'Long way to go' to fix Tayside's mental health services

A progress report into failing mental health services in Tayside has said “there’s still a long way to go“.

There have been some positive improvements but also missed opportunities for listening to people, while a lack of trust and respect and a culture of bullying continues, the report said.

NHS Tayside has acknowledged that challenges remain in a number of key areas.

Gillian Murray has been campaigning for change after her uncle took his own life in 2016.

David Ramsay had twice pleaded for help from the Carseview psychiatric centre in Dundee, but was turned away both times.

Ms Murray said: “I had to watch my uncle, my best mate, literally lose his mind in front of me and asking for help.

“It wasn’t there, it should have been there.”

The family’s campaign for change led to an independent review into the mental health services offered by NHS Tayside, and last year the inquiry made 51 recommendations.

However 18 months on, the progress report says there remains “a long way to go” to deliver the improvements required.

Dr David Strang, independent inquiry chair, said: “What we found was patients and families and carers saying they didn’t feel they were listened to and taken seriously.

“They were made promises that someone would get back to them and then found out they hadn’t.

“We spoke to a lot of staff who felt unsupported and quite isolated and there was a fear of a blame culture.”

The review praised improvements to child mental health services and the development of local mental health hubs

However, the report said a culture of trust is still lacking, with concerns from staff and families about the quality of care.

Community mental health teams are struggling with the demands, leadership is “still divided”, and the health board has an “over optimistic” assessment of improvements.

In a statement, NHS Tayside said it “recognises that challenges remain in a number of key areas, including clinical staffing and a shift in culture for patients, families and staff.

The health board said it “remains committed to its pledge to build a listening, learning and changing culture with our staff and a parallel, positive committed, long-term relationship with those whom we serve”.

For those who’ve lost loved ones, they say change must happen quicker to save other families the heartache they still suffer.

“They failed David but his death isn’t in vain because I fought and others fought to make sure other people actually get the treatment they deserve,” Ms Murray said.

NHS Tayside chair Lorna Birse-Stewart’s statement in full

“The board of NHS Tayside welcomes today’s report by Dr Strang and his review team and we will now be taking the time to consider all aspects of the report, alongside our partners, to respond to the five actions which have been recommended.

“The review team state in today’s report that it found a great deal of positive changes in progress and was impressed with the commitment and dedication of staff, partner organisations and others seeking to make a difference for patients and the wider community in Tayside.

“The report also recognises good progress on improvements to services across Tayside. This includes praise for the work to develop better ways to support inpatients and their families and carers on wards by involving them in care planning, ongoing improvements in child and adolescent mental health services and the delivery of many positive developments in the community such as the mental health discharge hub and the local mental health hubs planned in each Health and Social Care Partnership area.

“This feedback to our frontline health and social care teams delivering mental health services is extremely welcome as they have delivered these improvements against a backdrop of the uncertainties and additional daily challenges in dealing with the response to the Covid-19 pandemic.

“Nonetheless, we very much recognise that challenges remain in a number of key areas for all partners involved in delivering mental health and learning disability services in Tayside. These include clinical staffing, the longer-term achievement of a shift in culture for patients, families and staff, a simplification of the more complex arrangements and relationships between organisations providing different aspects of services and the ongoing commitment to co-design services which are truly centred around communities and individuals in need.

“The board of NHS Tayside will continue to make mental health and wellbeing a priority for action and has re-stated its commitment to do everything it can to make a difference and improve the mental health and wellbeing of the citizens of Tayside.”

Reflecting on key achievements since the publication of the Trust and Respect report in February 2020, Mrs Birse-Stewart added: “Trust and Respect represented a significant point for mental health and learning disability services in Tayside. The independent assessment of services delivered by Dr Strang to NHS Tayside and its partners laid out 51 recommendations which, when brought together, created a roadmap to achieve longer term and sustainable changes and improvements.

“The board of NHS Tayside accepted all recommendations in the report and, despite the uncertainties and demands of the intensive first phase response to the pandemic, immediately worked with a wide range of stakeholders to develop the Listen Learn Change Action Plan, published in August 2020.

“Since then, our mental health and learning disability workforce have worked hard to make the necessary changes and improvements to deliver many of the actions set out in the plan, as well as respond to the unprecedented challenges and increasing demands of the pandemic, both in our hospitals and in our communities.

“It is down to the hard work and dedication of the teams that the majority of the specific action-focused recommendations of Trust and Respect are complete. I would like to take this opportunity to thank them for their ongoing efforts; we remain extremely grateful to everyone working across our mental health and learning disability services at this time.

“One of the key recommendations set out by the Trust and Respect report was to conduct an urgent whole system review of mental health and wellbeing provision across Tayside to enable a fundamental redesign of services for Tayside.

“This significant piece of work was undertaken over a six-month period in 2020-2021 and culminated in February 2021 with the publication of the new Mental Health and Wellbeing Strategy: Living Life Well – a lifelong approach to mental health in Tayside.

“The strategy was developed following a programme of work with more than 600 local stakeholders, including people with lived experience, their families and carers along with voluntary and third sector organisations, NHS Tayside staff, local authorities and Police Scotland and it sets out a clear and ambitious direction of travel for services in the future.

“The delivery of the strategy is a key milestone in the improvement and change journey of mental health services in Tayside, however, it is recognised that the transformation of services takes time and NHS Tayside is clear-sighted about the progress achieved to date at a time when staff and services have been – and remain – under unexpected, additional pressures.

“We know that there is work still to do and we are realistic about the scale of the challenge ahead.

“Last month we published the Listen Learn Change Progress Overview which is NHS Tayside’s evidenced status report on the progress made against the 51 recommendations by teams and services since the publication of the Listen Learn Change Action Plan in August 2020.

“Importantly, it recognises that even where actions to address a recommendation have been completed, the improvements cannot stop there and therefore it looks ahead to the next steps and how we can build on the achievements so far and strengthen the progress made.

“Clearly, those with lived experience have been pivotal in the improvements made over the past 12 months and we wish to make sure their voices are strong as we embark on the next phase of our work which is to develop an implementation plan to deliver the Tayside Mental Health Strategy. It is crucial that their voices continue to be heard – and their experiences help us shape – the long-term future of mental health and wellbeing services in Tayside.

“The board of NHS Tayside remains committed to its pledge to build a listening, learning and changing culture with our staff and a parallel, positive committed, long-term relationship with those whom we serve.”