Carseview Centre mental health unit restraint ‘shocking’

Carseview Centre mental health unit restraint ‘shocking’

Marks on David Fong's face
David Fong says this photo, taken in 2013, was a result of being restrained in Carseview

An NHS mental health unit in Dundee restrained patients by pinning them down for too long and in a dangerous position, according to a leaked report.

The internal inquiry into the Carseview Centre was commissioned in response to a BBC Scotland documentary last year.

It exposed bullying and potentially life-threatening restraint on patients.

Prof Peter Tyrer, who chaired the group that wrote the NICE guidelines on restraint in mental health, said the report was “shocking”.

“I’ve seen reports like this before but not quite as damning as this,” he said.

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.

Carseview Centre
Carseview Centre was the focus of a BBC documentary last year

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.”

Professor Peter Tyrer
Prof Peter Tyrer chaired the group which wrote the guidelines on how to handle mental health patients

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”.

report
The internal report has not been seen by the public

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 said there seemed to be a toxic environment at the unit
Joy Duxbury said there seemed to be a toxic environment at the unit

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 said the unit was supposed to be about recovery not punishment
Marnie Stirling said the unit was supposed to be about recovery not punishment

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.

‘Total disgrace’

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.

Former patient David Fong said he had had his face rubbed along the floor during restraint
Former patient David Fong said he had his face rubbed along the floor during restraint

“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.

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GPs now prescribing ‘fresh air’ to treat patients in some Dundee surgeries

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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.”

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Concerns over potential impact of Dundee library cuts

Concerns over potential impact of Dundee library cuts

Cutting Dundee’s library budget could have long-term consequences on literacy, social isolation and mental health.

The warning comes after Leisure and Culture Dundee (LACD), the arms-length organisation that runs the service, announced plans to decimate libraries’ budgets this week.

The organisation has to find £860,000 to balance its budget this year and aims to do this through a combination of cuts and price increases.

The cuts include reducing the resource budget of libraries – the money available for new books and periodicals – and cutting staff numbers through voluntary redundancy and early retirement.

 

The organisation, which also runs the McManus, Camperdown and Caird Park golf courses and the Olympia Swimming Pool, said it may not replace all departing staff in order to keep costs down.

Sean McNamara, head of the Chartered Institute of Library and Information Professionals in Scotland, said cuts to library services can have serious long-term consequences.

He said: “We realise that council services are under severe financial pressure and difficult decisions need to be made.

“However, cuts to resources and staffing can impact on vital services that libraries provide for communities.

“Libraries and their skilled staff help improve literacy levels as well as tackling social isolation and supporting mental health and they also play a key role in the current digital strategy for Scotland by providing free access for people unable to get online at home.

“Any local authority considering cutting budgets must ensure they have fully assessed the long-term impact any cuts may have.

”Labour group leader Kevin Keenan said “slashing the culture budget” was the wrong thing to do when Dundee is trying to promote itself as one of Scotland’s leading cultural destinations.

He said: “Obviously, I am deeply disappointed to hear there is a potential load of job losses.

“When we are trying to attract people and tourists here with things like the V&A, slashing the culture budget does not seem like the thing to do.”

A report to Dundee City Council’s policy and resources committee this year revealed that Dundee has the highest percentage of citizens who are library users out of all of the Scottish authorities.

Nine of the 13 libraries showed an increase in visits in 2016-2017.

The Central Library is Scotland’s busiest.

Last year there were concerns cuts could lead to restricted opening times in some city libraries.

A spokesman for Leisure and Culture Dundee said there were currently no plans to reduce opening times.

He said: “There are no changes to opening hours at this time.”

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