The number of children and adolescents waiting to see a mental health specialist has reached record numbers, new figures show.
At the end of December, there were 10,820 young people waiting to start treatment at CAMHS.
This compares with 9,337 during the same period in 2018 and a low of 7,620 in December 2017.
The official stats show that two-thirds of children were seen within 18 weeks, well below the 90% target.
The Scottish government standard states children and young people should start treatment within 18 weeks of referral to CAMHS.
In the last three months of last year only NHS Borders, NHS Orkney and NHS Western Isles met the standard, with NHS Lothian seeing less than half within the allotted timeframe.
The statistics show 272 children and young people who were seen during the final quarter of 2019 had waited over a year.
A further 589 children who were still waiting at the end of December had already been waiting over a year.
There were 3,884 children and young people starting treatment in the final quarter of 2019, a 14.1% decrease from the same quarter in 2018.
There are now more than 30,000 open cases in CAMHS.
Mental health problems
The Scottish Children’s Services Coalition said the waiting time figures highlighted the “desperate need” for increased investment.
A spokesman said: “The simple fact is that we are continuing to fail thousands of children and young people with mental health problems, and more clearly needs to be done to address this epidemic.”
Mental Health Minister Clare Haughey said the Scottish government was creating new CAMHS posts as well as strengthening the support available in communities and schools.
She said: “This year’s Programme for Government builds on this progress even further.”
That includes community wellbeing services for children and young people and a new 24/7 crisis support service, Ms Haughey said.
Scottish Labour’s Mary Fee said: “At a time when youth suicides have been increasing these figures should shame SNP ministers into action.”
Scottish Liberal Democrat health spokesman Alex Cole-Hamilton said: “Problems that start small are becoming crises as help arrives too late.”
He called for a mental health practitioner in every GP practice and new 24 hours a day service in A&E.
A former health board chief has sparked fury by suggesting a landmark inquiry into mental health services should not have gone ahead because it held up work to improve care.
Crawford Reid, former chairman of the Perth and Kinross integrated joint board (IJB), believes the independent inquiry “completely screwed” plans to redesign local mental health facilities.
The inquiry, led by former prisons governor David Strang, strongly criticised what it described as a loss of “trust and respect” in local psychiatric services.
But Dr Reid believes the launch of the inquiry – at the behest of the bereaved families of suicide victims – has set progress back in Tayside by two years.
The redesign was signed off in January 2018 by Perth and Kinross IJB, which is in charge of inpatient mental health services, but was put on hold following the inquiry’s interim report in May last year.
Ahead of an NHS meeting to discuss a proposed action plan on mental health tomorrow (Thursday), Dr Reid said: “Several aspects of the inquiry report give me great concern. (Ex-chair and ex-chief executive) John Brown and Malcolm Wright came in at a time when Tayside was in a dysfunctional shape – it was a knee-jerk reaction.
“I’m not minimising how ruinous suicide is but what’s happened is the mental health transformation programme has been basically put on hold.
“If the transformation programme had started to move in, things would have improved with a full complement of consultants.
“They completely screwed it.”
Relatives of those who took their own lives after engaging with local mental health services have criticised Dr Reid’s comments as poorly considered.
“There have been ample opportunities for genuine change with regards to mental health services in Tayside over the years given the sheer volume of investigations and horror stories.
“Nothing was changing hence why I, and others campaigned for this inquiry.
“Perhaps if these fantastic changes that are being proposed had actually been implemented years ago, lives would have been saved and there would have been no need for an inquiry.”
Gillian Murray
She added: “I feel yet again that we, the bereaved families who campaigned tirelessly for change, are being used as a scapegoat for the never-ending list of failures.”
Mandy McLaren, who lost her son Dale Thomson to suicide in 2015, said: “The redesign was in the interim report, and it did say it should be halted.
“The matter with him is he doesn’t want to take any responsibility for the part they all played in allowing these failures and allowing these deaths.”
Following a near-two-year investigation, the Independent Inquiry issued 51 recommendations on February 5.
Witnesses who gave accounts to the inquiry described how the transformation programme appeared to be little more than an asset management plan to save money.
However, Dr Reid believes that, with time, the programme could have gradually reintroduced localised care at facilities such as the Mulberry Unit in Angus, which was mothballed in 2017 despite being only despite being opened in 2011.
He also believes independent case reviews should have been held for each person who dies after engaging with mental health services.
