Saturday, 28 March 2015

nurse practice training, monitoring, evaluation @nhsfife: what evidence of improvement Stratheden Hospital since Feb12?

old IPCU Stratheden Hospital
It's now been over 3 years since my son was subject to dehumanising treatment in the Stratheden psychiatric Hospital IPCU, Fife, in February 2012, and 6 months since I had my complaint against NHS Fife upheld by the Scottish Public Services Ombudman, in respect of "unreasonable treatment", in September 2014.  

There were also issues in Lomond Ward, Stratheden, on 1 February 2012 which led to the IPCU incarceration, and in March 2012 I had to raise further complaints about the nursing staff in Lomond, many of whom did not seem to care for patients as human beings.  I saw that the patients were at risk and had to keep a close eye on my son until he was discharged.  The staff appeared entrenched and clinical management defensive.

A catalogue of poor and bad practice that I was a witness to, and also subject to, when bullied by nurses and badmouthed in clinical notes written by nurses in the IPCU.  They even tried to put the blame on me in an Adult Protection Investigation, headed up by Fife Council Social Work staff.  When the real culprit was a failed system, poor monitoring and evaluation of nursing practice and patient safety.  A building "unfit for purpose" and staff who were in the habit of using dehumanising practices over a long period of time, unchecked.  A locked seclusion room, no toilet, water to drink, light switch outside, patients unobserved for hours at a time overnight.  Bullying and abusive behaviours.  And a cover-up by management who I hold to be ultimately responsible for the culture at Stratheden Hospital.

[I want to say, as a counterpoint, that I have experienced the psychiatric nursing at Carseview Centre, Dundee, from the carer perspective in 2012/13, and had no complaints.  The NHS Tayside mental health nurses, in the hospital and community, have behaved professionally and compassionately.]

In 2010 I had raised a number of concerns about the nurse practices and behaviours in Lomond Ward, Stratheden, to both NHS Fife and Scottish Government, not taking them to a complaint.  (at that point I had no experience of the IPCU)  I met with clinical nurse managers and with managers from OT and clinical psychology, in Stratheden, in both 2010 and 2011, to discuss my concerns.  But they didn't seem to listen properly to the issues I raised, to my suggestions for improvement, or to act upon them.  The OT head said she wasn't into "micromanagement" and the psychology head said she had no authority in Stratheden Hospital.

In 2011 I was asked by the Mental Welfare Commission CEO Donny Lyons to
speak at their Zero Tolerance Consultation event in Cosla, Edinburgh, from the "lived experience" perspective, having been a mental patient myself.  Here is Dr Lyons Email invitation from August 2011, after I had asked about travel expenses:

I told Dr Lyons that I had no experience of patients assaulting nurses but had experience of being assaulted by nurses, forcibly injected with psychiatric drugs, against my will.  To which psychiatrist Dr Lyons said:

"Just to point out – this is not about patients allegations of being assaulted by staff. I made that clear before. If I experienced that as a patient, I would have the right to make a complaint to the hospital and the police. There is a whole other issue about use of force under mental health legislation that the act and code of practice are not particularly helpful with and we have this issue or our radar too."

However he did say "Feel free to be forthright and even controversial!" and so I spoke out from personal experiences on the day, at which NHS Fife clinical nursing staff were present.

On 1 February 2012 when my son was face-down restrained, got a broken hand, was forcibly injected with Midazolam and transported in his underpants and bare feet to the Stratheden Intensive Psychiatric Care Unit (IPCU) I phoned the Mental Welfare Commission to ask for feedback on the IPCU and was told there was no negative feedback from patients or carers.  However I was soon to find out that this meant nothing in terms of patient safety and the MWC being an efficient watchdog.  It didn't mean that no news was good news.  It meant that they hadn't uncovered the human rights abuse of mental patients going on behind the closed doors of the locked ward at Stratheden.

It was left up to my son and I to both speak out about the abuse and to survive the experience.  Which we are still doing.  Picking up the pieces. 

