Trust And Respect - Independent Inquiry Into Mental Health .
Trust and RespectFinal Report of theIndependent Inquiry intoMental Health Services in TaysideFebruary 2020David Strang CBE
TRUST AND RESPECTIndependent Inquiry andAcknowledgementsChairDavid Strang was appointed to chair the Independent Inquiry in July 2018. Prior to this he was, forfive years, Her Majesty’s Chief Inspector of Prisons for Scotland. This followed a 33 year career inthe police service – in London and in Scotland. He was Chief Constable of Lothian and BordersPolice from 2007 to 2013. He was awarded an Honorary Doctorate from the University of Stirling in2018, and a CBE in Her Majesty’s Birthday Honours in 2019.Secretary to the InquiryDenise Jackson was seconded to the Independent Inquiry by the University of Dundee in August2018. She has worked in the University’s Library and Learning Centre Services for 26 years, latterlyas the Deputy Director. She is also an experienced complaints handler and an accredited mediatorwith Scottish Mediation.AcknowledgementsThe Chair would like to thank the following for their contribution to the Independent Inquiry’s work: All those who gave evidence to the Independent Inquiry – particularly those for whom it wasno easy task Irene Oldfather, Director of the Health and Social Care Alliance (the ALLIANCE), for conveningand supporting the Stakeholder Participation Group NHS Tayside staff who contributed to the Employee Participation Group The Clinical Advisors to the Independent Inquiry: Paula Shiels, Senior Nurse, Mental Health and Learning Disability Dr Ian Clarke, Consultant Psychiatrist, NHS Greater Glasgow and Clyde Samaritans in Dundee and in Perth for their support for people giving evidence to theIndependent Inquiry The University of Dundee, who hosted and supported the Independent Inquiry Bill Nicoll, Director of Strategic Change, NHS Tayside, who acted as the key link between theIndependent Inquiry and NHS Tayside The Independent Inquiry team for their research and support
TRUST AND RESPECTContents1. Introduction 6Mental Health in Scotland 6Independent Inquiry into Mental Health Services in Tayside 7How to read this report 8Opportunities 92. Executive Summary and Recommendations 10Trust and Respect 10What needs to change 11Cross-cutting themes 11Recommendations 143. Governance and Leadership 20Structure 20Integration of Health and Social Care 20Implications for delivery of services 21Risk Management 22Accountability 22Tayside Mental Health Alliance 24Relationships 24Staff 24Patients and families 25Boards 25Partners and external relationships 27Performance Management 27Record keeping and document management 27Learning Culture 281
TRUST AND RESPECTAdverse event reviews 28Fatal Accident Inquiries (FAI) 29Complaints 30Monitoring 30National Scrutiny 30Management of Change 31Lack of implementation of recommendations 32Unplanned changes 34Senior Staffing challenges 35Need for whole system response 36Summary 37Recommendations 384. Crisis and Community Mental Health Services 40Crisis Resolution Home Treatment Team (CRHTT) 41Access to treatment 42Universities 43Out of hours/NHS 24 44Centralisation of Service 45CRHTT location 46Police 47Distress Brief Intervention and Sanctuary Support 47Context of Community Mental Health Services in Tayside 50Waiting Times 54Community-based therapies 54Primary care mental health support 55Third Sector 55SAMH 56Summary 57Recommendations 572
TRUST AND RESPECT5. Inpatient Services 59Ward Environment 59Physical environment 59Patient experience 60Staff experience 61Smoking and illegal drugs 61Sense of safety 62Patient experience 62Staff experience 62Control and Restraint 63Availability of Services 64Communication 65On admission 65On discharge 65Communication between services 66Continuity and consistency of care 67Management of Change 67Summary 68Recommendations 686. Child and Adolescent Mental Health Services (CAMHS) 70CAMHS – NHS Tayside 70Management and Governance 70Services 71The MacX Service (intensive outpatient outreach) 72Waiting Times 72Neurodevelopmental Disorders 74Crisis services 74Workforce 75Patient Confidentiality 763