“If you look at each and every recommendation there’s not one that moves the process of improving mental health services in Tayside one inch forward,” he added.
“Not one of those 51 recommendations, without the transformation programme going on, will improve anything.
The Susan Carnegie Centre, at Stracathro Hospital, which housed the Mulberry unit.
“The transformation programme had no time to bed in and move forward – if it had been allowed to develop the situation would have been fantastic compared to what it was two years ago.
“It’s not perfect but it’s far better than what we’ve been left with at this time. The sooner it gets put back on the boiler the better.
“Without a shadow of a doubt, this inquiry should not have gone ahead.”
NHS Tayside and the independent inquiry have been contacted for comment.
“We really need to work with staff to fix mental health”
Renewed calls have been made by NHS staff representatives for health bosses to work with them to improve mental health services in Tayside following the publication of the Strang report.
Jenny Alexander, employee director at NHS Tayside and a Unison rep, said the 51 recommendations were unlikely to be met unless staff were on board with the health board’s plans
She warned that actions could not be rushed through in the way the mental health transformation programme was perceived to be by some observers in 2018.
She told a meeting of Dundee’s health and social care partnership board (HSCP) yesterday: “The partnership aspect of this is very, very important.
“If we are running off and doing things like in 2018 we’re not going to do anything differently.
“We really need to start working in partnership with staff-side – if we don’t have staff on side we will never get through those 51 recommendations.
“We need to make sure we have improvements done for these people that we’re caring for.”
The independent inquiry found that staff reported feeling disrespected and undervalued by senior colleagues.
One mental health staffer described the atmosphere in mental health services as “a culture of fear”.
Arlene Mitchell, Dundee HSCP locality manager, says actions have already been taken in response to the inquiry.
These include the creation of new senior mental health posts, a new process for investigating adverse events and a plan to improve better support for those leaving mental health inpatient services.
Ms Mitchell said: “From a Dundee perspective, we’re in a good position…to ensure a strong staff partnership approach.
“We feel there’s a need to strengthen some of the staff partnership activity.”
Almost half of Dundonians who have died by suicide sought help from crisis services in the year leading up to their death, according to official figures.
The Scottish Suicide Information Database (SSID) report shows that 45.5% of the city’s 198 suicide victims between 2011 and 2018 contacted one or more unscheduled care services in the 12 months prior to taking their own lives.
NHS Scotland’s latest update to the SSID comes after it emerged tragic TV star Caroline Flack had been visited by an ambulance crew at her London home less than 24 hours before her death on Saturday.
Two-thirds of those who sought unscheduled help in Dundee did so by calling for an ambulance – and half attempted to get support from the NHS 24 telephone service.
Just over a quarter of those who sought help from Tayside’s out of hours service, which currently operates from Dundee’s Kings Cross Health and Community Centre.
Researchers who compiled the SSID noted that people who went on to take their own lives were six times more likely to have had at least one contact with the ambulance service in the year leading to their death.
The out of hours service can make referrals to NHS Tayside’s Crisis Resolution Home Treatment Team (CRHTT) for cases of mental health crisis in Dundee.
However, staff working for the CRHTT have reported feeling undersupported as NHS Tayside focuses on inpatient services such as those offered at the Carseview Centre.
NHS Tayside is reviewing the SSID report, along with the final report published by the Independent Inquiry into Mental Health Services in Tayside two weeks ago.
Mike Winter, associate medical director for mental health, said reducing suicide attempts was “a priority”.
He added: “NHS Tayside and partner organisations have been reviewing our crisis care and home treatment centres and working to develop a Psychiatric Emergency Plan.
“It should however be recognised that a key aspect of suicide prevention is the opportunity for people in despair to talk about their problems, whether this is to a work colleague, a friend or family member, or to a volunteer from Samaritans.
“The Independent Inquiry report will guide our further work on suicide prevention and other improvements we wish to progress.”
Scottish Labour health spokesperson Monica Lennon said opportunities for health and care services to refer people for mental health treatment “cannot be allowed to be missed”.
She added: “Reducing mental health stigma needs our collective efforts, proper funding for health and social services, and joined up working so that there is no wrong door.”
Responding to the report, mental health minister Claire Haughey said £3 million of funding was supporting the Scottish Government’s existing Suicide Prevention Action Plan.
Ms Haughey noted: “This report represents a significant contribution to the growing evidence base around suicide in Scotland which will inform current and future policy and activity.”