I had to raise complaints continuously throughout the February and March of 2012, to NHS Fife, copied in to Scottish Government mental health division, to the Mental Welfare Commission, to my MSP and others.  These complaints of mine continued until eventually I had to take them to the Scottish Public Services Ombudsman, in September 2013.  A year later my complaint was upheld.  I had to singlehandedly mount a campaign for justice while also supporting my son after the systemic abuse.  The only medical professional contact was occasional appointments with psychiatrist Dr Reid, who supported us in the tapering of Haloperidol which had been forcibly injected into my son by IPCU nurses in the locked seclusion room, Feb12.

Here we are in March 2015.  What evidence is there of improvement in the psychiatric nursing practices at Stratheden Hospital?  What evidence of ongoing nurse training, monitoring and evaluation of nurse practice, of patient and carer experience, of patient safety?  I don't know.  I haven't heard.  But last Sunday I did experience being accosted and accused by a Stratheden nurse in the Ceres Centre shop, the former Named Nurse of my son when he was a Stratheden IPCU patient in February 2012 when the abuse was going on in the locked seclusion room.  And which resulted in two nurses contacting the police, giving my name, in connection with allegations to do with my behaviour.  No evidence to back up their claims.  A friend called it a "vendetta".  I would describe it as harassment. (see post 'misuse of power')

The fact that my son's Named Nurse from the Stratheden IPCU, February 2012, when he was being subject to "unreasonable treatment" and human rights abuse, has accused me of unprofessional behaviour and reported me to the police, 3 years later, is a matter of concern.  NHS Fife clinical nurse management should have been working with the IPCU staff from 2012, those who were unaware of the abusive treatment.  The locked seclusion room was being used overnight by staff, one shift in particular who left my son for hours on end unobserved then subjected him to abusive treatment after coming upon my son's dirty protest.  Other patients were also locked in and left.

I should not be subject to more bullying and harassment because I had to do the MWC's work for them.  Similarly with NHS Fife clinical management who should have been aware of what their nurses were doing in the IPCU after hours, overnight, with the locked seclusion room.  Ignorance is no excuse.  Blaming a mother for psychiatric abuse makes no sense at all and compounds the issue.  NHS Fife have a responsibility to protect patients, carers and staff.  Their management systems should be robust.  Similarly with their ongoing practice training, the monitoring and evaluation of nursing practice at Stratheden Hospital.

I contend that NHS Fife should have involved my son and I in the plans for the new IPCU, in talks with clinical staff and in discussing ways of improving conditions at Stratheden Hospital for patients and carers.  Rather than ostracising us and creating divisions.  That isn't good practice or good business sense.  The health board should have owned up to the failings and worked with us to create a collaborative relationship, rather than shoring up the divisions. 


Herald Scotland screenshot 7 Feb 14
I will have more to say about my relationship with the former CEO of the Mental Welfare Commission, Dr Donny Lyons. About how we were in regular contact until the dehumanising treatment was exposed in Stratheden Hospital and a year later, when I complained about the polypharmacy, the multiple drug prescribing at Carseview, Dundee, it resulted in "talk to the hand" and no more communications with Dr Lyons.  Who retired in early 2014.

See "World looks to Scotland after mental health care improved" - are you serious?, my blog post about the Herald Scotland article, 7 February 2014, on Dr Donny Lyons' retirement.

Friday, 27 March 2015

misuse of power

On Sunday when in the Ceres Centre shop at Stratheden, talking to the volunteer serving at the counter, I was accosted by a nurse who came into the shop and warned me not to be doing digital recordings of patients on NHS property.  There were no other people about.  No patients or others.

I was taken aback by this unprovoked attack.  I'd recognised the nurse although couldn't remember her name at that point.  She had been my son's Named Nurse when he was an IPCU patient in February 2012.  Where he had been locked in the seclusion room with no toilet, water to drink, overnight, light switch outside, for hours at a time, unobserved.

I had mentioned the nurse in my tweets that day: 'a Sunday stroll, tweeting and taking photos, going for refreshments and finding the new IPCU plans on view

I continued my walk around the grounds of the hospital on Sunday, coming upon the new IPCU plans in the canteen.  A nice surprise as I had not seen them before, despite having asked about them, and despite the fact that the new build unit and funding from Scottish Government of £4.4million came about after my son's dehumanising treatment in the old IPCU.

