Patients’ concerns highlighted in NHS Tayside mental health inquiry report

Patients’ concerns highlighted in NHS Tayside mental health inquiry report

Illegal drugs on wards and concerns over patient restraint have been highlighted in a report into NHS Tayside’s mental health services.

The independent inquiry’s interim report has identified “key themes for further investigation” after hearing evidence from more than 1,300 people.

It said some patients were frightened of certain staff members.

NHS Tayside said improvements had been made in key areas highlighted in the interim report.

The inquiry is reviewing safety, care standards and access to mental health services.

An investigation was initially ordered into Dundee’s Carseview Centre but was expanded following a campaign by families of people who took their own lives.

More than 200 written submissions were received by the inquiry team following its call for evidence, and more than 70 oral evidence sessions were held.

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.”

People talking

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.”

‘Top priority’

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.”

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Thousands of mental health appointments missed every year

Thousands of mental health appointments missed every year

More than five appointments with mental health specialists are missed every day across Tayside.

On average, 2,286 mental health appointments have been missed each year since 2013.

And the no-shows are increasing, with 2,667 appointments missed in 2018 being the highest figure in the last five years.

The reasons for patients not making it to appointments after a GP referral are complicated, according to a local mental health charity.

Wendy Callander, chief executive of Wellbeing Works Dundee, said anxiety is just one of many reasons.

Wellbeing Works is the rebranded name for the Dundee Association for Mental Health, following a change last month.

Ms Callander said: “It is difficult for me to say why people miss appointments with the NHS, but we have similar examples when people are referred to us.

“They often miss their first meeting if we send them a letter inviting them in after a referral. If we reach out to someone, there is a chance they will not show.

“There’s a lot of anxiety and not knowing what to expect that causes that.

“We get referrals from a wide source of people and places.

“What is more likely to work for us is if someone comes with them — a friend or family member of support worker, for example.

“With mental health, you don’t just wake up deciding you have a problem. It can take weeks and months to creep up.

“Going to a doctor about a cough can provide anxiety, so if it’s about mental health that can be even worse.”

While understanding how difficult it can be for someone with mental health issues to  reach out for help, Wendy insists it is worthwhile.

She added: “It’s a huge problem.

“NHS are telling us about missed appointments and they are trying to address that particular issue.

“Wellbeing wants to resolve the issues because the help is there, but if people aren’t able to get to it then they’re not getting the benefit.

“One problem is people not knowing what to say to a GP, but there is nothing you can tell them that they haven’t heard before.”

NHS Tayside does not report reasons for why appointments have been missed, as most of the time it is not known.

Missed GP appointments for all ailments cost the health board £277,000 in just one week last year.

At the time, NHS Tayside estimated that one in 10 GP appointments are wasted every week.

 

link to Courier article here

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Mental health staffing concerns as medics fear for future of Tayside psychiatric services

The Carseview Centre

 

Link to Courier article here

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Mental health bosses admit care standards slipping across Tayside

Youngsters in Tayside are facing an “alarming” mental health crisis after care bosses admitted standards have plummeted in six months.

The number of kids getting help for mental health problems within a reasonable time frame dropped from 96.6% in June 2017 to 43.9% in December.

The rate covers the proportion of youngsters who are referred to and seen by NHS Tayside’s child and adolescent mental health services (CAHMS) team within a target of 18 weeks.

Across Scotland, the target health boards are expected to meet is 90%.

Keiran Watson, of youth support charity Eighteen and Under, said he found it “alarming” that less than half of kids were being seen on time.

He said: “As it is, the 18-week timescale is too long.

“If you’re a young person who is feeling depressed or has delusions, or is self-harming or even feeling suicidal — or if you are a parent of a young person like that — can you imagine being faced with an 18-week wait?

“The fact that less than half of young people are being seen within that 18-week target is shocking. It’s really quite alarming.”

Lorna Wiggin, NHS Tayside’s chief operating officer, told the health board at a meeting this week the slide was due to staff shortages equivalent to 3.3 full time workers.

She said: “Previous attempts to recruit have been unsuccessful. However, the posts have been re-advertised and interviews are due to take place in March.”

