followed by cocaine (22%) and amphetamine (21%).

Self-harm

Information on self-harm was available for 273 (61%) of forensic patients. Among them, 21 (8%) had self-harmed in the week prior to admission, which is one percentage points lower than in 2022. Among those 21 patients, the majority (18 patients) had self-harmed by non-accidental injury. It's important to note that patients can self-harm in more than one way.

Suicidal Ideation

Information on suicidal ideation was available for 263 (59%) of forensic patients. Among them, 25 (10%) had expressed suicidal ideation on admission to the hospital, which is four percentage points higher than in 2022.