Safe spaces: scoping report

5. Safe Space

5.1. Introduction

The introduction of safe spaces could reduce the need for statutory measures, mitigating disproportionate and unnecessary infringement of rights due to the voluntary nature in which a safe space could operate. Safe spaces could also provide better outcomes for individuals in an environment more suitable for de-escalation (including reducing risk of traumatisation and crisis escalation), keep people safe when they feel suicidal or are self-harming, and reduce pressures on other frontline services who are not equipped to provide the best care. They can be implemented with less strict criteria and operate without waiting lists, thereby providing more flexibility in response to a wider range of presentations.

Escalation processes will be required for appropriate referral and transfer should the use of the Act be required to provide care and treatment and/or there is concern for the harm they may cause to themselves or others. This could include treatment for self-harm, ligature injury, or overdose. It has been suggested that it would be helpful to have the safe spaces, which are therapeutic in nature, located near the ED and/or psychiatric wards for occasions where transfer is required.

The implementation of safe spaces would provide a useful addition to the current system in most areas in Scotland where a response to moderate to acute distress would be available, bridging the gap between hospital admission and safe to leave at home/discharge home. Safe spaces would provide an early intervention and preventative response to escalations in mental distress from the onset.

5.2. Function

The use of a safe space could interrupt the episode of distress and crisis, helping with de-escalation. It could offer appropriate and proportionate support and advice to individuals who may be known to services or are having their first episode of distress and/or crisis. This in turn could empower them to access the help they need in responding to managing their distress. The implementation of safe spaces throughout Scotland would enhance the unscheduled care response where the people of Scotland receive the Right Care, in the Right Place, at the Right Time.

The availability of safe spaces could offer a more flexible and adaptable approach to responding to local need, with the potential to respond to a multitude of needs and varying degrees of risk.

5.3. Who Are the Spaces For?

Many existing safe spaces are provided for adults in distress or crisis, or who require a safe, calming, and nurturing environment to assess whether admission or detention is required. They are also providing comfortable spaces within community settings. It is evident that many providers operate policies that exclude young people, people who are intoxicated, and people with disturbed behaviour excluded from services.

5.3.1. Children and Young People

Mental Health Unscheduled Care mapping and the MWC’s report on PEPs suggest there is significant variation in pathways for children and young people. Where it is assessed that they cannot safely be left in the care of the parents or guardians, and no specialist child or paediatric wards are available, the ED is often the only option until CAMHS support can be secured. This may suggest that the need for alternative spaces for children and young people is greater than the need for safe spaces for adults.

5.3.2. Substance affected and in crisis

The Medicated Assisted Treatment (MAT) Standards^[13], published by the Scottish Government in 2021, advocates choice and support for individuals with substance use. A safe space could compliment the standards to improve unscheduled care pathways for individuals who are substance affected and in crisis.

5.3.3. Exclusions

Alternative safe spaces would not be appropriate for individuals who require physical health intervention. They are also not appropriate for those who do not meet the criteria for section 297 or Mental Health Detention and who do not consent to being supported in an alternative safe space.

5.4. Conclusion

A safe space would ideally be accessible to all, including children, young people, and older adults with a range of mental health and wellbeing needs, and those who may also be substance affected - encapsulating both drugs and alcohol – noting that adults and young people can be substance affected and in crisis. They should also allow for a family member and/or friend to attend with a person seeking support.

However, in practice the implementation of a service and/or the use of a safe space which caters for all poses safeguarding, possible cultural difficulties (e.g. mixed gender spaces), and risk management challenges due to there being a wide number of cohorts who would benefit from safe spaces but have a wide range of needs, with the combining of these groups not being appropriate. These include children and young people, substance affected individuals with a dual mental health diagnosis, individuals experiencing a mental health crisis who pose a threat to others, individuals lacking capacity due to an intellectual disability and/or individuals lacking capacity and are experiencing mental distress or crisis.

This is perhaps supported by the existing practice examples outlined in the annex to this report, with most current services providing adult or child only services and not designed to meet the multitude of needs that alternatives are required for. It may therefore be necessary to create different provision to meet the needs of different populations groups to ensure they remain safe; for example, specific provision tailored to meet the needs of adults and children, spaces that are culturally sensitive, or spaces designed to meet the needs of individuals at high risk of harming others.