Then on Wednesday afternoon I had two police officers at my door.  My son let them into my house as I was having a lie down due to a sore leg.  I limped downstairs to hear what the police had to say.  They had received a complaint from two psychiatric nurses at Stratheden Hospital who gave my name and that of my son.  In relation to a "paranoid" patient who thought that someone might be taking photographs of them in the hospital grounds.

The nurses had contacted the police on the Monday to make this allegation about me.  I assumed it was the nurse who had accosted me on the Sunday although the police officers could not confirm this.  I was very annoyed at being accused of something I did not do.  Three years after nurses at Stratheden Hospital accused me of causing harm to my son, when they were subjecting him to psychiatric abuse.

Rubbish at Stratheden Hospital (Fife Today)
I showed the police officers this blog, the Sunday tweets and photos, my other blogs, and told them that I had been writing about Stratheden Hospital for over 3 years.  I highlighted the photos from 2012, the cigarette ends on the pavement outside the grounds where the staff smoked.  The "Land that time forgot" article on Fife Today website, 29 July 2012.  

I described something of what happened to my son in February 2012 when a patient in the Stratheden IPCU and my winning the Ombudsman complaint against NHS Fife in September 2014.   [see Scottish Sunday Express article 5 October 2014]

Scottish Sunday Express 5 October 2014

The police officers accepted my side of the story, said there was no need to take it any further and that I was free to walk around Stratheden Hospital grounds.  After they left, late on Wednesday afternoon, I wrote a letter of complaint to the General Manager, Mental Health, NHS Fife, copied in to others, including my MSP Roderick Campbell, about the staff nurse who had accosted me on Sunday:

Strapline: a complaint about a staff nurse who accosted me on Sunday in the Ceres Centre shop, Stratheden Hospital 

"Dear Mr Monteith

I am writing to you to make a complaint about Staff Nurse ...........  (SN ..... was my son's named nurse when he was an inpatient of the Stratheden IPCU, February 2012)  SN ...... accosted me on Sunday 22 March 2015 in the Ceres Centre shop at approximately 12.30pm and accused me of digitally recording patients.  I was taken aback by her accusations and refute them absolutely.  I recognised her at the time and remembered her name later.  I am not happy at being targeted in this way.

The reason I am raising the complaint at this point in time is because I have just had two police officers in my home, in response to my name being given to them by two psychiatric nurses in Stratheden Hospital, accusing me of photographing patients.  The PCs told me that the complaint was made on Monday this week.  The two nurses said that a paranoid patient thought that someone was taking photos of them on the Sunday.  From the description given the nurses worked out it was me.  Gave my name to the police, and that of my son.  The police officers looked up my details and came to my door at 4.30pm this afternoon.  

I was upstairs having a lie down, resting a sore leg.  My son let the police officers into my house.  I limped downstairs to speak to them.  I took their details and they took mine.  I told them about SN ..... accosting me on Sunday.  I said that I do not take photos of patients or nurses and neither do I record them speaking.

I showed the police officers my Stratheden Blog, the post about my Sunday walkabout the grounds.  I also showed them the posts from 2012, the cigarette butts everywhere, the newspaper articles about the "Land that time forgot", and my other blogs, including Mad in America where I have a presence.  I told them I was a writer, activist and human rights campaigner, an advocate for mental patients.  I recounted something of my son's dehumanising treatment in the Stratheden IPCU in February 2012.

The PCs said that they accepted my explanation and there was no need to take it further, that I was free to walk around Stratheden Hospital grounds. 

I am assuming that one of the two psychiatric nurses who made the accusation was SN ........  At the time that SN ..... confronted me I was speaking to the RVS shop volunteer.  (I used to work with WRVS in Kirkcaldy, 1999/2000, as a Youth Project Manager)  There were no patients or any other people in the shop at the time.  SN ...... came in to the shop on her own and came right up to me.

