Tayside is at the epicentre of a “national scandal” in adult psychiatry care, with senior managers breaking ranks to brand wider services across Scotland “unsafe”.
The region was likened to a “canary in the coal mine” as new analysis found it has the worst record for recruiting general adult psychiatry consultants anywhere in the country.
The Courier can reveal a professional body representing leading psychiatrists is warning patients in Scotland are being put at risk by services at breaking point.
Situation is ‘critical’
Dr Amanda Cotton, chair of the Senior Medical Managers in Psychiatry group, said: “The situation regarding consultant psychiatrist vacancies across Scotland is critical.
“A review of vacant consultant posts undertaken by our group of Senior Medical Managers in Psychiatry last year demonstrated true vacancy rates in Scotland from 13% to over 50% around the country.
“Often it is the most impoverished areas of the country, and the areas that experience the worst rates of drug-related deaths, that have the least number of psychiatrists.
“This is a national scandal.”
Dr Cotton is also Associate Medical Director for Mental Health and Learning Disability Services at NHS Borders.
She warned bosses are trying to manage a “terrible shortage” of consultant psychiatrists by employing temporary locum doctors, “some of whom might not have undergone the necessary training”.
She added: “This is unsafe and would not be accepted in other areas of healthcare.”
And she called for a reduction in the number of services being offered until the next generation of consultants is trained.
She said: “We have raised our concerns directly to the Scottish Government and asked that they begin an urgent conversation with the Scottish public about what care specialist mental health services can and cannot provide over the next few years.
“Staff in mental health services need to feel they are doing a job that is safe, realistic and achievable.”
Crisis in Tayside laid bare
New analysis from the Senior Medical Managers in Psychiatry group, seen by The Courier, lays bare the extent of the crisis in Tayside and across Scotland.
The region should be employing 24.5 full time equivalent consultants in general adult psychiatry but has only five in post.
Health chiefs have tried to plug the gaps with temporary locum hires but still has a need for 4.5 full time equivalent staff.
It means 18% of Tayside’s psychiatry requirements are currently unfilled, the worst rate anywhere in Scotland.
The vacancy rate across the country as a whole is 9%.
In Fife, the vacancy rate is 8%.
‘Shocking’
Dundee-based MSP Michael Marra described the figures as “truly shocking” and said they “lay bare the massive task in rebuilding mental health services”.
He said: “The situation in Tayside – considerably worse than the rest of Scotland – has been described to me as the canary in the coal mine of an over-stretched mental health service nationally.
“Despite all of the warnings, the major reports and promises of action from SNP ministers there is scant progress on any of the big issues.”
NHS Tayside said the health board is working closely with staff to develop new workforce models, including advanced prescribing roles for non-medical practitioners.
A health board spokesperson added: “There is a UK-wide shortage of consultant psychiatrists which is creating a very challenging recruitment environment.”
SNP minister Kevin Stewart said the mental health workforce has “expanded significantly” under the current government.
Mr Stewart noted that “record numbers of staff” are providing more varied support to a larger number of people than ever before.
He added: “As part of our ongoing commitment and investment, we are working with partners to develop both a new Mental Health and Wellbeing Strategy and Workforce Plan in 2023.”
Latest waiting figures for child mental health services have shown 40 youngsters waited more than 12 months for treatment
Scores of Scottish youngsters with mental health problems have been waiting more than a year for specialist treatment.The latest NHS waiting time figures have revealed that 40 young people faced a wait of more than 12 months for an appointment with specialist child and adolescent mental health services (CAMHS).
More than a quarter of children are not being seen within the 18-week waiting time target, and the Scottish Children’s Services Coalition (SCSC) has said the figures show that the system is failing.
Covering the quarter from October to December 2017, the figures note that 4,015 children and young people started CAMHS treatment in this period.
The NHS in Scotland, including 10 of the 14 regional health boards, failed to meet the Scottish Government 18-week waiting time target for children and young people to receive treatment from CAMHS.
More than a quarter (26.9%) of youngsters who have been referred for treatment are failing to be seen within this period.
A spokesman for the SCSC said: “There must be a radical transformation of our mental health services, with a focus on preventing such problems arising in the first place and intervening early, especially when we know that half of all mental health problems begin before the age of 14.
“With mental health and the issues associated with it representing one of the greatest public health challenges of our time, we must ensure that children and young people are able to get the care and support they need, when they need it.”
Barnardo’s Scotland has said that cross-sectoral action to improve support for children and young people’s mental health and wellbeing, and a wider discussion on what other agencies can do to support CAMHS, is needed.
The charity’s head of policy, Kirsten Hogg, said: “Not all children and young people with mental health difficulties will need a specialist CAMHS service, and we must make sure that we make use of the relationships and expertise present in other services, to ensure that these children and young people have access to appropriate support. This is not an issue for the health sector alone to deal with.”
Mental health minister Maureen Watt recognised that there are too many young people experiencing long waits for treatment.
“Demand for mental health services is increasing as people become more aware of both mental health problems and of the care available, and as stigma reduces,” she said. “But there are too many people who are experiencing waits that are too long.
“That’s why we’ll continue to support the improvement of mental health services through the £150 million of extra funding we’re providing over five years to help deliver our mental health strategy.”
She wants GPs to be unable to prescribe anti-depressants to under-18s without the knowledge of their parents.
MSPs have ordered more information on whether children are prescribed anti-depressants as “the first port of call or the last port of call”.
Annette sees this as a turning point in her fight.
She said: “For me this is about the minister for mental health agreeing we have a real problem with teens and treatment and the way we treat children.
“No child should go on a first visit to a GP with depression and leave with any medication without being referred first to someone who deals with mental health.”
She wants the change for her other daughter and for her son and everyone else’s sons and daughters.
Young people contact her with similar problems: “The number of young people who have reached out to me, who I’ve spoken with and helped to get in contact with someone who can help them has helped me too.
“I’ve even had messages from people who said they were going to end their life but once reading my Facebook wall – the stuff I keep public – and watching my videos they say they can’t leave their parents in the pain I’m in.
“It’s bitter sweet – Britney’s story is saving not only her friends who knew her but also people she never knew and for me that’s a positive thing.”
Annette takes comfort in watching Britney’s friends living their lives to the full and never taking for granted what they have.
She wants to talk to as many young people as possible and get them to help each other when they have mental health issues or concerns for each other.
And at the end of the petition she named Britney’s Plea, Annette wants at the very least to see better guidelines for GPs when prescribing medication for young people.
She said: “Hopefully they will agree to bring in place new training for GP’s and I also hope they make it that no child or person is given pills on a first-ever visit to a GP.
“I want them to have to be referred and seen by a mental health professional before any treatment is given.
“If that had been in place with Britney she wouldn’t have been given those pills.”
She wants more discussion of the issues.
“I don’t want this to be the end.
“I want to be out there helping people, taking to them about mental health – about Britney.”
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