TRUST AND RESPECTTayside Children’s Collaborative 77Community and Third Sector 77CAMHS Regional Inpatient Unit 77Transition from CAMHS to General Adult Psychiatry (GAP) 78Summary 79Recommendations 797. Staff 81Staff attitude and behaviour 81Workforce (Recruitment and Retention) 82Staff concerns regarding patient safety 85Responsibility 86Accountability 87Service Redesign Programme 87Communication 88Bullying and Harassment 89Training and Supervision 92Summary 93Recommendations 948. Implementation Plan 959. Abbreviations 97Appendices 99Appendix A: List of organisations and groups which gave evidence to theIndependent Inquiry 99Appendix B: NHS Tayside news update January 2020 100Appendix C: Review of arrangements for investigating the deaths ofpatients being treated for a mental disorder. Scottish Government,December 2018 (White report). 104Appendix D: Right person, right time, right care with no waiting times:Systems dynamics analysis of interim findings of the Independent4
TRUST AND RESPECTInquiry into Mental Health Services in Tayside and a group model buildingworkshop with student practitioners. 106Appendix E: Responding to Drug Use with Kindness, Compassion andHope: a report from the Dundee Drugs Commission. Part One: The Report.Conclusions. 16 August 2019. 108Appendix F: Cambridgeshire and Peterborough 113Appendix G: Third sector/community mental health information. 114Appendix H: NHS Tayside. Staff vacancies: June 2018 – June 2019. 123Appendix I: NHS Tayside Response to NHS Highland / Sturrock Report.BOARD57/2019. Tayside NHS Board. 27 June 2019. 124Appendix J: Adult Mental Health (Inpatient) Services OrganisationalDevelopment Review: Summary of Diagnostic and Recommendations/Adult Mental Health Services Organisational Development Plan. 1305
TRUST AND RESPECT1. IntroductionMental Health in Scotland1.1There is no doubt that there has been amarked increase in the awareness of mentalhealth issues in Scotland in recent years.Mental health and wellbeing have receiveda much-needed greater attention as thesubject has moved from the shadows to aposition of prominence in public awarenessand debate. There is a welcome increasedemphasis on recognising and addressingthe underlying causes of mental ill-healthand providing support and treatment forthose affected.1.2Mental health disorders are the third highestcause of death and disability in Scotland,after heart disease and cancer. Acrossthe UK, mental illness is the top cause ofsickness absence from work and accountsfor almost half of all ill-health of thoseunder the age of 651. The largest number ofdeaths of men under the age of 45 in the UKis by suicide. In 2018 in Scotland, 43% of allprobable suicides occurred within the 35-54age range and roughly 75% of these were ofmen2.1.3Research has shown that poverty increasesthe risk of mental health problems and canbe both a causal factor and a consequenceof mental ill-health. Across the UK, bothmen and women in the poorest fifth of thepopulation are twice as likely to be at risk ofdeveloping mental health problems as thoseon average incomes3.1.4In 2017 the Scottish Government publishedits ten-year Mental Health Strategy4,in recognition of the significance andimportance of promoting positive mentalhealth and wellbeing for the wholepopulation. The strategy emphasisedthe need to improve prevention andearly intervention, access to treatment,the physical wellbeing of people withmental health problems, and thepromotion of rights, use of informationand involvement in planning for all. Thestrategy acknowledged the changes thathad occurred in the previous decade andthe excellent work of many people involvedin the provision of mental health servicesacross Scotland.1.5Tayside has seen a “gradual increase in theprevalence of mental health conditionssince 2008, as recorded by primary care”according to the Tayside Director of PublicHealth. More specifically, all three of thelocal Health and Social Care Partnerships(HSCPs) have given examples of theprevalence of mental health issues intheir respective strategic commissioningplans. For example, in Angus 1 in 20people are affected by depression5 andin Perth & Kinross, around a quarter ofadults experience a mental health episodein a year, from anxiety and depressionto “more acute symptoms.”6 WithinDundee City, there was a 63% increase inhospital admissions for mental health andbehavio
Final Report of the Independent Inquiry into Mental Health Services in Tayside February 2020 David Strang CBE. TRUST AND RESPECT Independent Inquiry and Acknowledgements Chair David Strang was appointed to chair the Independent Inquiry in July 2018. Prior to this he was, for
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