Shetland psychiatric patients waiting for a treatment plan must wait in a ‘bleak’ room that is ‘not fit for purpose’, a report has revealed.
The Mental Welfare Commission for Scotland visited Shetland to review the community mental health and learning disability services on the islands.
There are no mental health inpatient facilities in Shetland and the only hospital is the Gilbert Bain Hospital (GBH) in Lerwick.
The report found that those requiring a short-term place of safety due to not being suitable for admission to the medical unit are staying in a room “not fit for purpose in its current state.”
The room where these patients are placed in the GBH does not allow nurses to “remove themselves safely” in the event of aggression.
Meanwhile, people detained under the Mental Health Act 2003 have to wait in a side room with medical equipment around “which could pose a risk” for an individual in distress.
Inspectors also flagged that communication between Mental Health Officers (MHO) and Community Mental Health Team (CMHT) has not been “as effective” since the pandemic.
Shetland psychiatric patients stay in room ‘not fit for purpose’
The GBH has a ‘low stimulus room’ originally designed for patients requiring a safe short-term place of safety while waiting for a Multidisciplinary Team (MDT) treatment plan.
This is to support people in acute crisis and distress who are not fit for admission to the medical unit.
The report states this room, located at the end of a corridor, is “not fit for purpose in its current state”.
“It was bleak with no windows, and only contained a bed and a chair, with no access to outside space or fresh air,” it reads.
Meanwhile, the room offers no ability for nursing staff to remove themselves safely and still observe an individual in the event of aggression.
There was also no alarm system to summon help.
The Commission was told that there is a team of senior staff trained in the management of aggression that could be called if one took place.
However, they could live up to an hour or more away and be unable to provide immediate assistance.
Concerns around other detention area
Examiners were also taken to the area hosting individuals detained on a Short Term Detention Certificate (STDC) prior to transfer to the Royal Cornhill Hospital in Aberdeen.
This was a side room made available in a medical ward, where the person would be supported by Community psychiatric nurses (CPNs) mostly on a one-to-one basis.
Although the facility was described as a “better option than the ‘low stimulus room’”, some “obvious concerns” were raised.
The report states that there were “lots of medical equipment around which could pose a risk should an individual be in a stressed and distressed state.”
However, commission visitors also “acknowledge the challenge posed to provide care and treatment in the confines of what is available.”
Inspectors ‘pleased’ with NHS Shetland staffing
The report highlights a recent “improvement” in the staffing complement, which had posed a “significant issue in the past.”
Inspectors were told by the nursing team that there is “stability” in the medical team.
However, at the time of the visit, in September 2024, there was only one LD nurse on the island, which has double the national average population of people with a learning disability.
Another LD nurse has been in post since the visit.
Meanwhile, the Commission was “pleased to hear” that the MHO team had a full complement of staff.
They added that there was nearly always an MHO available to consent to emergency detention certificates (EDCs) and out of hours short term detention certificates (STDCs).
NHS Shetland ‘actively progressing’ recommendations
A spokesperson for NHS Shetland said: “NHS Shetland has considered the recommendations outlined in the Mental Welfare Commission report and is actively progressing them.
“Work was already underway prior to the visit, reflecting some of the focuses included in the report aligned to improvement the team and service were progressing. This is reflected in the positive aspects of the report through the openness of sharing improvement actions with MWC from NHS Shetland.
“The recommendations made are on track for completion within the timeframe. The MWC are returning in 2025 to follow up on these actions.”
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