‘Serious challenges’ at Tayside mental health services

Report warns getting care can be ‘difficult’ as Scottish Government announces new oversight body

Wednesday 22nd May 2019

Mental health services in NHS Tayside face ‘serious challenges’ in areas like crisis support, patient safety and care quality, an interim report has found.

David Strang, who chairs the inquiry investigating mental health support at the board, says there are ‘many’ examples of good quality, patient-centred care but warns ‘it is clear that accessing mental health services and support can at time be difficult for patients’.

The former Lothian & Borders chief constable and prisons chief inspector for Scotland says ‘new thinking’ is needed.

In response, the Scottish Government has pledged to set up a new mental health safety and quality oversight group.

Clare Haughey, the Minister for Mental Health, said Tayside health leaders had to act ‘immediately’.

The inquiry into mental health services in Tayside, which is poring over more than 1000 documents, is currently halfway through its investigation.

This interim report examines key themes that have emerged so far from interviews and meetings with patients, families, carers and staff.

Among the findings is that the mental health crisis team struggles when there are sudden surges in demand – in some cases, families getting in contact were advised to call the police or NHS 24.

It’s also warned that the centralisation of the out-of-hours Crisis team to the Carseview centre in Dundee has made it harder for patients in Angus and Perth & Kinross to get mental health support.

Assessment of patients experiencing a mental health crisis is said to be inadequate. Some reported ‘telling staff they were suicidal but the risk was not taken seriously until they made a serious attempt to take their own life.’

Also detailed are concerns with a GP referrals process some think is ‘not fit for purpose’ and lengthy waiting times for children’s mental health services.

In another theme, some patients reported they felt unsafe or threatened.

Staff had not been given enough training to deal with volatile situations and worried ‘staffing levels are lower than they should be in some wards’.

The fact that patients are able to self-discharge from inpatient facilities without any plans for their care or notification to families or simply walk out of the ward is a ‘serious patient safety concern’, according to Mr Strang.

Staff also told the inquiry they were uneasy about how often patients were being restrained on wards.

Meanwhile, though many patients said staff were ‘dedicated and highly motivated’, others believe a lack of care slowed their recovery or even worsened their condition.

Families described a “never ending circle of frustration” at not being able to see the same psychiatrist twice, because of a reliance of locum consultants.

Mr Strang also finds cases where managers have not moved to learn from adverse events and says staff were often unclear how to follow up when they happened.

On leadership, he states ‘it is not clear who is responsible for leading the [mental health] service’.

Mr Strang concludes: ‘New thinking is required to address the serious challenges that are facing the provision of mental health services in Tayside. To ensure that the Inquiry will lead to improvements in the provision of mental health services in Tayside, the recommendations will need to be supported by a credible implementation plan. The Inquiry’s final report will address how this can be achieved and monitored.

There is now a real opportunity for Tayside to transform its provision of comprehensive mental health services to meet the needs of all people living in Angus, Dundee and Perth & Kinross. The Inquiry team is grateful to everyone who has provided evidence to the Inquiry so far, recognising that for many people, it has taken courage and commitment to do so.’