This article appears as part of the Inside the NHS newsletter.

How busy are Scotland's mental health wards? Who is being admitted for inpatient psychiatric care - and how long are they staying in hospital?

A recently published census has provided a snapshot - and provoked criticism that patients are being badly let down.

Beds and boarding

The Mental Health Inpatient Census has been carried out every year since 2014.

It provides an insight into NHS-run services on a given day - in this case, April 12 2023.

The number of inpatient psychiatric beds in Scotland has declined by 19%, to 3,436, between 2014 and 2023.

The number of inpatients has fallen even faster, by 22%, to 3,058.

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This is in line with trends for the UK as a whole, and Europe, as healthcare systems shift towards trying to support people to access treatment on an outpatient basis in the community instead.

For every 100,000 people in Scotland, there are now 62.7 inpatient psychiatric beds - a 26% reduction over the past decade.

Occupancy rates are high - at 89% - and particularly high in some areas, such as Grampian, where 95% of beds were occupied on the day of the census.

In addition to acute admissions for patients experiencing a mental health crisis, the beds are used for patients with dementia, eating disorders, learning disabilities, addiction, and perinatal illness - where mothers experience psychiatric disturbances in the year after birth.

NHS Scotland has cut perinatal mental health beds from 12 in 2018 to five, all of which were fully occupied on the census date.

In acute mental health, beds have gone from 1,331 and 86% occupancy in 2018 to 1,272 and 93% occupancy in 2023.

Occupancy rates have risen as bed and patient numbers decline (Image: ScotGovt) Against this backdrop, "boarding" is on the increase.

This is the practice whereby patients are transferred to another hospital outwith their own local catchment area - sometimes to another health board - usually because no beds are available closer to home or because their local hospital lacks the necessary services.

This can mean patients are tens, or even hundreds of miles, from their loved ones.

According to the 2023 census, 105 patients (3.4%) were boarding, including 32 who had been sent to another health board region.

This compares to 70 in 2022 and an average of just 42 between 2016 and 2019, suggesting boarding is becoming much more common.

A growing number of mental health patients are being treated in hospitals out of their local area (Image: DerekMcArthur/Newsquest)

'Damning' delays

The 2023 census identified 321 patients (11%) as "delayed discharges" - meaning they remained in hospital after being found medically fit to leave.

The median length of delay was 87 days - almost three months. 

Patients with dementia and acute mental health conditions accounted for more than half of delayed discharges, but the longest delays (around14 months) were experienced by adults with learning disabilities who also had a history of offending - known as "forensic learning disability" patients. 

There have been significant improvements for non-forensic learning disability patients, however, with delays down from 760 days in the 2019 Census to 155 days in 2023. 

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Nonetheless, critics said the overall picture was one of failure given the SNP's promise, a decade ago, to "end" delayed discharge.

Brian Whittle, the Conservatives' shadow minister for mental wellbeing, said it was "completely unacceptable for hundreds of vulnerable patients to be stuck in limbo" in hospital.

Scottish Labour said the statistics were a "damning indictment of Scotland’s overstretched social care system".

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Paul Sweeney, the party’s health spokesman, added that the issue will "hinder patients’ recovery and pile pressure on services".

Mental Wellbeing Secretary Maree Todd said agrees that the current situation is "completely unacceptable", but says the Scottish Government is taking action, including allocating £20m to health boards "to design community-based solutions to avoid or limit future hospital use".