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inpatient services will be provided at Murray Royal Hospital Perth, after services were transferred out of the outdated Mulberry unit at Stracathro in Angus.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.
“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.”
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.”
The family of Avicii have set up a foundation in his name to support causes including mental illness and suicide prevention.
The Swedish DJ took his own life in 2018 while on tour in Asia.
The Tim Bergling Foundation “is our way to honour his memory and continue to act in his spirit,” say his family.
Tim Bergling is Avicii’s real name.
And people currently working on mental health in the music industry say that his legacy has already helped improve awareness in the field.
“One of the main issues Avicii’s death highlighted was the reluctance of men to talk about the subject of mental health,” Tristan Hunt from the Association For Electronic Music tells BBC Radio 1 Newsbeat.
He’s the co-chair of a group that’s working to improve mental and physical health among fans and professionals in the dance music industry.
‘Suicide cuts right across our society’
“His suicide brought into sharp relief just how many men suffer from this, especially within our industry.
“It’s not just electronic music. It cuts right across the industry, it cuts right across our society – but men do find it particularly hard to talk about.”
More recently, Keith Flint from The Prodigy died from hanging, which his Prodigy bandmate Liam Howlett confirmed as suicide on Instagram.
Foundation can bring light to ‘dark’ incident
One person who knows about how working in the music industry can affect your mental health is Manchester DJ and producer Ben Pearce, who says the anxiety and depression he has faced was brought on by working in music.
“I’m glad a foundation is being set up in Tim’s name,” Ben tells Newsbeat.
“It was a really awful tragedy but out of such a dark time, there can be a light. If the foundation helps anybody, I’m sure that will go to redress the balance.”
Ben says it’s “amazing” that anyone is committing time and resources to tackling mental health issues in the music industry.
“Just working in such a volatile industry like music, there are a lot of factors that can influence how your day to day life is,” he says.
“Schedules can change quite drastically and deadlines can change for a lot of people and that puts a lot of additional stress on.”
‘Avicii’s death has changed the music industry’
Since Avicii’s death, Tristan says the music industry has started to address the need for mental health provisions in the same way as it has been in schools and other businesses.
“Avicii’s death sadly brought that into sharp relief but I think one of his greatest legacies will be that he’s helped transform our industry in terms of giving mental health the importance it’s always needed,” he says.
“Now the focus has now been very much upon that to get it resolved.”
The Tim Bergling Foundation will also work on nature conservation and endangered species – among other issues.