Support is available by calling Samaritans free 24 hours a day on 116 123. If you prefer to write down how you’re feeling, you can email jo@samaritans.org.
The parents of two young men who committed suicide after perceived failures of care by medical staff in Tayside have said they hope the deaths of their sons will not be in vain.
Dale Thomson took his own life in 2015 after spending time in Dundee’s heavily-criticised Carseview Centre, used to house and treat patients with mental health problems.
Dale’s heartbroken mum Mandy McLaren, a vocal critic of the health board and a campaigner for better mental health provision in Dundee, claims NHS Tayside “killed her son” and said she will “never forgive” the board and staff for the treatment Dale received.
She sat down for an interview with Tele, joined by Phil Welsh and Lesley Nicoll, who are also from Dundee.
Their son Lee Welsh took his own life in August 2017 after what the couple say were failings by his GP.
Lee, a talented musician, had endured mental health problems on-and-off for over nine years, being prescribed various alternative medications, but never actually receiving a particular diagnosis.
Phil and Lesley feel if he had received different treatment when he contacted his doctor in the days prior to his death, he would still be alive today.
Phil was given a Valium prescription to give to Lee on Friday August 4 and told to double his dose as his anxiety worsened, when his parents felt he needed to be admitted to Carseview.
They said his doctor told him he would not be able to get a referral to Carseview as it was the early evening on a Friday.
Lee went back to his GP on Monday August 7, having self-harmed over the weekend. However, he was again not referred to Carseview.
Lee’s parents Phil Welsh and Lesley Nicoll.
He took his own life the following day, aged 27.
NHS Tayside said that as an independent contractor, the actions of Lee’s GP were not the responsibility of the health board.
Mandy McLaren said it was the lack of care by NHS Tayside’s staff at Carseview in 2015 which led to Dale’s death.
The 28-year-old died in January 2015 after leaving the unit, which is part of Ninewells Hospital.
He had referred himself to Carseview via his GP and had been staying there between January 8 and January 10 that year. He discharged himself against medical advice.
Dale Thomson.
Dale’s sister later phoned police to inform them he had threatened to burn down people’s homes once out of the unit, and he was detained by police and returned to Carseview.
However, once assessed by doctors, he was returned to police custody and allowed to live with his grandmother.
Despite a follow-up GP visit and the prescription of an anti-depressant, Dale took his own life.
In 2016, while saying she could not comment on specific cases, the then-health minister at Holyrood, Shona Robison, apologised for any care which fell below the expected standard.
Ms Robison, who was replaced in the role by Jeane Freeman in June 2018, said: “If a service or part of the health service doesn’t meet the standards it should meet, then of course I would apologise to their family — whether that’s in mental health services or any other service.
“Obviously I can’t comment on individual cases to any great extent, because I’m not party to the full clinical information.
“Most of the time, our services are of a very good quality – sometimes services do fall short of where they should be.”
The three grieving parents spoke openly and frankly about the circumstances surrounding Lee and Dale’s deaths, and the heartbreak they have lived with since losing their sons.
Both Lee and Dale’s cases have tragic similarities.
The pair were both men in their 20s, had a history of mental health problems, had been supported by their families and had sought help from the NHS.
Both families claim the care they received fell far short of what their sons needed.
And, perhaps most tragically of all, both men left behind young daughters.
Mandy has been involved with a Stakeholders’ Group, set up in 2018, made up mainly of families or service users whose lives have been affected by mental illness or suicide.
They continue to campaign for better mental health services and meet next on February 20, one week before the upcoming NHS Tayside board meeting.
Mandy said she also receives messages and phone calls, sometimes from strangers in Carseview, asking for advice as they struggle with their mental health.
The website aims to share stories relating to mental health issues which can be shared with politicians, charities, and other people, in the hope that “funding and a fresh approach to the subject of mental health will finally be discussed and implemented”.
The family say that if they can prevent one family from enduring the same heartache they are currently suffering, Lee’s death will not have been in vain.
They are also campaigning for a crisis centre for people who can access acute mental health services without referral.
In the Trust and Respect report, it states that the Scottish Association for Mental Health (SAMH) has been working with various agencies and bodies in Tayside “to support the drive to increase access to preventative and short-term interventions”.
The leader of Dundee City Council has responded to an independent inquiry into mental health services in Tayside.
John Alexander has today posted a statement on Facebook, stating that the capacity of the services “needs to increase” and that there are “too many people spread too thinly”.
