Relatives of a man who killed himself after being refused admission to a mental health centre have joined calls for the health secretary to quit.
David Ramsay hanged himself at the age of 50 in 2016 after twice being turned away from the Carseview unit in Dundee.
His family has been campaigning for a public inquiry into mental health services at NHS Tayside.
Their case was raised by Scottish Labour leader Richard Leonard at First Minister’s Questions.
Nicola Sturgeon strongly denied claims from Mr Leonard that her government had been “silent” over the issue.
Her official later told journalists that the first minister continued to have full confidence in Health Secretary Shona Robison.
Opposition parties have been calling for Ms Robison to be replaced after accusing her of presiding over a series of failings, including a financial crisis at NHS Tayside.
Who was David Ramsay?
Mr Ramsay made three separate attempts at suicide in the space of a week in the autumn of 2016.
His family convinced him to seek urgent help from his GP, who referred him to Carseview because he “required admission”.
Mr Ramsay had two emergency assessments, but was turned away from the centre on both occasions.
His niece, Gillian Murray, told BBC Scotland there had been a catalogue of failures over the handling of her uncle’s case in the days before he killed himself.
She said Mr Ramsay’s death had been preventable as he had told staff “in no uncertain terms” and on separate occasions that he did not want to live and needed help.
Ms Murray added: “It could happen to anyone – it could be me or you who needs that little bit of help, and he was turned away.
“The hospital took no ownership, they took no accountability. They passed the buck to the family – I was having to Google how to look after a suicidal individual, how to look after somebody with psychosis. That shouldn’t have been left to us.”
Ms Murray called for a “change of attitudes” and more funding for mental health, and said a public inquiry was needed for the “many, many lives that have been swept under the carpet”.
And she said Ms Robison – a Dundee MSP – “needs to resign”, adding: “I think that’s the right thing to do, the honourable thing to do.
“She knows about the mental health crisis, she’s ignored other families previously. She knew about the corporate governance scandal [at NHS Tayside]. She can’t bury her head in the sand.
“These are people’s lives that are being taken, and you need to do the decent thing and step down.”
Earlier, Mr Leonard told Holyrood that Scotland’s suicide rate was more than twice as high as the rate for Britain as a whole, while in Dundee it had increased by 61% in a year.
He asked the first minister: “Why has your government remained silent on this crisis and silent on this demand for a public inquiry?”
He told Ms Sturgeon that Mr Ramsay’s relatives were “yet another family failed by your government”.
Mr Leonard added: “So, first minister, how many more families must be failed? How many families need to suffer before you finally recognise that now is the time for change?”
What has Ms Sturgeon said?
Ms Sturgeon told MSPs that her “deep condolences” went out to Mr Ramsay’s family and that the government had been in contact with them.
But she said that while one suicide was one too many, a five-year rolling average showed suicides were on a downward trend in Scotland.
On Carseview, she said: “I don’t think it is right or fair to say that the government has remained silent.”
Ms Sturgeon said Health Secretary Shona Robison had visited the unit and the Mental Welfare Commission had carried out an unannounced inspection in March and made a number of recommendations.
She said: “We expect NHS Tayside to fully respond to those recommendations within three months and they have also, as I understand it, been shared with Healthcare Improvement Scotland.
“We will pay very close attention to NHS Tayside’s response and if there is further action that we consider is required, then that action will be taken.”
The first minister said it was “simply not the case” that no action was being taken, adding that the government’s forthcoming suicide prevention strategy would ensure that the best facilities were in place for those who need help.
On the individual case, she said it would be up to the law officers to order a fatal accident inquiry.
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Workers at University Hospital Wishaw are putting the focus on the rights of patients admitted to hospital due to mental ill health.
Colleagues in ward one at the hospital have been piloting the Rights in Mind pathway, designed to help staff in mental health services ensure that patients know their rights and can access them.
Senior charge nurse Frances Smillie, who appears in a short video made by the Mental Welfare Commission for Scotland to raise awareness about Rights in Mind, said staff were enthusiastic about the guidance
The pathway was developed by the Commission and other experts, including people with experience of mental ill health. It highlights various issues with human rights in mental health care settings, putting legislation into context.
For example, voluntary patients are sometimes unaware they could leave a ward or refuse treatment and patients who are detained have additional rights, such as being told how long they are detained for and whether they can appeal against their detention.
Frances said: “When I started as a nurse it was about what we did to patients, such as detaining them and deciding their care plans.
“Now it’s more about what patients want and their rights, so it’s changing mindsets.
“The patients’ rights pathway is going to help immensely as it makes healthcare staff more aware of the rights of the people we care for. If patients are informed of their rights they are less anxious and emotional and feel empowered about their treatment.”
Frances explained a key aspect is the use of an ‘advance statement’ – a document written by a patient, when they are well, to say what treatment or care they would like, or would not like, if they get ill again. Anyone who makes decisions about their treatment, like doctors or a tribunal, can then read their advance statement and consider their wishes.
The ward ran a project to promote awareness of the statements and succeeded in ensuring nearly 96 per cent of patients knew they could write one if they wished.
Frances said: “We now have a weekly session about advance statements, led by nurses, patients and peers.
“Lots of patients didn’t realise they could have this input in deciding their treatment and many use them to list the things that have helped them in the past or what they don’t want, such as anti-psychotic medication they’ve had a bad experience with.
“We have a commitment to ‘person-centred’ care and this is a great example of that.
“Patients feel their personal concerns are being listened to and that means a lot to me and my colleagues.”
Kate Fearnley, executive director (engagement and participation) at the Mental Welfare Commission, said: “Rights in Mind can make a practical and positive difference to patients.
“We are delighted that NHS Lanarkshire is promoting it more widely amongst staff.
“Frances and the team at University Hospital Wishaw worked closely with us to create this guidance and they are already proof that it works.”
The Rights in Mind booklet and videos, including the one featuring Frances, are available at www.mwcscot.org.uk/rights-in-mind.