As Dr Smith said, the Glasgow secure care centres have access to a jointly co-designed secure care pathway, which meets the needs of the young people in the three Glasgow centres and the secure care centres in the geographical area.
We do not have that in Tayside. Members might have read a bit about my background. I was a psychiatric nurse in Fife before I moved to social work and then, through various twists, found myself as head of operations at Rossie Young People’s Trust. When I came to Rossie 12 years ago, having been a mental health officer in Dundee—an MHO is a social worker with training in mental health—I thought that I would have a significant impact in that area.
We used to have a project called Rossie/Elms, and Dundee used to have some secure care beds. That shared facility gave us what we needed and still need, that is, a consultant adolescent psychiatrist who was interested in our client group and undertook inreach work to review cases, along with two project officers. At the time, the project officers happened to be a social worker and a nurse; they were primary mental healthcare workers who operated in Rossie and in the unit in Dundee. The service was funded via intensive support moneys, and when those moneys came to an end in 2008—despite the service evaluating very well—the consultant psychiatrist and two primary mental healthcare workers were subsumed back into NHS Tayside.
Since then, despite the levels of adversity, trauma and need relating to mental health that exist in secure care, which colleagues on the panel have described, we have been able to access that service only via a referral process. The referral is made either by a member of our specialist intervention service, which includes a forensic psychologist, a general trained nurse and some specialist intervention workers, or by our GP.
I want to be balanced in my account to the committee—I read Mr David Strang’s interim report on mental health services in NHS Tayside, in which he makes brief mention of CAMHS. The balance bit is that where the system works—and there are examples of it working—it works very well. Where it works well, we are getting that inreach so that a multidisciplinary team operates around the child.
Where the system does not work or meet the needs of young people is when we make referrals to the service; we have very mixed response times. Before I came away yesterday, I picked out three cases. In one, a young person was referred on 22 August. There was a follow-up consultation by telephone in September, and there was a telephone consultation on 18 December to advise us that the young person was still on the waiting list. The young person remained on the waiting list until their discharge date in April 2019. That means, unfortunately, that I must report that, over a timeframe of nearly eight months, that young person, who had extensive mental health needs, was not seen, despite our referring them to a service that we believed that we would get for them.
We are currently dealing with a young person who was referred for a medication review. She was admitted, and she was taking a number of psychiatric drugs that needed to be reviewed. Some drugs that are provided in relation to ADHD come with a requirement for regular blood pressure checking, and aripiprazole and some of the mood stabilisers, such as lithium, require regular bloods to be taken, to check toxicity levels and therapeutic value. The young person was referred for a meds review in January 2019, and we have not received that service. Nor have we had any confirmation that the referral was received.
There are clearly geographical disparities. Certainly, in Angus we look with jealous regard to the secure care pathway that is being created by Dr Smith and the centres in Glasgow. It is clearly a better system: it ensures that there are key points of contact for referral; waiting times are short; and there is active inreach by the consultant psychiatrist into centres, alongside CAMHS and forensic CAMHS staff.
In essence, a key reason why I was keen to come to this meeting was so that I could highlight to the committee exactly what that disparity looks like for some of our most vulnerable young people who are currently accommodated within Rossie.