National Preventive Mechanism Second Annual Report 2010–11 MWCS also adopts a more strategic approach to its work, frequently responding to government and Scottish Parliament consultations. One such response concerned a proposal to extend the scope of fatal accident inquiries to include automatically anyone who dies in mental health detention. MWCS rejected this proposal in favour of a twostage process under which cases can first be screened to avoid the need for an inquiry into a death from natural causes. MWCS has also highlighted to the Scottish government and others where it considers that mental health and incapacity legislation are incompatible with human rights law. For example, it noted that when a person detained under a long-term order is transferred into Scotland, he is unable to appeal against his detention until three months have passed since the granting of the order. Northern Ireland In Northern Ireland, mental health detention is monitored by RQIA. More than 1,300 people were detained under mental health law in 2010–11 and RQIA carried out 46 inspections of mental health and learning disability services where people may be detained. RQIA’s inspection programme is supplemented by a programme of ‘patient experience reviews’. This is aimed at keeping under review the care and treatment provided to detained patients and involves offering each detained patient the opportunity to be interviewed privately by an inspector. This year, RQIA met 133 patients as part of this programme. A number of key themes arose from these inspections, many of which were similar to those identified in the rest of the UK, including 40 concerns about how patients are informed of their rights; issues relating to informed consent; and effective engagement with patients in care planning and treatment. RQIA was also concerned about patients’ limited access to independent advocacy and a lack of patient-focused information on admission and discharge leading to continuity of care being compromised. RQIA also identified several instances of poor patient assessment. Patient experience reviews highlighted additional issues, such as patient privacy and dignity; limits on patients’ time out of the ward, whether accompanied or unaccompanied; and limited access to smoking facilities. In 2011, RQIA published a review of child and adolescent mental health services. This review looked specifically at the care of under-18s on adult wards, a number of whom are detained under mental health law. The RQIA considers that admission of a young person to an adult ward constitutes admission to an inappropriate environment. Nonetheless, it noted that, in recent years, significant safeguards have been developed and implemented regarding the way in which young people on adult wards are accommodated and managed. Next year, as part of its inspections of mental health and learning disability services, RQIA will focus on the human rights theme of protection, which will include an assessment of the use of seclusion, restrictive practices and physical restraint. It will also consider the safeguarding of vulnerable adults and children in hospitals and will conduct a review of risk assessment and management in mental health services. This latter activity will include a specific focus on those patients with a dual diagnosis of mental disorder and substance misuse.