An unannounced inspection of the State Hospital in Carstairs, South Lanarkshire, has found that patients continue to be routinely confined to their bedrooms during the day because of staff shortages, despite repeated warnings from Scotland's mental health watchdog. The Mental Welfare Commission for Scotland says the facility, the only high-security psychiatric hospital serving Scotland and Northern Ireland, has made "no progress" since earlier visits flagged the same problem.
What the inspection found
The commission's July visit was a follow-up on concerns raised previously about "daytime confinement," defined in the report as periods when patients must stay in their bedrooms and are barred from wards, communal hubs, outdoor grounds or therapeutic sessions. Investigators concluded this practice has become "a routine feature of service delivery linked to insufficient staffing" rather than a response to any individual patient's clinical risk or needs.
Inspectors also learned that the hospital has been redeploying staff from therapeutic roles - including Skye Centre personnel, allied health professionals and psychologists - into nursing duties to keep wards covered, further reducing access to structured treatment and activities.
Why the practice raises concern
The report states that repeated confinement was "adversely affecting individuals' mental state and recovery" and warns it carries serious human rights implications. Risks cited include loss of liberty, institutionalization, deteriorating mental health, reduced access to rehabilitation, longer hospital stays, and the normalization of what should be an emergency measure rather than standard practice.
Claire Lamza, executive director of nursing at the commission, said the organization has "repeatedly highlighted" this issue and called the lack of progress unacceptable. She urged the hospital to act with urgency, implement a clear improvement plan with board oversight, and ensure any restriction imposed on a patient is necessary, proportionate and individually reviewed.
What happens next
The commission has instructed the State Hospital's board to submit an improvement plan by November 16 detailing how and when daytime confinement will be reduced and ultimately eliminated. It has also notified Healthcare Improvement Scotland, the body responsible for monitoring the hospital's compliance with statutory care regulations.
A spokesperson for the State Hospital board said it welcomed the report and accepted its recommendations, adding that while "significant work has already been undertaken," the hospital recognizes "there is more to do" and will continue working with staff, patients and partner organizations toward sustained improvement.