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.
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.
‘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.
“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.
“Concrete evidence” of how valuable an axed Angus mental health unit was has sparked calls for its return.
It comes after figures revealed Angus mental health sufferers have spent 17,000 days receiving treatment in Dundee since radical care changes.
The Mulberry Unit at Stracathro Hospital closed to acute inpatients in 2017 due to a shortage of junior doctors and Angus patients were forced to uproot to Dundee.
The decision to officially close the unit as a general adult psychiatry base came in 2018, despite a high-profile campaign to retain local health services.
Since February 2017, the Carseview clinic in Ninewells Hospital has admitted 212 patients who would have been seen at Stracathro.
A total of 461 admissions were made involving Angus residents between February 2017 and February this year, including 19 intensive psychiatric care unit (IPCU) patients.
Angus patients spent 16,707 bed days in the new Mulberry ward at Carseview, in Dundee, for mental health admissions.
Brechin Community Council chairwoman Jill Scott said: “All the predictions have proved to be correct.
“Nobody listened then and nobody will listen now.
“What does it take for those who claim to have our best interests at heart to realise that these vulnerable Angus patients need to be given adequate and proper care?
“We had a purpose-built facility providing the best possible care and outcomes for patients.
“Now they are being herded into a facility miles from home and bursting at the seams.
All this is done in the name of economy.
“Shame on every single person involved in the decision that closed Mulberry Unit, leaving many patients and family members in a state of distress.
“NHS Tayside must act in the best interests of these vulnerable patients and re-open Mulberry.
Scottish Conservative MP Kirstene Hair said the figures show the Stracathro unit is “still sorely missed.”
She said: “The closure of the Mulberry Unit at Stracathro was a blow for local healthcare and a sad day for many who relied on the facility – or knew someone that had.
“I still strongly believe it was a mistake and that it should be re-instated.
“I appreciate the medical staff at Ninewells do a great job under high pressure but these figures are concrete evidence of how valuable the unit in Angus was to local residents.
“It is sorely missed by the people who needed it most, who should have been at the centre of the decision-making.
“The so-called consultation was a tick-box exercise which was shown to be deeply unfair.”
Perth and Kinross Health and Social Care Partnership host General Adult Psychiatry inpatient services in Tayside.
A spokesperson said, “It is important to remember that most people with a mental health problem are treated at home or in the community. When it is no longer possible to do this safely, a patient will be admitted to hospital.
“Approximately only 6% of people who access our mental health services each year need hospital care.
“Angus residents were admitted to General Adult Psychiatry beds outside of Angus prior to the 2017 relocation of the Mulberry Unit from the Susan Carnegie Centre at Stracathro Hospital and whilst the move of Mulberry was a change – the practice of admitting patients based on clinical need has not changed.
“Community Mental Health Teams and services in Angus continue to provide high quality care to those using outpatient services and at home.
“We have also been redesigning services to adapt to the changing needs of our populations and new services have been introduced to manage people in crisis and support people to remain at home.
“Our communities would expect treatment to be available to them and their families when it is required and we remain committed to ensuring our patients can access the best treatment in the most appropriate place.”
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.”
Plans to turn a former city centre factory into offices have been submitted to the council.
The largely empty Locarno Works building near Dudhope roundabout is set to be revamped into offices for Wellbeing Works, a mental health group, if Dundee City Council gives the project official approval.
The proposed new Wellbeing offices could be open later this year, according to chief executive Wendy Callander.
She said: “The offices would be purpose-built and we are all excited about the plans.
“As an organisation, we provide support for people who have mental health challenges and we do that in a lot of different ways with various activities.
“We have working groups, arts and crafts, music and lots of different things to engage with people.
“This new site will give us the opportunity to extend the reach of that work.
“For instance, we would have a training kitchen to help people with domestic living skills such as cooking on a budget.
“We are also planning a cafe area where people could learn barista and cooking skills to help get back into work again. And all in a bigger, brighter building.”
City architects Andrew Black Design lodged an application with planners on behalf of Broughty Ferry firm Torridon Developments.
Although the upper part of the building is owned by the Embassy Snooker Club, a council planning spokesman revealed the space could be transformed into a main HQ for the mental health charity.
He said: “The applicant is considering the long-term future of the entire site and a redevelopment of Locarno Works.
“In the short term, it is proposed to refurbish part of the existing buildings to make them useable as office accommodation for Wellbeing Works, which would like to relocate from its current premises on Panmure Street.”