Inspectors who visited Carseview mental health unit in Dundee say some patients are being cared for inappropriately in a locked ward.
The Mental Welfare Commission visited the NHS Tayside 10-bed intensive psychiatric care unit (IPCU) at Carseview in December.
The report highlighted examples of patients under 18, or those with learning disabilities, who were placed on the ward due to bed shortages elsewhere.
The IPCU is normally used to provide care for people detained under the Mental Health Act, allowing medics to treat people who do not otherwise have the capacity to make decisions about their health.
This comes after another visit in 2020, when inspectors observed an “informal” patient in the ICPU who had no time out of the ward.
“We spoke to one informal patient who told us that they wished to leave the ward,” the report said.
“We were advised that this patient was receiving ‘ward-based care’ which meant they had no time out of the ward either escorted or unescorted.
“We were concerned that the patient was not clear, nor had they understood their rights as an informal patient.
“The clinical team advised us that informal patients have their rights explained to them however we could find no evidence of this.”
When returning for the latest visit, inspectors found three informal patients still being treated in the IPCU, awaiting transfer to less restrictive care.
This included one patient who told the report’s authors that they wished to leave the ward.
“On the day of our visit, there were individuals in the IPCU who were not detained under the Mental Health Act,” the report said.
“The commission considers that the admission of informal patients to an IPCU should only happen in exceptional circumstances and for the shortest time as is necessary.
“The patient should provide valid consent to such admission.”
In a statement following the report, NHS Tayside said IPCU admissions are “reviewed daily”.
The health board has been asked to develop a policy for admitting patients who do not require an IPCU bed and send updates to the commission when this takes place.
“We remain concerned about the inappropriate placements of some individuals in the IPCU and the impact on patients who are not receiving the appropriate care in the least restrictive environment that will meet their needs,” the report added.
The clinical team advised us that informal patients have their rights explained to them however we could find no evidence of this”
Mental Welfare Commission
As well as this, the commission has also asked NHS Tayside bosses to ensure that there is a dedicated clinical psychology input for the ward.
“During our visit we saw there were a number of patients in the ward who have complex needs, including some with a diagnosis of emotionally unstable personality disorder,” the commission report continued.
“Psychological therapy is considered to be a first line treatment for people with such a diagnosis and as such we feel this supports the need to have dedicated psychology input into IPCU.”
Elsewhere the report praised staff, saying patients spoke highly of those working on the ward and the care and treatment they provided.
“Staff were described as welcoming and those that we spoke with told us that they had good connections with staff,” it said.
“During our visit we saw staff communicating and interacting with patients on the ward.”
NHS Tayside respond to Carseview report
Responding to the recommendations made by the Mental Welfare Commission, NHS Tayside said: “Concerns around informal patients being in IPCU were discussed with the clinical team and it was recognised this can happen occasionally due to bed pressures in general wards.
“This is reviewed daily and the service is working closely with colleagues across the three health and social care partnerships to ensure that patients are cared for in the most appropriate setting.”
Claire Pearce, executive director of nursing, said: “We welcome these positive reports which provide important feedback on our services and recognise the commitment of our staff to providing excellent care for people in Tayside.
“Our teams have been working tirelessly throughout the Covid-19 pandemic and I’m particularly pleased the patients themselves spoke so highly of staff in these wards.”
