We should face up to the madness of the Scottish mental health system

Race to the Scottish Parliament: but who will win how many seats?

Fiona Sinclair of the pressure group Autism Rights concludes her two part series on some of the implications of current and mental health legislation in Scotland, and urges cross party support for real change.

bluemarine_logoThere are more general statistical and informational `black holes` in the Scottish mental health system which compound the failure to offer basic protections of human rights for people with Autistic Spectrum Disorders (ASD) and Learning Disabilities.

There are no published statistics on the numbers of deaths in the mental health system. There is no separate collation of data for those people who commit suicide whilst in the `care` of the mental health system. There is no collation of data on assaults or other `adverse events` that happen in the system. When the Westminster government discovered that there were 40,000 face-down restraints in the previous year within the English mental health system, it decided that action needed to be taken.

Most of the deaths in custody of people with mental health diagnoses are associated with this type of restraint: it is acknowledged to be the riskiest type of restraint. In Scotland, there is no collation of data on restraints within the mental health system, and Police Scotland were unable to give me any information on restraints, injury or deaths of people with a `mental disorder` within their custody, even though more than half of the deaths in police custody within England are of people who are subject to compulsory treatment under the Mental Health Act.

The Scottish Government claims that the Scottish Patient Safety Programme – Mental Health will deal with these chronic deficits in statistical information.  This programme was initiated in 2012 and has still failed to address any of the statistical `black holes` that I have drawn attention to. In fact, the only publication to date of the numbers of people who die in the Scottish mental health system came about because of a Freedom of Information request submitted by me to the Mental Welfare Commission for Scotland.

Scottish Parliament is considering crucial mental health legislation
Scottish Parliament is considering crucial mental health legislation

The Mental Welfare Commission Scotland (MWC) was only able to give me the barest detail – numbers and type of compulsory treatment order – but was then able to publish an entire report 4 months later  – employing a registrar to collate some further information by asking health boards to trawl back through their own very limited data. Sadly, the MWC were then neither willing to inform me that they had managed to track down more of the information I was seeking, nor to give me the credit for the publication of their `Deaths in Detention` report.


The actual body count was 78 people, which is at least twice the death rate of the system in England, even if you agree with the MWC’s claim that Scottish  statistics are not comparable with the rest of our United Kingdom. To give one comparison, a study of the Scottish penal system identified 97 deaths in Scottish prisons over a five-year period. My complaint to the Scottish Information Commissioner about the actions of the MWC  went nowhere – their senior policy officer was not even willing to suggest to the MWC that it might be a good idea if their publication scheme included annual statistics on deaths and suicides. The Equality and Human Rights Commission’s (EHRC) first investigation of deaths in mental health detention, which was published this year (and which drew heavily on INQUEST’s own investigation of this matter), could not include Scotland in its remit, because of the absence of data, so instead regurgitated much of the MWC’s own report.

Fatal Accident Inquiries (FAIs), howsoever flawed they are, are mandatory for deaths in the Scottish penal system, but not for deaths of patients in its mental health system. In spite of Lord Cullen’s recommendation that there ought to be FAIs for deaths of all of those subject to compulsory `treatment` under the Mental Health Act, the new Inquiries into Fatal Accidents and Sudden Deaths etc. (Scotland) Bill, which is also currently wending its way through the Scottish Parliament, does not consider this to be necessary. Both the Scottish Human Rights Commission (SHRC) and the EHRC agree that it would be acceptable to give the MWC the task of holding FAIs into deaths in the mental health system, even though the MWC has a direct conflict of interest, because of its role as `individual safeguard` of the rights of people subject to compulsory treatment under the Mental Health Act. They would essentially be being asked to investigate their own failures.

MSPs should embrace cross party agreement on legislation and accept challenges to the system
MSPs should embrace cross party agreement on legislation and accept challenges to the system

Whilst government and mental health charities will happily admit that people with Learning Disability and mental illness die, on average, at least 10 years earlier than the rest of the population (international statistics put this at 25 years), there is no mention, let alone examination, of the role that psychotropic drugs play in this reduction in life expectancy.

Scotland does not collate any information on the side effects of the toxic drugs that form the `treatment` that people are forced to endure, even though those critical of mainstream psychiatry, who include noted psychiatrists and scientists themselves, maintain that they are the main cause of death in the mental health system. Given the drug dependency of most western mental health systems, the conflicts of interest are legion, particularly where, as in Scotland, there is no working register of commercial payments to doctors and where lobbying of `decision makers`, elected or unelected, is entirely opaque.


The legal system is devoid of any checks  or balances on this system: the Law Society for Scotland had to issue recommendations to its own members, because of their repeated incompetence and failures in representing patients at Mental Health Tribunals, where compulsory treatment is enforced, often after the administration of drugs. Where cases have additional complexity, as with ASD and its associated medical conditions, the way that legal aid is paid heaps injustice upon incompetence, because it does not accept that such complexity even exists. Complaints about the Scottish mental health system are dealt with in-house before they can be referred to the Scottish Public Services Ombudsman, who relies on one psychiatrist to give advice. Complaints cannot be made if there is an intention to appeal to a Mental Health Tribunal, nor if a detention is current and complaints against Tribunals cannot be made about the conduct of a Tribunal – only its administration. The only appeal beyond a Tribunal is to Judicial Review, for which copious amounts of legal aid are needed.