An inquiry to examine the accessibility, safety, quality and standards of care provided by all mental health services in the region was commissioned after concerns were raised in the Scottish Parliament.
Mr Alexander wrote: “Last week in a 136-page document, Dr David Strang set out the results and recommendations stemming from the independent inquiry into mental health services in Tayside.
“I spent the weekend pouring over the entirety of the document, considering it’s contents and thinking about what kind of service could be provided if those 51 recommendations are adopted.
“It’s vital that each word on those page is taken in. It was hard hitting, honest and to be frank, painted a deeply worrying picture of where things were.
“Mental health and it’s impact on too many people is an issue very close to my heart, even closer more recently but it’s also something that isn’t talked about enough – between family members and friends. I spent my Sunday morning with friends and one of the things we were talking about was the battles with mental health.
“I defy anyone to find someone that doesn’t have a family member, friend or someone that they work with who hasn’t suffered from issues related to mental health.
“We need to continue to remove any stigma associated with it and support those who need support. There is of course, a wide spectrum and the impacts can often be unseen, sometimes until it’s too late.
“There continues to be a significant number of people in crisis, at the end of their tether and struggling to manage daily life. What this report says very strongly and clearly is that people have been let down by services in Tayside. What it also says is that going forward, the services must change.
“The bottom line for me is that the capacity of those services needs to increase. There are too many people spread too thinly and too many silos that don’t allow for sustained collaboration.
“The Chief Executive of NHS Tayside has, to his credit, apologised for those failings and has said that his “…personal commitment to the people of Tayside is that I will work with them to address all the recommendations made by Dr Strang in his report.”
Grant Archibald.
“I’ve already discussed the matter with officers and look forward to meeting with NHS colleagues to see what actions have already been taken forward and hear how they intent to address the 51 recommendations.
“This report has been long anticipated and whilst I think there was a general expectation that there were issues, the fact that it has done such a thorough analysis and 1,500 interviews during that process should provide the evidence base required to make some big and necessary changes.”
The chief executive of NHS Tayside has publicly apologised to patients, family and staff for the failings of mental health services laid bare in a damning report.
Grant Archibald has also pledged that he personally will oversee and drive change and improvement in the mental health care offered by the health board.
Mr Archibald spoke to the Tele six days after the findings of the Independent Inquiry into Mental Health Services in Tayside was published.
David Strang’s Trust and Respect report identified 51 recommendations to be implemented to improve mental health services in Tayside.
It also highlighted numerous failings, including a breakdown of trust and respect, a failure to deliver services, a lack of psychiatrists, a lack of leadership and a lack of accountability.
Mr Archibald said: “We apologise, I apologise to all patients and families who have felt let down by services.
“Our aim is to care for each individual patient. I apologise if that has not happened.”
“Dr Strang’s report was hugely important for Tayside and for the people of Tayside.
“We recognised 18 month ago the level of concern there was over mental health services in Tayside. We responded by commissioning the independent review.
“We now realise that it is important that we now learn from this report which goes into significant detail following interviews with 1,500 people during the process.
“It is important that we listen to these voices and to the experiences detailed by patients and others.
“First of all we apologise, we have listened and now we need to learn and change.
“We must rebuild confidence in the NHS and we recognise that that is not going to be easy.
“My personal commitment to the people of Tayside is that I will work with them to address all the recommendations made by Dr Strang in his report.”
Among the recommendations the board are now going to look at are the provision of a 24/7 crisis care centre.
A review will also take place into its current facilities, including Carseview, to establish whether they are fit for purpose.
Meanwhile, allegations of bullying from staff will also be investigated, and the board is also going to attempt to identify new ways of attracting more staff, including more psychiatrists.
Mr Archibald said that the process of change had already begin, with a statement of intent now signed by him, the chief executives of the local authorities in the board area, and police
He added: “This will take time but we will be listening and we are are committed to learning from past mistakes
“I personally will be playing a key role and will continually report back progress that is made.
“We are aware the the spotlight is now on us I will be ensuring that all the recommendations made by Dr Strang to improve mental health services are acted upon.”
“I recognise there are challenges with all of these issues but there is a real enthusiasm to meet these challenges and improve mental health services provided by NHS Tayside.”
Mr Archibald said Dr Strang will return in a year’s time, by which point he hoped to “provide him with the evidence that change is actively taking place”.
