Mental Welfare Commission reviews long term hospital placements in ‘Hospital is not Home’ report

The Mental Welfare Commission calls for urgent changes so people with learning disability and complex needs can leave hospital and flourish.

The Mental Welfare Commission has published the ‘Hospital is not Home’ report. The report looks at the circumstances of people with learning disability and complex needs who have been in hospital for 10 years or more.

The Commission was tasked by the Scottish Government to review the care and treatment of these individuals, and a further 25 people in long term hospital placements, to check whether all safeguards were in place.

This report arose after Public Health Scotland (PHS) published their ‘Insights into Learning Disabilities and Complex Needs – Statistics for Scotland‘ in December 2023. PHS identified that 30 people with a learning disability had remained in either a learning disability or a mental health hospital for more than 10 years.

Despite multiple previous policies, including ‘The Keys to Life’ and the Coming Home reports, the right to live independently and to be included in the community is not being realised for this group of people.

One of the key actions identified in the Coming Home Implementation report was the creation of a Dynamic Support Register (DSR). This Register was established to help ensure that people remain in hospital only for as long as they need assessment and treatment.

People are still staying in hospital for too long: the average stay in hospital being 18 years and 2 months with 10 people recording stays exceeding 25 years.

There remains a lack of consistent approach across Scotland on placing people on delayed discharge and dynamic support registers and not others. There was a lack of recorded information, in most cases, as to why some people had been placed on these lists and for how long they had been there. The Commission were told by services that other groups of people, who had not made it onto any list, would not be leaving hospital and that hospital was their home.

Although there was evidence of some good, collaborative practice in place committed to inclusive and active discharge planning, there was reluctance and concern regarding the capacity of community care resources to safeguard the person and meet their needs.

In fact the number of people with learning disability living in hospital for over 10 years is growing. The number of people recorded as being in hospital for over 10 years rose from 30 people in September 2023, to 44 people in December 2023 and 45 people in March 2024.

In response to the report, the Equality and Human Rights Commission (EHRC) has stated:

“We are deeply concerned by the findings of the Mental Welfare Commission for Scotland’s new ‘Hospital is not home’ report, which gives much-needed insight into the experiences of people held in hospital for over 10 years…

It is evident from these findings that the Scottish Government’s ‘Coming Home’ Strategy‘ has not yet succeeded in its aim to ensure that people are only in hospital for as long as they require treatment.

We urge the Scottish Government and all health and social care agencies to pay close attention to these findings and take urgent action to ensure proper compliance with equality legal requirements.”

Living in hospital for over 10 years brought a loss of independent living skills, a loss of confidence, added distress living in a group ward situation, frustration, and repeated disappointment when discharge plans fell through, a paternalistic approach borne out of genuine concern and perhaps lack of understanding of how community arrangements can and do manage risk and positive risk taking.

It is clear that there is a significant gap in national strategic oversight and the lack of a national body to drive forward change. The Commission argue that it is critically important to bring key partners together, as proposed, to share challenges, share learning and to develop creative solutions to support people to leave hospital and to flourish. Further work must be done to address why the intentions of the DSR have yet to be realised for people including those with forensic needs.

Read the full report here.

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