Section one Context other legislation during the year 2017–18 increased to 1,891, of whom 843 were female.139 CIW reports the total volume of DoLS applications received by local authorities in Wales increased by 6% in 2018–2019. The majority of DoLS applications were for individuals aged 65 or older. The vast majority of applications that were refused were on the grounds of mental incapacity: the authoriser required further evidence that the person lacked the mental capacity to make the decision in question before the DoLS was accepted. Most standard applications were not completed in 28 days. Very few people were referred to Independent Mental Capacity Advocates (IMCAs) or to the Court of Protection. As such, supervisory bodies were unable to assure themselves that people’s human rights are not being breached by being deprived of their liberty unlawfully. During the reporting period, HIW undertook 13 inspections to NHS hospitals including a Children and Adolescent Mental Health Services (CAMHS) unit, a medium secure unit, a learning disability service, a psychiatric intensive care unit and elderly care services across Wales. Generally, HIW reported positive findings. It also undertook 15 independent health care inspections, including to one learning disability hospital, medium secure units and CAMHS units. HIW identified positive findings including respectful staff interactions and engagement with patients from dedicated and motivated staff. It also found that patients were provided with a good range of therapies and activities, and it saw some good examples of care and treatment planning. In some instances, there was good progress on recommendations since previous inspections, less restrictive models of care and effective governance which had a positive impact. However, HIW also identified issues within these settings relating to failings in the maintenance and refurbishment of oftenoutdated wards, in some cases impacting on patient safety and dignity, some inappropriate interactions with patients and issues with physical health and inadequate personal alarm systems. Quality of care planning across Wales varied considerably, with some very concerning examples. Staff training in a range of vital areas was also lacking, as was the effective management of medication. HIW identified many good practices in its monitoring of the Mental Health Act, including in implementation and documentation, and a good level of governance and audit. However, there were some recurring issues with unclear or out-of-date records, and significant improvements were required around the admissions processes to ensure detention was appropriate. In Scotland, MWCS reported that over the past 10 years the total number of compulsory treatment orders (CTOs) in existence in Scotland has risen steadily: by 22 percentage points from 54% to 66% per 100,000 population. In 2018–19, Scotland saw the highest number of episodes of compulsory treatment since new mental health legislation came into effect in 2005, with a 41% increase in longer-term orders over the past 10 years. The rise in rates in community-based detention orders also reached new levels in the last reporting year: nearly half of all CTO detentions are now in the community.140 139 Stats Wales, Admissions to mental health facilities by local health board, https://statswales.gov.wales/Catalogue/ Health-and-Social-Care/Mental-Health/Admissions-to-Mental-Health-Facilities/admissionstomentalhealthfacilitiesbylhb [accessed 24/08/2020] 140 MWCS, October 2019, Mental Health Act Monitoring Report 2018-19, https://www.mwcscot.org.uk/ publications?type=44&leg=54 [accessed 24/08/2020] 45