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.”
First Minister Nicola Sturgeon has said an interim report into mental health services in Tayside will be published “imminently”.
Responding to questions from Scottish Labour leader Richard Leonard about the inquiry, Ms Sturgeon said she would expect relatives who campaigned for the inquiry to be given advance copies of the interim report, which is expected to be published this month.
The inquiry was launched following a public campaign by families who blamed poor care at the Carseview Psychiatric Centre at Ninewells Hospital for a series of suicides.
The interim report will be published next week although it will be several months before the full inquiry report is completed.
Mr Leonard told the First Minister that some of the relatives whose campaigning led to the inquiry feel they have not been kept up-to-date with its progress and believe it is not “transparent”.
He said that when the inquiry was set up then health secretary Shona Robison said it should be seen as “a force for good” and asked if Ms Sturgeon believed this aspiration is being met.
Mr Sturgeon said it would be wrong for the Scottish Government to “pre-empt” the inquiry but said its findings would be scrutinised and any recommendations acted upon.
She added: “Of course we want to learn lessons and our sympathies are with the families who have experienced those losses.
“We established an independent inquiry in Tayside. That hasn’t yet reported. I hope it will report soon and it will be fully scrutinised by the government.”
Mr Leonard said Mandy McLaren, the mother of Dundee suicide victim Dale Thomson, has lost confidence in the inquiry.
He said: “She asked me to ask you directly if families will see an advance copy of the interim report before it is published.
“Will you listen to the voices of those families? Will you do what you can do to restore their confidence in this inquiry?”
Ms Sturgeon replied: “This inquiry is being led by David Strang. It is an independent inquiry.
“If the government was interfering in the conduct of that inquiry, I am sure Richard Leonard would be raising that in the chamber.
“I understand David Strang has met with family members. It would be full my expectation that an advance copy of the report would go to those directly affected.
“I will pass that specific point to David Strang but I would stress it is an independent inquiry.”
Earlier, Conservative MSP Bill Bowman pressed health secretary Jeane Freeman over plans for a 24-hour crisis centre in Dundee.
Councillor Ken Lynn, the the vice-chairman of Dundee Heath and Social Care Partnership, has pledged his “total commitment” to creating a centre in Dundee, but Ms Freeman the issue had not been raised with her or the minister for mental health, Claire Haughey.
Mr Bowman said later: “It was clear from the cabinet secretary’s answer that the SNP are disconnected from the challenges faced on the ground.
“There seems to be no plans for the new centre in Dundee, or for the government to help NHS Tayside create one.”
A probe into serious abuse allegations at Carseview could impact a controversial shake-up of mental health services.
The first phase of a planned review, which will see general adult psychiatry acute admissions centralised in Dundee, is due to begin in June.
However, health chiefs say they are prepared to make changes if necessary,when the findings of an independent investigation into claims patients were pinned to the floor and mocked by staff at the Carseview mental health unit in Ninewells.
The Perth and Kinross Integration Joint Board heard preparatory work on the mental health review is already under way, with the first phase due to begin in June.
The plan was agreed in January 2018, following months of consultation and protest. Learning disability inpatient services will be provided at Murray Royal Hospital Perth, after services were transferred out of the outdated Mulberry unit at Stracathro in Angus.
The board was given an update by the four-person panel leading the review.
Conservative councillor Colin Stewart asked: “We’ve heard that we need to work quickly to address risks, but we are also told there are delays to the redesign programme.
“I understand there is going to be an interim report on the independent inquiry published later this month.
“Have you had any indication that there may be points raised for action in this report, that might have implications for the redesign programme?”
Arlene Wood, associate director for mental health, confirmed she had not had any feedback or update on the review. “The clear steer that we have had from the chief executive is that we continue, for now, on the quality improvement and redesign programme because we know there are inherent risks in the system and this work needs to happen,” she said.
“It would be remiss of us to wait for the report. If there are things raised that require us to change our course of action, then we would address that at the time.”
