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.”
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.”
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.”
The only possible course of action is that Carseview Centre is shut down, says Record View
The best thing that could happen to the Carseview Centre would be if it was razed to the ground.
The details of a leaked report into the conditions at the Dundee mental health unit are nothing short of horrifying.
Patients were restrained using dangerous and “life-threatening” techniques.
Vulnerable people who needed care and attention were instead subjected to bullying and unsafe practices by untrained staff.
The internal inquiry even found evidence staff pinned down patients for as long as an hour and 45 minutes.
And the suspicion remains that this would all still be going on if it wasn’t for the brave actions of whistle-blowers.
The scandal is another serious headache for Health Secretary Jeane Freeman who has an overflowing in-tray.
It’s vital the SNP minister ensures the complete report is published as soon as possible and that its recommendations are delivered in full.
The case raises extremely grave questions about mental health provision in Scotland. Steps must be taken to ensure these types of failures are not being repeated elsewhere.
The families of suicide victims are demanding the facility is shut down so new mental health services that are fit for purpose can be introduced instead.
That is now the only possible course of action.
Social media crisis
Responding to the myriad of ways social media is changing the world is one of the biggest challenges facing politicians.
An important Scottish Government report today raises fears of a looming mental health crisis among teenagers.
It reveals the number of 15-year-old girls in Scotland reporting emotional and behaviorial difficulties has soared over the past decade.
And it’s no coincidence this decade coincides with the rise of social media.The new pressures of Facebook, Twitter and Instagram are immense.
Young people’s every action is scrutinised online. This can be destructive to people’s body image and sense of worth.
The evidence suggests young girls are particularly susceptible to the problem.
The Scottish Government has responded by unveiling a £90,000 package to boost wellbeing in schools, including teaching healthy use of social media and screen time.
This is a welcome first step in a very important battle.
GPs in Dundee are now able to prescribe spending time in nature to improve patients’ health and wellbeing as part of a pilot scheme.
A trial programme of “green health prescriptions” will be available from Lochee Health Centre, Whitfield Health Centre and Taybank Medical Centre.
The three Dundee GP practices will discuss with patients if it is appropriate to offer a nature-based intervention as part of their treatment or as a preventative measure.
The activities have been designed by NHS Tayside and will be printed on prescription paper.
NHS Tayside chief executive Grant Archibald said: “There is no doubt there is a strong connection between green space and good mental and physical health. Parks, woodlands and open spaces make a real difference to how happy we feel.
“They also improve our immune system and encourage physical activity and social interaction.”
The Dundee Green Health Partnership (DGHP) will signpost green initiatives and raise awareness about the positive impact that nature can have on people’s health.
The project is a collaboration between NHS Tayside, Dundee City Council, the voluntary sector, Dundee University, Abertay University and local community initiatives.
Neighbourhood services convener, councillor Kevin Cordell, said: “I’m delighted to see a host of key partners coming together with a goal to use our wonderful outdoor spaces to improve physical and mental health.”
A new suicide prevention initiative will be launched in Dundee after findings showed the city has the highest rate of people taking their own lives in Tayside and Fife.
Poverty and welfare reform have been cited as one of several contributing factors in the city, which is infamous for having one of the highest numbers of benefit sanctions in Scotland.
The Suicide Prevention Strategic Plan would bring the city council, NHS, emergency services and specialist mental health services more closely together to work on preventing deaths.
It will be under consultation until April and is expected to be endorsed by the Dundee Integration Joint Board in June.
An investigation carried out between 2013 and 2017 showed 131 people died by suicide in the city in that time.
The rate of 19 per 100,000 population was significantly higher than the Scottish average of 13.5.
Males in Dundee have the second highest mean rate of suicide in Scotland.
A report compiled by the Tayside Multi-Agency Review Group, set up in 2016 to investigate the issue, said: “Scotland continues to have a higher suicide rate than the rest of the UK mainland and there is a strong association between suicide and socio-economic deprivation.
“A number of cases have highlighted the impact of issues around benefits in potentially contributing to local suicide deaths.”
Concerns have also been raised about ambulance staff having no access to mental health records when dealing with emergencies, unlike the police.
Speaking at Tuesday’s Health and Social Care Partnership meeting, the committee’s chair Trudy McLeay said: “I was surprised that the ambulance service don’t have access to mental health records.
“It must be a very difficult situation, especially when dealing with an attempted suicide.”
Common factors identified in Tayside men and women who died by suicide included bereavement, a criminal history, harmful use of alcohol, adverse childhood experiences and physical health problems.
Among men, a significant number were found to have had a record of abuse perpetration, psychotic or organic brain conditions, Autistic Spectrum Disorder, a career history in the military and/or Eastern European ethnicity.
Meanwhile, a common factor specific to women was infertility.
A further report submitted to the Dundee Health and Social Care Partnership raised concerns that there may not be enough funding to implement the new plan.
DWP spokesperson said: “Suicide is a highly complex issue and it’s wrong to make a link with welfare reforms.
“This report is over 300 pages long and mentions welfare reform in just one paragraph.”
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.
