A former health board chief has sparked fury by suggesting a landmark inquiry into mental health services should not have gone ahead because it held up work to improve care.
Crawford Reid, former chairman of the Perth and Kinross integrated joint board (IJB), believes the independent inquiry “completely screwed” plans to redesign local mental health facilities.
The inquiry, led by former prisons governor David Strang, strongly criticised what it described as a loss of “trust and respect” in local psychiatric services.
But Dr Reid believes the launch of the inquiry – at the behest of the bereaved families of suicide victims – has set progress back in Tayside by two years.
The redesign was signed off in January 2018 by Perth and Kinross IJB, which is in charge of inpatient mental health services, but was put on hold following the inquiry’s interim report in May last year.
Ahead of an NHS meeting to discuss a proposed action plan on mental health tomorrow (Thursday), Dr Reid said: “Several aspects of the inquiry report give me great concern. (Ex-chair and ex-chief executive) John Brown and Malcolm Wright came in at a time when Tayside was in a dysfunctional shape – it was a knee-jerk reaction.
“I’m not minimising how ruinous suicide is but what’s happened is the mental health transformation programme has been basically put on hold.
“If the transformation programme had started to move in, things would have improved with a full complement of consultants.
“They completely screwed it.”
Relatives of those who took their own lives after engaging with local mental health services have criticised Dr Reid’s comments as poorly considered.
“There have been ample opportunities for genuine change with regards to mental health services in Tayside over the years given the sheer volume of investigations and horror stories.
“Nothing was changing hence why I, and others campaigned for this inquiry.
“Perhaps if these fantastic changes that are being proposed had actually been implemented years ago, lives would have been saved and there would have been no need for an inquiry.”
She added: “I feel yet again that we, the bereaved families who campaigned tirelessly for change, are being used as a scapegoat for the never-ending list of failures.”
Mandy McLaren, who lost her son Dale Thomson to suicide in 2015, said: “The redesign was in the interim report, and it did say it should be halted.
“The matter with him is he doesn’t want to take any responsibility for the part they all played in allowing these failures and allowing these deaths.”
Following a near-two-year investigation, the Independent Inquiry issued 51 recommendations on February 5.
Witnesses who gave accounts to the inquiry described how the transformation programme appeared to be little more than an asset management plan to save money.
However, Dr Reid believes that, with time, the programme could have gradually reintroduced localised care at facilities such as the Mulberry Unit in Angus, which was mothballed in 2017 despite being only despite being opened in 2011.
He also believes independent case reviews should have been held for each person who dies after engaging with mental health services.
“If you look at each and every recommendation there’s not one that moves the process of improving mental health services in Tayside one inch forward,” he added.
“Not one of those 51 recommendations, without the transformation programme going on, will improve anything.
“The transformation programme had no time to bed in and move forward – if it had been allowed to develop the situation would have been fantastic compared to what it was two years ago.
“It’s not perfect but it’s far better than what we’ve been left with at this time. The sooner it gets put back on the boiler the better.
“Without a shadow of a doubt, this inquiry should not have gone ahead.”
NHS Tayside and the independent inquiry have been contacted for comment.
“We really need to work with staff to fix mental health”
Renewed calls have been made by NHS staff representatives for health bosses to work with them to improve mental health services in Tayside following the publication of the Strang report.
Jenny Alexander, employee director at NHS Tayside and a Unison rep, said the 51 recommendations were unlikely to be met unless staff were on board with the health board’s plans
She warned that actions could not be rushed through in the way the mental health transformation programme was perceived to be by some observers in 2018.
She told a meeting of Dundee’s health and social care partnership board (HSCP) yesterday: “The partnership aspect of this is very, very important.
“If we are running off and doing things like in 2018 we’re not going to do anything differently.
“We really need to start working in partnership with staff-side – if we don’t have staff on side we will never get through those 51 recommendations.
“We need to make sure we have improvements done for these people that we’re caring for.”
The independent inquiry found that staff reported feeling disrespected and undervalued by senior colleagues.
One mental health staffer described the atmosphere in mental health services as “a culture of fear”.
Arlene Mitchell, Dundee HSCP locality manager, says actions have already been taken in response to the inquiry.
These include the creation of new senior mental health posts, a new process for investigating adverse events and a plan to improve better support for those leaving mental health inpatient services.
Ms Mitchell said: “From a Dundee perspective, we’re in a good position…to ensure a strong staff partnership approach.
“We feel there’s a need to strengthen some of the staff partnership activity.”
Almost half of Dundonians who have died by suicide sought help from crisis services in the year leading up to their death, according to official figures.
