An independent inquiry into mental health services in Tayside has found failings at all levels.
In May 2018, concerns were raised in the Scottish Parliament about the provision of mental health services in Tayside.
An inquiry to examine the accessibility, safety, quality and standards of care provided by all mental health services in the region was commissioned as a result.
The final report, Trust and Respect, was published earlier today and was chaired by David Strang CBE.
It contains no fewer than 51 recommendations to improve mental health care in Tayside and highlights numerous failings, including a breakdown of trust, a failure to deliver services, a lack of psychiatrists, a lack of leadership and a lack of accountability.
It notes that some staff members within NHS Tayside felt that there was a “culture of bullying” which could be observed that “originated at management level but was now being adopted across the whole service”.
A stressful working environment, territorial conflicts and poor communication were considered contributory factors in the rise of unacceptable behaviours from staff.
One consultant, who recently left NHS Tayside’s employment, said: “I was told early on in my time in Tayside that ‘bad behaviour gets results’. There seems to be a culture that if someone is difficult, they get what they want or are even promoted to positions of authority.”
A current employee said: “I am still deciding whether to pursue a number of grievances but given the nature of these and the lack of action on the bullying I have experienced, I have no confidence in the organisation to undertake these fairly.”
Some of the recommendations made:
- Develop a new culture of working in Tayside built on collaboration, trust and respect.
- Conduct an urgent whole-system review of mental health and wellbeing provision across Tayside to enable a fundamental redesign of the services for Tayside.
- Ensure that there is urgent priority given to strategic and operational planning of community mental health services in Tayside. All service development must be in conjunction with partner organisations and set in the context of the community they are serving.
- Consider developing a model of integrated substance use and mental health services.
- Develop a cultural shift within inpatient services to focus on de-escalation, ensuring all staff are trained for their roles and responsibilities.
- Focus on developing strategies for prevention, social support and early intervention for young people experiencing mental ill-health in the community, co-produced with third sector agencies.
- Ensure that bullying and harassment is not tolerated anywhere in mental health services in Tayside.
- Encourage, nurture and support junior doctors and other newly qualified practitioners, who are vulnerable groups of staff on whom the service currently depends.
- Develop clear pathways of referral to and from university mental health services and the crisis resolution home treatment team.
- Provide clear information to patients, families and carers on admission to the ward, in ways which can be understood and remembered.
The physical environment at Carseview Centre
One part of the report examines the inpatient services available across Tayside, focusing on the patient experience of being in a mental health ward and the surrounding physical environment.
It said: “The physical space, fabric, decoration and atmosphere at Carseview Centre are not conducive to a welcoming and safe space. The building itself is dated, with poor quality furniture and fittings, tired and in a poor state of repair.
“Patients have described it as feeling bleak, which impacts on the ability to improve wellbeing and deliver good therapeutic care.
“Although a programme of refurbishment was approved and has commenced in 2019, concentrating on ensuring the bedrooms met required safety standards, it would have been helpful for the overall environment to be improved with better quality furnishing, artwork, music and facilities to make it feel more welcoming and supportive.
“Some wards at Carseview Centre do not have ready access to outside space and fresh air.”
The patient experience at Carseview Centre
The report notes that patients have described feelings of isolation, boredom and loneliness. It states: “Their interactions with others on the wards – with both other patients and staff – have been difficult and, at times, frightening.
“Some have described feeling frightened of other patients and having been bullied by other patients. Fights between patients have been witnessed.
“Whilst many patients felt that they were well cared for by the staff, some felt that the staff were not interested or were too busy to pay them the attention they requested. They sensed a lack of staff engagement with patients.
“Staff felt they had limited time for one-to-one interaction with patients. Patients with particular dietary requirements did not always receive suitable meals which met these requirements. As a consequence, patients may have gone without sufficient food.”
Understanding the patient and staff experience across the region
The report details receiving evidence of “excellent staff” providing compassionate and professional care for patients. However, it also notes that some patients felt a level of hostility from staff which created a “them and us” culture.
