Inspectors find Tayside mental health patients at risk from "ever-changing locums" and postcode lottery for care

In particular, inspectors said it was "concerning" that patients in Angus who might struggle to travel to the Carseview Centre in Dundee due to physical disabilities still lacked a seven-day home treatment service two and a half years after this was first highlighted as a problem.

This had been caused initially by a lack of funding, but more recently by a "lack of available and qualified staff to fill posts", said inspectors.

Residents in Perth & Kinross also faced difficulties in accessing home visiting despite living far from the Carseview Centre, where the crisis resolution team is based.

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The report said: "We consistently heard concerns that travel time could exceed an hour for people attending the Carseview Centre in Dundee.

"Due to demands upon the service, some people were being offered times for assessment late at night.

"This then meant that it might be difficult or impossible, depending on the person’s address, to attend the centre and return home on the same day."

People experiencing an acute deterioration in their mental health which puts them at risk of serious self-harm or suicide should be seen for an emergency crisis assessment within four hours.

However, inspectors found that this was "would often be breached due to the demands on the service", with referrals to the Crisis Resolution and Home Treatment Teams (CRHTT) coming from police and NHS 24, as well as for older adults, children and teenagers.

Inspections of the community mental health service were carried out between January and March this year following concerns raised last June about staffing levels, with half of consultant psychiatrist posts vacant.

Inspectors stressed that recruitment was hampered by a national shortage of psychiatrists, but noted that "too many ever-changing locum consultants, alongside a large number of vacancies, tips the balance with regard to the provision of care into a significant risk for the service".

"Staff told us that they need to spend considerable time and energy supporting new locum psychiatrists," said the report. "The need to constantly adapt to and monitor the work of a new doctor creates its own risks due to the distraction it causes."

Inspectors added that staff were also worried that "decisions with regard to medications, diagnosis and care planning could change frequently" as a result of changes in doctors, and that this "had at times been unhelpful and had a detrimental impact on the person receiving care".

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The recruitment process was described as "extremely lengthy and problematic", with some vacancies taking nine months to be filled.

Meanwhile, some patients who were identified as potentially benefitting from occupational therapy, clinical psychology or psychiatry were waiting up to a year for an appointment.

Inspectors also found a "disconnect" between the senior leadership at NHS Tayside and frontline staff, which "has contributed to low morale, with staff not feeling listened to".

One problem which was "happening regularly" was community mental health teams accepting referrals for people experiencing "vague suicidal thoughts or superficial self-harm in reaction to life events or social stressors".

Inspectors said these individuals might be more appropriately helped in primary care or the third sector.

"It was acknowledged by some teams that they were risk averse and believed it was simpler to see the person for an assessment and to signpost to more appropriate services afterwards.

"Lack of consistent medical leadership to support decision making about referrals were highlighted as a contributing factor and raised as a concern with the review team.

"The review team was concerned that these current working practices may be detrimental to the person receiving care due to the delay in receiving the most appropriate intervention at the time of greatest need."

Inspectors also found in a survey of local GPs that only 48% were aware of the referral criteria for the community mental health teams, who are intended to support those with severe, complex, and chronic mental illness.

However, inspectors praised "positive working relationships" between staff, saying they used the outcomes of significant adverse events "to drive improvement" and were committed to reducing waiting times by running extra services on a Saturday.

There were "examples of good practice and encouraging initiatives", said inspectors, but these "were confined to individual areas and pockets of the service rather than being consistent pan-Tayside initiatives"

It comes after the findings of an independent inquiry, published in February, said Tayside mental health staff had endured a "culture of fear and blame".

It also found that a "breakdown in trust and a loss of respect has undoubtedly led to poor service, treatment, patient care and outcomes".

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The inquiry was ordered following campaigns from the families of mental health patients in Tayside who had taken their lives.

Ann Gow, deputy chief executive and director of nursing at HIS, said: “The main focus of this review was to find out if people referred to Community Mental Health Services in Tayside have access to care where and when they need it, and if they are able to move through the system easily to receive appropriate care in the right place at the right time.

"We found that this is not always the case for everyone. Our report therefore makes a number of recommendations.

“We observed a very committed workforce from all specialties across the service and identified areas of good practice which had a positive impact on patient care and services.

"We recognise there is a national shortage of consultant psychiatrists and difficulty in recruiting permanently to these posts.

"However, this issue is an area of significant concern which needs to be addressed as a priority.”

In a joint statement, NHS Tayside and Angus, Dundee and Perth & Kinross Health and Social Care Partnerships said improvements were already underway to meet the recommendations of the report.

They added: "Although the HIS review recommendations are predominantly related to our community services, it is crucial that all of our services in all of our organisations – from GP referrals into our community mental health teams, to crisis response and pathways into our inpatient facilities and back home, and the services provided by local authorities and the important role of the third sector - are as connected and work together in the best interests of people with lived experiences.

"That is why it is so important that we continue to listen to service users, families and our staff.

"We made a promise to the people of Tayside that we will listen, learn and change in response to the Independent Inquiry and the further actions which we will take from today’s report reinforce that pledge."