I wish to make it clear that I do not take photos of patients and do not digitally record patients.  Neither do I take photos of nurses even when I have seen them smoking on hospital grounds.  On occasion patients speak to me when I am walking round the Stratheden grounds, sharing stories.  It is always a two way conversation.  They speak to me and I speak to them.  

Here is the storify of my tweets from Sunday, for your information:

I hope that my complaint will be listened to and taken seriously.  I am not happy at being accosted by SN ........ and accused of something I did not do. You will notice from my tweets on the storify that I mentioned being taken aback.  

In the last 3 years I have often walked around Stratheden Hospital grounds taking photos and blogging about it.  This is the first time that I have been accosted by a nurse in all that time and I have taken many, many photos, of various scenes, often publishing them in my blogs or in tweets. 

I look forward to hearing from you that my complaint has been received.  I am copying in various others, for their information and as witnesses.

Yours sincerely,

Chrys Muirhead (Mrs)"

Saturday, 21 March 2015

'Psychiatric care unit plan approved' Fife Herald 20 March 2015 - updated with @nhsfife response

Updated 23 March 2015 with Email response from Mary Porter, NHS Fife General Manager:

"Dear Chrys

Thank you for your email. As previously advised the business case for the IPCU will be considered on the 7 April by the CIG, as part of our submission we are required to seek and include planning permission. Once the business case is approved I will write to you with the dates of our public events.

Kind regards.



I have written to Mary Porter, General Manager NHS Fife, to confirm the dates and details regarding the new IPCU planning approval, copying in my MSP Roderick Campbell and other NHS Fife managers:

"Dear Mary

I am writing to you again about the new IPCU business case approval which you stated, in attached Email, would be after the "Capital Investment Group at the Scottish Government which next meets on the 7th April 2015".  (see link to blog post with Email sent 3 March 2015)

Yesterday's Fife Herald had a brief news piece announcing that planning approval had been granted, regarding the build of the new IPCU at Stratheden, subject to a number of conditions.  See attached copy.

Can you please confirm what the details are, regarding dates of approval and public consultation or briefing events.  

Thank you,

With regards, Chrys

[this Email and the Fife Herald article will go in a blog post for the sake of transparency]"

NHS Fife appoints chief executive - New man at the helm of @nhsfife

In the Fife Herald, 13 March 2015:


In the Courier, 13 March 2015: New man at the helm of NHS Fife

"Paul Hawkins, who has been working with a Welsh health board, will take up the role as chief executive at the board following the retiral of interim chief executive Dr Brian Montgomery.

Dr Montgomery has been acting as chief executive since the departure of John Wilson last year. 

Mr Hawkins is chief operating officer at Hywel Dda University Health Board in Wales where he directs an integrated health system made up of four district general hospitals, general maternity services, mental health and community services across three counties with a population of 400,000.

Before that he worked as director of operations for planned care for Barnet and Chase Farm Hospitals NHS Trust, a major London trust providing acute services for a population of more than 500,000 people. 

Mr Hawkins, who has an MBA from Ashridge Business School, has a number of areas of particular interest, including patient safety, the patient environment and integrated rural health services. ..."

Read complete article

Wednesday, 18 March 2015

Antidepressants and The Tell-Tale Heart (parts 1&2) @DrDavidHealy

'Antidepressants and The Tell-Tale Heart part 1' on Dr David Healy blog, 9 March 2015:

"This post feeds into a series of posts about antidepressant withdrawal on RxISK – see Antidepressant Withdrawal: a Prozac Story and the dangers of letting a strange medication into  your life – see Saving Grace.  

from David Healy blog
Perhaps linked to the Rape theme, in healthcare at least it seems to be mostly women who stand up to power, who want to reclaim the streets or in this case our clinics, and whose oratory echoes great men who have spoken out in other settings.  But no-one has made a movie of their march from Selma to Montgomery yet… "

"Like many of us I have an Achilles heel.  For me, that topic is familial mental health. This is due to my father who had a breakdown when I was a teenager. He behaved erratically, desperately for a few weeks, and then disappeared into the local mental health hospital, before re-emerging tearful and vulnerable.