The Scottish Suicide Information Database (SSID) report shows that 45.5% of the city’s 198 suicide victims between 2011 and 2018 contacted one or more unscheduled care services in the 12 months prior to taking their own lives.
NHS Scotland’s latest update to the SSID comes after it emerged tragic TV star Caroline Flack had been visited by an ambulance crew at her London home less than 24 hours before her death on Saturday.
Two-thirds of those who sought unscheduled help in Dundee did so by calling for an ambulance – and half attempted to get support from the NHS 24 telephone service.
Just over a quarter of those who sought help from Tayside’s out of hours service, which currently operates from Dundee’s Kings Cross Health and Community Centre.
Researchers who compiled the SSID noted that people who went on to take their own lives were six times more likely to have had at least one contact with the ambulance service in the year leading to their death.
The out of hours service can make referrals to NHS Tayside’s Crisis Resolution Home Treatment Team (CRHTT) for cases of mental health crisis in Dundee.
However, staff working for the CRHTT have reported feeling undersupported as NHS Tayside focuses on inpatient services such as those offered at the Carseview Centre.
NHS Tayside is reviewing the SSID report, along with the final report published by the Independent Inquiry into Mental Health Services in Tayside two weeks ago.
Mike Winter, associate medical director for mental health, said reducing suicide attempts was “a priority”.
He added: “NHS Tayside and partner organisations have been reviewing our crisis care and home treatment centres and working to develop a Psychiatric Emergency Plan.
“It should however be recognised that a key aspect of suicide prevention is the opportunity for people in despair to talk about their problems, whether this is to a work colleague, a friend or family member, or to a volunteer from Samaritans.
“The Independent Inquiry report will guide our further work on suicide prevention and other improvements we wish to progress.”
Scottish Labour health spokesperson Monica Lennon said opportunities for health and care services to refer people for mental health treatment “cannot be allowed to be missed”.
She added: “Reducing mental health stigma needs our collective efforts, proper funding for health and social services, and joined up working so that there is no wrong door.”
Responding to the report, mental health minister Claire Haughey said £3 million of funding was supporting the Scottish Government’s existing Suicide Prevention Action Plan.
Ms Haughey noted: “This report represents a significant contribution to the growing evidence base around suicide in Scotland which will inform current and future policy and activity.”
Support is available by calling Samaritans free 24 hours a day on 116 123. If you prefer to write down how you’re feeling, you can email firstname.lastname@example.org.
The success of a new approach to supporting mental health issues in Dundee has been hailed as a national success.
Making Recovery Real, which has been trialed in Dundee, brings people who have battled mental health challenges together with professionals, to decide the best support to offer in the city.
Participants from Making Recovery Real in Dundee traveled to Edinburgh to speak at a Scottish Recovery Network about how the scheme works.
They premiered a short film showing how people with experience of mental health issues could give their perspective on what helped them and go on to offer support to others.
It is hoped that the project will be adapted by communities across Scotland looking for a new approach to developing and accessing mental health support.
One of the service users, Rona Foy, said working with people who had similar experiences helped her see how the group could help her and she is now supporting others.
“I saw other people flourish that were on the group and they started to become more confident and wanted to help other people.
“It has given me lots of different opportunities and it has just been great.
“I am going to be facilitating a peer to peer course myself after doing on which is exciting and I just think it’s so worthwhile.”
The participants worked with professionals from Dundee Health and Social Care Partnership, NHS Tayside, Dundee City Council and Dundee Volunteer and Voluntary Action (DVVA), among others.
Ruth Brown, team leader of mental health engagement and involvement at DVVA and chairwoman of the Making Recovery Real partners group said: “Our work with Scottish Recovery Network has been transformational for individuals who live with mental health challenges, for mental health organisations, and for our strategic planning and delivery mechanisms in the city.
“It enabled us to work more effectively together, to make better decisions, to keep lived experience at the centre of all we do, to maintain our focus on recovery and to invest in growing peer support.”
Health chiefs say a controversial shake-up of psychiatric services across Tayside is being hampered by “significant workforce challenges” – exactly as opponents predicted more than a year ago.
NHS Tayside pressed ahead with its planned review in January, despite concerns that many staff would be unwilling or unable to make the move to new cities.
Under the scheme, leading disability inpatient services will be provided at Murray Royal Hospital, Perth, while services are being transferred out of the Mulberry unit at Stracathro Hospital near Brechin and general adult psychiatry acute admissions centralised in Dundee
However, members of the Perth and Kinross Integration Joint Board have now been told that the majority of staff – around 55% – are unable to move for a variety of reasons.
