Children have been forced to wait more than year for treatment after being referred to mental health services in Tayside.
One mental health campaigner described the figure as “frightening”.
Figures released by NHS Tayside in response to a Freedom of Information request revealed the longest wait for treatment to begin at the health board’s Child and Adolescent Mental Health service was 425 days – around 14 months.
A small number of children were also required to wait more than a year for their treatment to begin.
However, the health board said no child – defined as someone under the age of 16 or 18 if in full-time education – on the current waiting list for treatment has been on it for longer than 305 days.
Mental health campaigner Gillian Murray said there is “no excuse” for such lengthy delays between referral and treatment starting.
She said: “That’s frightening that a child has had to wait over a year for treatment, there’s no excuse for any wait that long.
“Isn’t there meant to be a set time limit when you’re legally meant to be seen?
“It definitely shows how poorly patients are being treated by NHS Tayside but I think those figures would likely be the same throughout Scotland, to be honest.”
Ms Murray’s uncle David Ramsay killed himself after being turned away from the Carsewive Centre at Ninewells Hospital and has campaigned for an independent review into mental health services in Tayside.
An NHS Tayside spokeswoman said patients are prioritised according to need.
She said: “There has been a lot of work undertaken by staff in our Child and Adolescent Mental Health Services (CAMHS) to improve access to services for young people in Tayside over the past 12 months.
“We have been working closely with Healthcare Improvement Scotland Mental Health Access Improvement Support (HIS) Team to deliver an improvement plan which will reduce waiting times. This includes a full CAMHS service workforce review and recruitment drive to key posts, to ensure that the team are fully equipped to manage the service demand and enhance the experience for children and their families.
“We are determined to continue making improvements to ensure all our children and young people receive the best quality care without delays and we hope to reach the national standard in the near future.
“When a child or young person is referred into CAMHS their referral will be scrutinised by our Clinical Specialist Referral Management Team and prioritised by clinical need into urgent, soon or routine. It is important that a child or young person who requires an intervention is seen by the right person at the right time.”
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.
The independent inquiry into mental health services in Tayside has retired to consider the key issues hampering the system’s ability to care for patients.
Launched following pressure from the families of suicide victims in Dundee, the inquiry’s evidence stage has concluded after receiving hundreds of submissions from the public.
Alongside other evidence, these will now be examined by the inquiry, chaired by former chief inspector of prisons David Strang.
Mr Strang said: “I am pleased with the response we have received to our public call for evidence. More than 200 people have submitted written documents and personal statements and there have been more than 60 oral evidence sessions held.
“Evidence has been submitted from a wide range of people including patients, families, carers, NHS employees and third-sector organisations.”
Agencies such as Police Scotland, student welfare teams and Dundee Drugs Misuse Commission have also contributed.
The evidence stage has taken several months, with discussions held with parties with an interest in improving mental health services.
The inquiry has visited psychiatric units including the Carseview Centre, the Rohallion Clinic and Stracathro in order to understand the systems currently in place.
The information it has gathered to date will be used to identify key issues in mental health services.
A statement from inquiry chiefs said: “The next stage of the inquiry’s work is to analyse all the data evidence, relevant government reports, statistical data, internal NHS review documents and data, in order to identify common themes which will then be the subject of further investigation and analysis.”
The inquiry was commissioned by NHS Tayside last year after campaign group Lost Souls of Dundee claimed it had identified at least 10 suicides which could have been prevented in the area.
A Tayside musician is helping beat the stigma of mental illness by rapping about his time in a Dundee psychiatric hospital.
Kieran Smart, who studied music production in Perth before being admitted to Carseview, posted a video to social media which detailed his battle against self-harm and hallucinations.
The 23-year-old mentions his feelings of isolation while struggling with his mental health, which led him to spend a total of four months in the unit over the past two years.
He said he hoped the video would encourage more people to seek help sooner, after revealing it took him five years to get treatment.
He said: “It’s an overview of what I was feeling at the time. Now I feel not much different but better – music definitely helps with that. It gives me an outlet – a way to put things down as I’m not really big on speaking to people and this is easier.
“I’ve been writing for ten years and when I came out of Carseview the second time that’s when I recorded my first song.
“I put this video online to help break down the stigma of mental illness. I want to bring awareness to that – I want people to know it’s all right to not be all right.
“It’s a constant reminder for me but I’d rather it helped someone – I hope it would. I’ve been dealing with this since 2012 and I didn’t seek any help until 2017 because I had the idea that being male I had to mask it.”
Mr Smart has also praised staff at the facility at a time when mental health services in Tayside have come under fire, with unit closures in Perthshire and Angus.
He said: “When I first went into Carseview I wanted out as soon as possible because I was in a locked ward but the treatment was really good and the staff were great – they were always willing to talk.”