Detentions of older adults under the Mental Health (Care and Treatment) (Scotland) Act 2003

This study prospectively examined all initial emergency and short-term detention orders of older adults under the Mental Health (Care and Treatment) (Scotland) Act 2003 in a Scottish health region in 2008 to determine differences in characteristics and outcomes by patients' age, gender and those detained by consultant compared with non-consultant clinicians. Detention order papers were scrutinized, the detaining practitioners were interviewed and case records were examined. Appropriate statistical analyses were performed. For the 87 detentions, subjects were Caucasian, male (54%) and 45% were aged 80 years or older. Ninety-four percent of detentions occurred on a weekday, during working hours (87%), in hospital (67%) with consultants initiating 74% of orders. Detention rates ranged from 66 to 171 per 100,000 over-65s. Seventy-five percent of patients had an organic disorder, 46% exhibiting psychotic symptoms. The older group had higher rates of confusion, organic diagnoses, but lower levels of previous psychiatric admissions. Consultants were more likely to detain patients with a wider variety of disorders, with more admissions to and detentions in psychiatric hospital care. Final detention outcomes were significantly different between the consultant and non-consultant groups. The results indicated few differences between the genders, but differences were more significant between the age cohorts and were further influenced by the grade of the detaining clinician. Further research is required to examine the influence that community mental health teams, advance statements and the use of guardianship and incapacity legislation have on the increasing rates of mental health detentions in the aging population.