Ms Wiggin said significant improvements would not happen until those positions are filled, but added that high-priority children can be seen within five days of referral if their case is judged to be an emergency. We’re expecting a slight improvement in the next three months, but not a major one.

“We were able to rely on adult (mental health) services for some support but they’re not able to do that now.”

NHS Tayside may well reach out to other health boards for support with CAMHS in the near future.

Chief executive Lesley McLay said she had requested a review of the system with managers to avoid any further repeats of the situation.

She added: “We recognise that action is already happening (to improve performance). We may involve another health board as well.”

 

Link to Evening Telegraph here 

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Mental health service revamp across Tayside gains approval

The Carseview Centre

Health chiefs in Tayside have stated having two centres of excellence is the only safe way forward for inpatient mental health services.

The decision was taken at a meeting of Perth and Kinross Integration Joint Board following months of consultation, campaigning and protest.

It will see general adult psychiatry acute admissions centralised at the Carseview Centre at Dundee’s Ninewells Hospital.

Learning disability inpatient services will be provided at Murray Royal Hospital in Perth alongside other specialist services, including rehabilitation and substance misuse.

The decision will see services relocated from the outdated Strathmartine Hospital and the Mulberry unit at Stracathro Hospital in Angus.

The board voted five to one (an abstention) in favour of the preferred option.

Clinicians believe the steps will secure the future of inpatient services, improve the quality of service and environment available to patients and make services more attractive to potential staff.

Individual health and social care partnerships in Angus, Dundee and Perth and Kinross will be working to enhance mental and health and learning disability services in local communities, where 94% of mental health care is delivered.

More than 100,000 people took part in an often-criticised consultation process and more than 57% of those who responded said they were against the proposals.

NHS Tayside’s medical director Andy Russell, however, said the present model of care could not continue, with the redesign proposed “the only safe option”.

 

Link to Evening Telegraph article here  

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Deep concern expressed over mental health beds drop in Tayside

The Carseview Centre.

“Deep concern” has been expressed over a 10% drop in acute mental health beds across Tayside over the past five years.

The number of beds for men and women dropped from 99 in 2013 to 90 last year.

Health chiefs said the reduction was due to a reconfiguration in Perth and the interim relocation of the Mulberry Unit in Angus to the Carseview Centre and insisted most patients were now treated in the community.

However, Angus MP Kirstene Hair is seeking a reassurance from NHS Tayside that the numbers will not fall any further.

She said a total of 44 beds were likely to be relocated from Murray Royal Hospital and the Mulberry Unit at Stracathro in Angus as part of a shake-up of mental health care, while a similar number will be set up in Dundee at Ninewells Hospital.

But she added: “This research finds that the number of beds for a growing problem is reducing anyway – which is of deep concern.

“There needs to be a reassurance from NHS Tayside this number will not shrink any more.”

Conservative MP Ms Hair said she was also concerned that there are no eating disorder beds locally, meaning people are still having to go to Aberdeen for specialist treatment.

“It’s my concern and that of many of my Angus constituents that local health services are disappearing in the background,” she added.

“It is only huge change, such as ward closures, which makes people sit up and take notice.”

Closure of the Mulberry ward at Stracathro Hospital has been identified as the preferred option in a programme to address what officials have described as an unsustainable model for mental health care across the region.

Perth and Kinross integration joint board will have the final say on the package next week.

The move is likely to mean the axe for the Angus unit while general adult psychiatry acute care will be provided from four wards at Dundee’s Carseview Centre, along with learning disability inpatient services from three wards at Murray Royal Hospital in Perth.

Chief officer for Perth and Kinross health and social care partnership Robert Packham said only around 6% of people who access mental health services each year need hospital care.”

He acknowledged there had been a small reduction in the number of acute general adult psychiatry beds in the last five years, adding: “This is due to the reconfiguration of Moredun Ward at Murray Royal into separate male and female environments, and the interim relocation of the Mulberry Unit to the Carseview Centre.

“We have also been redesigning services to adapt to the changing needs of our populations and new services have been introduced to manage people in crisis and support people to remain at home,” said Mr Packham.

“Our communities would expect treatment to be available to them and their families when it is required and we remain committed to ensuring our patients can access the best treatment in the most appropriate place.”

 

Link to Courier article here 

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