Section Four National Preventive Mechanism member profiles dealing with practical or ethical difficulties, such as guidance on the use of restraint in residential care settings.54 All guidance is developed in consultation with stakeholders, including patients and carers. In keeping with its preventive role under OPCAT, MWCS operates a telephone advice service for patients, carers and professionals. This offers advice on the care and treatment of those subject to mental health or incapacity law, including those who are deprived of their liberty. In recent years, there have been efforts in Scotland to reduce the burden on public services caused by external scrutiny bodies. As part of these efforts, it was at one stage proposed that MWCS be merged with a governmental organisation. However, membership of the UK’s NPM and OPCAT’s emphasis on the need for independent inspection helped MWCS to resist the proposed merger. Instead, some structural changes to MWCS, to be made in April 2011, will allow it to retain its independent status and will strengthen its focus on the rights and welfare of the individual.55 More generally, designation as part of the UK’s NPM has given MWCS the impetus to take an increasingly human-rights based approach to its work. Summary of activities and key issues In 2009–10, MWCS carried out visits to 770 individuals subject to mental health and incapacity legislation. It saw an additional 1,089 individuals, not all of whom were subject to compulsory care or treatment, as part of its focused and themed visits. During one visit to a hospital, MWCS found that patients were being restrained unlawfully and their rights were being infringed by strict behavioural regimes. MWCS reported its concerns and intervened to ensure that the patients were informed of their rights and that staff understood the rights of patients. Since then, the culture and practice of the hospital has changed significantly. 54 55 56 57 58 MWCS identified a number of key issues in the course of its work. It noted several interferences with the rights to privacy and dignity, including the use of searches, taking samples for drug or alcohol testing and restrictions on communications. These interferences were often applied in an arbitrary manner. MWCS has since published good practice guidance on using restrictions appropriately.56 MWCS published themed reports on older people’s care, intensive psychiatric care and secure facilities. In a themed report on people subject to short-term detention, MWCS found that their rights were generally well respected. It found evidence that individuals were involved in decisions about their care and that the care provided met their needs and was frequently reviewed. However, it also found that not all individuals were aware of their right to appeal against their detention.57 In conjunction with the Care Commission, MWCS published a themed report on people with dementia in care homes.58 This work had a significant influence on the development of a national strategy on dementia. Looking forward Over the next year, MWCS will continue to monitor the care and treatment received by people subject to mental health and incapacity legislation. In particular, it will look at the care and treatment of patients subject to community compulsory treatment, patients in adult acute care and persons with learning disabilities in residential care. MWCS will also monitor the care and treatment of patients with dementia in general hospitals. These patients may not be formally detained, but they have no choice about where they reside and may be de facto detained. MWCS will also look at compliance with safeguards for medical treatment under mental health legislation. MWCS, Rights, risks and limits to freedom (2006). These changes will be made when relevant provisions of the Public Services Reform (Scotland) Act 2010 come into force. MWCS, Specified persons guidance (2010). MWCS, Short-term detention (2010). MWCS & Care Commission, Remember I’m still me (2009). 49