This was frightening to witness, difficult to understand and – being a teenager – embarrassing.  Due to my parent’s subsequent divorce I became estranged from him for years and those memories of his mental health deteriorating, leading up to his business collapse, divorce and losing our home are traumatic ones.  They made me susceptible to suggestions of hereditary mental illness.  Usually reasonable, I am quite the reverse around this topic, and easily frightened by it.

Becoming Depressed?

Twelve years ago,  I was exhausted and tearful and had moved from a town where I had employment as a teacher to an idyllic rural location away from my family… the ripples of divorce and my father’s behavior yet again having caused problems for me in my thirties ...

Read complete blog post


'Antidepressants and The Tell-Tale Heart part 2' 18 March 2015:

Editorial Note:  This is Part 2 of The Tell-Tale Heart.  It fits into a sub-series about Pharmaceuticals: Rape and Consent.  It also maps straight on to Antidepressant Withdrawal: A Prozac Story and Saving Grace both of which are on RxISK.  Saving Grace picks up the Bipolar theme running through Tell Tale Heart.  

For the record, there is no question but that citalopram and escitalopram have significant effects on the heart, and astonishingly almost none of these are at present understood.  We talk about QT interval changes but even these are not understood.   There are EKG – ECG – cardiogram Apps but not one that can handle some the problems SSRIs cause.  Someone who could design one would help a lot of people."  

"After 6 months my GP suggested coming off the antidepressant again. I had learned a little about tapering by then and asked to be referred to Addaction. Maybe I was addicted.

Addiction was added to my file notes… another nail in my coffin, as addiction, I later discovered is often considered to be co-morbid with SMI – Serious Mental Illness.  My GP referred to it as “chemical dependency”…. but addiction was the only thing that appeared in my notes.

My GP wanted me off the antidepressants quicker than the 3 month taper I had researched through an online support group called CITA. However, she prescribed drops and tolerated my request to do it slowly.

Addaction were very helpful and supportive but knew nothing about citalopram. They researched withdrawal but found no advice. We were in the dark and followed the withdrawal charts I had downloaded from CITA ..."

Read complete blog post

Wednesday, 4 March 2015

my comment about Stratheden Hospital on @thecourieruk 'Struggling NHS Fife calls in help'

The Courier news article 'Struggling NHS Fife calls in help' by Claire Warrender, 3 March 2015

What I had to say:

“I hope that NHS Fife are including psychiatric hospitals in their review, looking at the standards of care in Stratheden Hospital in particular.  Where my son was subject to "unreasonable treatment" in February 2012, despite my raising complaints from the 1st of February, and not being listened to with any seriousness. 

It took me 30 months to have my complaint against NHS Fife upheld by the Scottish Public Services Ombudsman, in September 2014.  During this time I also had to singlehandedly support my son after his traumatic experience as a Stratheden inpatient.  The Adult Protection Investigation led by Fife Council Social Work Service at the time failed to identify any issues and tried to put the blame on me, a mother and carer. 

I have had to become a writer, activist and campaigner, to have a voice and to be heard.  On a Carers Allowance of £61/week.  I believe that NHS Fife psychiatric services should receive the same scrutiny as general medical services in Fife.  Parity of esteem.  People with mental health issues should not be discriminated against and receive sub-standard care because of it.  Neither should their carers.

Emailed to the NHS Fife board Chair and CEO, copied in to MSPs, senior managers at both NHS Fife and Fife Council, to the Fife Carers Centre Manager, to local Councillors and to Courier reporters:

Tuesday, 3 March 2015

Letter to NHS Fife General Manager about new build IPCU and bullying culture at Stratheden Hospital - Updated with response

[updated with response from General Manager, NHS Fife, dated 1 March 2015]

"Dear Chrysler

Thank you for your email.

We are planning to hold the events in May. As you will have noted in the document the business case requires to be approved by the Capital Investment Group at the Scottish Government which next meets on the 7th April 2015, therefore we cannot finalise any events until after that date.

I note your request to attend a briefing session I will ensure you are notified of the dates.