The board heard the heads of health partnerships in Dundee, Perth and Angus were working on a Tayside Mental Health Alliance, to tackle a range of challenges facing the sector.
Professor Keith Matthews, associate medical director for mental health services said: “It would be a mistake to underestimate how challenging the environment is for mental health services.
“We have issues with recruitment and there are emerging difficulties with retention of staff.”
He said the Scottish Government was attempting to address a national shortage of psychiatrists with an international recruitment campaign.
“Although many efforts are being taken to resolve these matters, the likelihood of anything being resolved soon are pretty low.”
He added there was a need to move away from a workforce reliant on high-cost agency work.
The report has not been made public but has been seen by the BBC.
It found that untrained staff were carrying out risky restraints on patients and that the number of restraints was high.
It said face-down, and particularly face down in a prone position, are the highest tariff interventions of physical restraint, and the most dangerous techniques to deploy.
The report looked at a sample of 40 cases and found more than half were patients being restrained face down on the floor for longer than 30 minutes.
The longest restraint was one hour and 45 minutes.
“That is completely against all guidelines,” Prof Tyrer said.
“You may have to do things for five minutes or up to 10 minutes but to go beyond 40 minutes there is something badly wrong in the organisation of a unit if that is allowed to continue.”
Carseview is a hospital to care for patients with mental illness from depression and anxiety to schizophrenia and psychosis.
In July last year, BBC Scotland broadcast allegations by patients of bullying by staff, illegal drug-taking and being pinned to the floor unnecessarily.
Experts called it abusive and said the unit should be closed down.
NHS Tayside responded by commissioning an internal report into Carseview to go alongside independent reports into mental health in Tayside.
The internal report says a whistleblower has come forward and accused Carseview of “very serious concerns over leadership, safety and malpractice”.
It came up with 11 recommended actions including urgent action on staff training and critical action on illegal drugs on the ward.
It said the restraint policy should emphasise the safety of patients as well as staff and that the culture of the unit should be “based around the caring and compassionate leadership approach”.
NHS Tayside said the recommendations covering patient care and culture were “now being progressed”.
Prof Peter Stonebridge, acting medical director for NHS Tayside, said a “steering group has been established” to focus on restrictive care practices, including the reduction of face-down restraint.
Joy Duxbury, professor of mental health at Manchester Metropolitan University, told BBC Scotland: “I think this is a terribly toxic environment.
“The figures on physical restraint are exceptionally worrying.
“These are very vulnerable clients who are being restrained, in my view, unnecessarily and by far too many staff in too many situations.
“For me, given what we know about psychological and physical trauma of the use of restraint in such setting, this is of significant concern.”
Marnie Stirling, who had two stays in Carseview with anxiety and depression, spoke to the BBC documentary last year.
Reacting to the report, she said: “If you think about mental health, it’s supposed to be about recovery. This isn’t recovery, it’s further punishment for people.”
David Fong spent a month in the unit after experiencing psychosis in 2013.
He claimed staff used restraint violently and repeatedly during his time there.
His mother Lorraine said: “This is a total and utter disgrace that this has gone on for seven years and maybe longer.”
David told BBC Scotland that staff were quick to see frustration and anger arising from detainment as aggression.
“Staff are too keen to initiate restraint and offer little or no de-escalation when no actual aggression has been displayed by the patient,” he said.
“I ask how many of these restraints were actually needed and if some are instigated by staff rather than patients?
“I personally was physically assaulted with the application of intense pain through twisting of arms, wrists and fingers or a member of staff’s knee being dug into my back, had my face rubbed into the floor causing loss of skin from my face, and had verbal abuse screamed at me during restraint.
“I also could not have been the only patient that these tactics were being used upon.”
A separate report looking at the patient experiences came up with separate 23 recommendations in December.
It is feeding into an independent inquiry, which was announced in the Scottish Parliament last year, and is still ongoing.