At a meeting on Tuesday, Gordon Paterson, chief officer of the Perth and Kinross Health and Social Care Partnership, said: “The progress of implementing the redesign programme has been slow and that is partly because of some of the significant workforce challenges, in relation to the proposed transfer of patients and wards from one site to another.
“We need to ensure that we have adequate staffing in place. We need to engage with nursing staff and clinical staff to ensure that that they can transfer from Perth to Dundee, or Dundee to Perth. If they can’t we have to make sure we can suitably redeploy them and there are some alternative options.”
He said: “We recognise that this is an upheaval for staff and we recognise that some staff can’t travel.”
Mr Paterson said it was crucial to get to the next phase of the plan, which involves shifting a ward from Carseview to Murray Royal.
“We are anticipating we will be in a position to progress this early in the new year, notwithstanding the fact we are sensitive to the impact and implications for staffing,” he said.
Independent councillor Xander McDade described the situation as “quite disturbing”.
He said: “At the meeting in January 2018, the main rationale for the redesign – which we were given repeatedly – was that the only way we could safely staff the service was to go ahead with this model.
“That was the clinching argument.”
NHS Tayside’s Alan Drummond said: “This was raised as a red risk prior to that meeting.
“It wasn’t a case that staff didn’t want to carry on their care for patients, they were just unable to make the move.
“We raised this as part of the consultation and we were told that the risk would be managed. This is not the unknown we are dealing with, this was raised three years ago.”
Mr Paterson said he was also aware that an independent inquiry into mental health services, led by Dr David Strang, was due to be published in February and could make further recommendations.
Dr Strang said earlier this year that the redesign should be halted to allow for a wider review of health services.
It said the key themes were patient access to mental health services, patient sense of safety, quality of care, organisational learning, leadership and governance.
Referring to risk management, the report said: “Patients report telling staff they were suicidal but the risk was not taken seriously until they made a serious attempt to take their own life.”
‘Violated and traumatised’
In relation to patient safety, the report noted: “Some patients report being frightened of certain staff on the wards who have a poor attitude to the patients in their care.
“Others mentioned that another patient had assaulted them whilst they were on the ward.”
The report said the use of restraint within inpatient facilities was of “great concern” to patients, who had experienced it or witnessed it taking place.
It said: “Patients feel violated and traumatised, particularly if they have personally suffered violent abuse in the past.”
It added that staff seemed unable to control the availability and use of illegal drugs on the wards in the inpatient facilities.
“Both patients and families report seeing drugs delivered, sold and taken within the Carseview Centre site,” the report said.
“Staff confirm this is a serious issue which is not being adequately addressed.
“There is a lack of support from management for frontline staff attempting to address this issue and it is having a detrimental effect on patient care and treatment regimes”.
‘Unexpected and concerning’
In a section on the Crisis Service, the report said that the Crisis team “struggles to respond to sudden surges in demand on the service.”
It said: “There are occasions when the length of time to wait to be seen is long and families supporting someone in crisis are advised to phone the police or NHS24, if they are worried.
“This advice is unexpected and concerning to carers coping with a crisis in a domestic situation.”
The report said the centralisation of the out-of-hours Crisis team to Carseview Centre has had a “detrimental effect on those patients in Angus and Perth & Kinross who are experiencing mental health crisis”.
It said: “There is a perception that whilst the Crisis service has expanded in recent months, the situation has worsened in terms of patients being assessed then not being offered any crisis intervention, or referred back to the GP.”
Inquiry chairman David Strang said: “The themes which have been identified will shape the next stage of the inquiry.
“Our final report will include conclusions and recommendations which will lead to the improvement of mental health services in Tayside.”
NHS Tayside chief executive Grant Archibald said: “We are taking on board all comments in the interim report, alongside the feedback we received from the Health and Social Care Alliance (the Alliance) published in their report in December 2018.
“The key themes which have been identified in both the Alliance report and in today’s interim report are recognised by the board and the mental health leadership team – and we are taking action on these.
“I also recognise and want to thank the many staff who are already working really hard to improve services and look forward to their continued support.
“It is clear that we have further work to do but since I came to Tayside, I have made mental health a top priority and I am confident we can learn lessons, strengthen our engagement with patients, service users, families and the public and make the right kinds of changes, at the right time, to transform our mental health services.”
He added: “We would like to thank everyone who has shared their experiences so far and we look forward to the independent inquiry’s final report and recommendations which will be a major influence on the future shape of mental health services in Tayside.”