It cannot be denied that collation and publication of statistics on deaths, suicides and other `adverse events` represent basic measures of compliance with human rights, but the dogged resistance by the Scottish Government to implementation of this is verging on the suspicious, especially when notification of such information is supposed to be given to the MWC by health boards.


The government must acknowledge the merit in publishing these statistics, and should back Adam Ingram MSP’s amendments to the Mental Health Bill on this matter. It is one thing for a government to proudly present policy initiatives as improvements to public services but quite another to continue to assert that a whole range of clear deficiencies in a public service do not need reform. The fact is, that there are too many overlapping responsibilities within the mental health system, and far too much power to do harm, without any kind of responsibility or accountability, either to those directly affected or to the body politic.

Autism Rights’ contributions to the wider debate on the mental health system have complemented the work of other activists within and outwith Scotland, which should be noted here. The news coverage of the `Scottish` media has not touched on any of the ongoing international news and debate taking place on mental health, even though professional publications, such as the BMJ, have hosted many of these debates, which have included eminent psychiatrists and scientists, such as Professor Peter Gøtzsche, Director of the Nordic Cochrane Centre and co-founder of the Cochrane Collaboration.

International debate is led by mental health `survivors` and professionals, including some psychiatrists, such as Dr. Joanna Moncrieff and Professor David Healy, who are deeply unhappy at the powers gifted to their profession to `treat` mental illnesses with toxic drugs, when both the evidence for the damage caused by such treatment and the evidence against the efficacy of such treatment is substantial and growing. They think that these drugs should only be used cautiously over a short period for the most serious mental illness because of this – the polar opposite of what is actually happening to many people trapped in western mental health systems. The importance of the amendment submitted to Stage 2 of the Scottish Mental Health Bill by Adam Ingram MSP on use of psychotropic drugs must be understood in the context of the wider international debate. We hope that this amendment will be included in the Bill.


The `Scottish` media has barely reflected the grassroots initiatives here in Scotland that have either directly or incidentally revealed serious deficiencies in the overall `care` of vulnerable people.

Hunter Watson, who has long campaigned against covert medication of elderly people in `care` homes, submitted a petition calling for changes to mental health legislation. The several submissions to this petition produced powerful testimony and evidence for the Health and Sport committee’s consideration of the Mental Health Bill.

Dr. Peter Gordon’s petition for a `Sunshine Act` for Scotland has likewise pushed the issue of the lack of any register of commercial payments to doctors and other healthcare workers on to the political agenda. Beth Morrison’s petition, asking for guidelines on the restraint of children with disabilities, has provided further evidence that the supposed increased risk of `mental illness` for people with Learning Disabilities and ASD is very often a consequence of incompetent or abusive care.

Andrew Muir of Psychiatric Rights Scotland has submitted his own petition, calling for an Inquiry into the mental health system and Andrew’s wife, Claire, who directly experienced this system, garnered 503 votes as an independent candidate, standing purely on a mental health rights platform, at the recent Westminster election.

Chrys Muirhead’s complaint about the treatment of her son in a Fife mental health hospital was upheld by the Scottish Public Services Ombudsman. Chrys blogs on mental health rights, both in her own blog and as Scottish correspondent for Mad in America and is not afraid to ruffle establishment feathers.

Two of Scotland’s best known whistleblowers, Rab Wilson and Dr. Jane Hamilton, both worked in the mental health system, further confirming the troubling practices in this system. Rab highlighted the practice of using `gagging clauses` in severance agreements with staff, to prevent whistleblowers exposing malpractice. Dr. Hamilton claimed to have been victimised after speaking out on patient safety issues at a specialist mother and baby psychiatric unit.


The Scottish Parliament’s Cross Party Groups on Human Rights and Mental Health have both been repeatedly asked to permit dissenting voices to give a presentation on their view of mental health legislation, but have refused that opportunity, when charities funded to the tune of millions of pounds of taxpayers’ cash are regularly given the opportunity to present to the Mental Health CPG and have ready access to various taxpayer-funded conferences and other events in which to `network` their own interests. Even the Health and Sport Committee passed up the chance to invite Professor David Healy, who is an international expert on the side effects of psychotropic drugs, to give oral evidence on the Mental Health Bill. Nor was I called to give oral evidence on behalf of Autism Rights which, given the `black holes` that I’ve identified in scrutiny of the mental health system, is perhaps no surprise.

The Scottish mental health system does not and cannot currently comply with any `Rights to Life`, particularly for its most vulnerable people – those with ASD and Learning Disabilities. We think that it’s about time it did, which is why Autism Rights is backing the amendments to the Mental Health Bill from Adam Ingram and those from Richard Simpson and Jackie Baillie, that seek to end or review the inclusion of people with ASD and Learning Disabilities within the provisions of the Mental Health Act. We have campaigned for 4 years for positive change to the Scottish mental health system and, with the support of you and your MSPs, this could be about to happen.