Safety concerns remain at Edinburgh's teenage mental health ward

The safety of young people at Edinburgh's inpatient teenage mental health unit remains a concern, nearly a year after inspectors identified problems with the use of physical restraint and force feeding.

A team from the Mental Welfare Commission (MWC) said some procedures at the Melville Unit had improved but processes for protecting both patients and staff from violence and aggression needed more work.

The MWC, which revisited the unit in March, said some children described feeling "scared and unsafe" at times.

NHS Lothian said safety of patients and staff was its top priority and that it took concerns and recommendations "extremely seriously".

The Melville Unit, based at the Royal Hospital for Children and Young People, cares for 12 to 17-year-olds who may have a range of mental health illnesses including eating disorders, depression and psychosis.

The most recent inspection found a number of young people had been experiencing high levels of stress and distress, which at times led to violence and aggression towards staff and, on occasion, other young people.

Some parents and carers also reported their child had been subject to physical aggression from other young people or had witnessed staff being assaulted.

The commission said managers at the unit should ensure all available options to manage risk are considered to maintain the safety of young people, staff and others.

The 12-bed unit had previously been inspected jointly by the MWC and Healthcare Improvement Scotland in May 2025, when the safe use of proportionate restraint was found to be a "significant issue".

The MWC said there had been notable progress since that visit, with improved care plans in place for children as well as multidisciplinary team working.

Young people spoke positively about members of staff, describing their approach to care as "compassionate", "empathetic" and "positive".

However, concerns remain about the use of restraint which was often used for nasogastric feeding - where a narrow feeding tube is placed through the nose down into the stomach.

The MWC said senior managers had reported an 84% reduction in the use of restraint.

But while the service had made overall progress, the inspectors said there should be improvements in reporting restraint accurately, as well as ensuring alternative options had been explored.

Jillian Torrens, services director for Royal Edinburgh Hospital and associated services in NHS Lothian, said: "Mental health is complex and can at times present very specific challenges.

"We work closely with young people to understand their needs, manage risk and recovery and always take prompt action to support anyone affected by challenging behaviour by providing additional care, separate safe spaces, increased staffing, one-to-one and enhanced nursing support and regular care reviews.

"We will continue to strengthen our safeguarding processes and keep patients and families informed as we work through our focused improvement plan."

Unannounced inspections of Scotland's three adolescent mental health inpatient units were ordered by ministers in 2025 after BBC Scotland's Disclosure programme uncovered allegations of a "culture of cruelty" at Skye House, the young people's inpatient facility in Glasgow.

A joint inspection of Skye House by Healthcare Improvement Scotland and the Mental Welfare Commission published in February continued to find "significant concerns" over the treatment of patients.

NHS Greater Glasgow & Clyde said it had made significant improvements but admitted more needed to be done.

Claire Lamza, the commission's executive director of nursing told Radio Scotland Breakfast, the Melville Unit can be a very complex and challenging environment at times where staff have to manage young people who have a variety of different needs.

Lamza said the report highlights improvements in the report from a number of areas in the unit but said there is still more work to do.

She said: "The staff never quite know who is coming through the door so some of the challenges include when a young person comes in who is very unwell, and quite hostile and aggressive, the staff have to change their approach with different presentations.

"There were a lot of really positive things we heard from the staff, from the records we could see a mapped reduction in the number of restraints that had taken place.

"The care planning and information in the risk assessments around the process of restraints were all far improved from what we saw last year.

"There is more work to be done involving the carers, by being in discussion with the multi-disciplinary team and by being involved in giving information on what worked best for their child."