Kind regards



Here is a letter just sent to the NHS Fife General Manager Mary Porter, copied in to others:

Strapline: The Reprovision of the Intensive Psychiatric Care Unit, Report to the Board 24 Feb15 - the bullying culture at Stratheden Hospital - freedom to speak out

"Dear Mary

I am writing to you about the new IPCU building planned for Stratheden Hospital, and in particular to do with the document, which has your name on it, presented to the board at the 24 February 2015 meeting: 'The Reprovision of the Intensive Psychiatric Care Unit':
Firstly, I would appreciate if you could let me know, in person, by Email, when the "Public Information Events" are planned, as mentioned at point 6:

The operational group has public representation. Public information events are planned once the Business Case is approved.

I would not want to miss the opportunity to attend one of these events through not having the information about them.  My son Daniel will also want to be present at an information event about the new IPCU building.  I think it's important for both of us to be included and not to be missed out.

Secondly, I am concerned about the phrase in the document "The design of the new accommodation has been strongly influenced by clinical staff.".  Because it doesn't say that the design has been "strongly influenced by patients, carers and people who have engaged with the IPCU in the past".  I believe that the "customers" of psychiatric services are just as important as the service providers.  After all, without us you wouldn't have a service, or a job I suppose.

Finally, I wanted to express my disappointment that I have not been included, up to this point, in any discussions or meetings about the new IPCU build or about improvements to nursing practice in Stratheden Hospital.  In the report from SPSO, following my complaint about the treatment of my son in the Stratheden IPCU, there was a statement on page 10, paragraph heading "Significant Event Review":

"During our investigations, the Adviser raised some concerns about the Significant Event Review carried out by the board .... the report lacked transparency in relation to how these conclusions were reached .... he would have expected to have seen a more systematic approach. ... He also said that he had not seen any evidence of parent/carer involvement in the process ..."  I have screenshot the piece from the SPSO report and attached.

The point I am making is that neither my son nor I have been invited to any NHS Fife clinical management meetings to discuss the failures in his treatment and care during February 2012, and our suggestions as to how it might have been handled differently or how practices may be improved in the future.  Neither of us have been involved at any stage of the IPCU new build planning.  I think it would have demonstrated good will on the part of NHS Fife to have attempted to meaningfully involve us in the decision-making process.  Rather than keep us as spectators on the outside.  That doesn't look good to anyone who is watching the state of play.  In my opinion.

The fact is that the IPCU was declared "unfit for purpose" by the Mental Welfare Commission years ago, as far as I understand it, and NHS Fife did not act upon this declaration.  Whether due to lack of funds or poor management of resource, or a combination of the two, plus inappropriate, and on occasion abusive, nursing practices, that is up for discussion.  What I do know is that the culture in the Stratheden IPCU has not been a positive one, because I have heard other feedback from patients about it.

Just because the MWC had no negative feedback on record did not mean that the patients and carers were happy about the state of affairs in the Ward 4/IPCU regime.  I expect they feared to say anything because of the repercussions of doing so.  What might happen to them or their relatives if/when they had to enter the ward again as a patient.  They might be, and no doubt would be, at risk of retaliation for speaking out.  And get worse treatment than before.

I know that the threat of Ward 4 has often been used by certain nurses in Lomond Ward to manage the patients.  I have heard it from many sources, over the years, and my son experienced it.  I can name the nurses.  The bullying culture at Stratheden Hospital really does have to end, for the sake of the patients, their carers and family members.  It has gone on for far too long.  The people of Fife who find themselves engaging with Stratheden psychiatric services should have the freedom to speak out if they are unhappy with the service, without fear of retaliation.  

I hope that you will respond to this Email and keep me in the loop about the new IPCU public information sessions.  I also hope that you will listen to my critical feedback and take it seriously, in terms of ensuring that any improper or bullying behaviour by Fife psychiatric nursing staff will not be tolerated. 

I am copying in Jim Leiper, Director of Estates, Graham Monteith, Acting General Manager in Mental Health, and Allan Burns, Chair of the Board.  And I will be putting this Email into a blog post for others to see, plus any responses that I receive.  In the interests of transparency.

Yours sincerely,


SPSO Review Letter 26 September, page 9-10


Link to SPSO Decision Report on my complaint, online December 2014