Patients who talked about suicide reported that they were told to “get a grip”, “pull yourself together”, “you wouldn’t be here if you didn’t harm yourself”, adding to the perception that staff blamed the patients for their situation, rather than recognising that they were seriously unwell.
The report adds: “The use of control and restraint is a very sensitive issue within a hospital setting. There are, of course, instances when the use of physical restraint is necessary for the prevention of harm to a particular patient, to other patients and to staff and other people present.
“For a patient subject to restraint, its exercise can cause anxiety, fear and feelings of humiliation. There is the potential for patients to feel violated and traumatised, particularly if they have suffered violent abuse in their past.
“Patients witnessing the use of restraint on another patient can also experience raised anxiety and fear. Physical and psychological trauma can be caused by the use of restraint.
“Some staff were described by patients as being gentle and calming when using restraint, whilst others were perceived as being aggressive, both verbally and physically. Staff reported that they found the use of control and restraint distressing and contributed to raising their own levels of anxiety.”
The report states that there are a lot of dedicated staff working in mental health services across Tayside, but the public concerns about the quality of services detailed in the local press have made for a “very difficult and challenging workplace” in the last two years.
A lack of resources and staff shortages, however, have been considered a constant challenge to good services, with one family noting: “In general, we feel that most of the staff within the service do care about their patients and try to do their best.
“However, it is abundantly clear that the entire service has been severely under resourced for some time, and from our recent interactions it appears to be close to collapse.”
A registrar who has now left NHS Tayside’s mental health service made this comment about nursing staff: “The vast majority are exceptionally caring, understanding, wise professionals that offer the bulk of the inpatient and acute therapy. This is a hugely undervalued resource.
“These people work in tough conditions constantly feeling undervalued. If they were not so dedicated to helping others, they would all be working in other jobs. These people should be empowered to do their best.”
So, what has the reaction been?
David Ramsay, 50, took his own life in Templeton Woods in 2016.
Mr Ramsay had presented at Dundee’s Carseview Centre on October 5, 2016 seeking help with his mental health problems.
Staff instead sent him home, suggesting he walk his dog. He was found dead four days later.
Consultant psychiatrist Dr Tim Rogers later found the “negligence” of NHS staff at a mental health unit led directly to Mr Ramsay’s death.
Mr Ramsay’s niece Gillian Murray has been fighting for answers ever since.
Gillian said: The past three and a half years of campaigning have been hell.
“Quite honestly, it has nearly killed me. I have been diagnosed with PTSD and I am now a broken person because fighting for the truth, fighting for answers and being met with hostility by the health board has been soul destroying. ”
Mandy McLaren, whose son Dale Thomson took his own life in 2015 after discharging himself from Carseview, said: “I blame NHS Tayside for the death of my son.
“He was failed by Carseview. but there is no accountability, no one is prepared to take the blame.”
Grant Archibald, Chief Executive of NHS Tayside said: “The publication of today’s report delivers a challenging set of recommendations for mental health services across Tayside, which are based on the lived experiences of a wide range of people and extensive evidence provided to the inquiry team.
“Dr David Strang has stated that the report provides an opportunity for Tayside to develop world class mental health services, where the population are served with commitment and passion.
“That is the spirit in which we receive the report today and we are determined to make the significant changes needed to deliver on this opportunity and rebuild confidence in services.”
Independent Inquiry into Mental Health Services in TaysideResponding to the report of the Independent Inquiry into…
NHS Tayside Chair Mrs Lorna Birse-Stewart said: “As chair of NHS Tayside I welcome today’s report from the independent inquiry. The board views the recommendations as an opportunity to embrace a fresh approach to the design and delivery of mental health services across Tayside.
“I would like to thank the chair of the independent inquiry Dr David Strang and his team for their work. It is important that those living with mental ill health, their families and carers, and our staff, know that the underpinning themes of the inquiry report – Trust and Respect – will run through every aspect of our future plans, which will be developed in partnership with our Integration Joint Boards in Angus, Dundee and Perth & Kinross and all stakeholders.”