Letter below sent by Email today, 19 April 2015, to Professor Keith Matthews, psychiatrist on the Advanced Interventions Service based at Ninewells Hospital, Dundee and Head of Neuroscience at the University of Dundee.
Background information about DAIS and Prof Matthews from the Dundee University website:
“With the context of delivering a national specialist service for NHS Scotland, the Advanced Interventions Service is committed to the rigorous evaluation of a range of treatment approaches for patients with chronic, refractory mood disorders and OCD. These approaches include psychological therapies (e.g. CBASP, ERP and CBT), neurostimulation (vagus nerve stimulation – VNS and deep brain stimulation – DBS) and lesion surgery (anterior capsulotomy and anterior cingulotomy).”
“Professor Matthews is executive adviser to the World Society for Stereotactic & Functional Neurosurgery Psychiatric Neurosurgery Committee.
Professor Matthews is Clinical Lead for Tayside and a member of the Management Board of the Scottish Mental Health Research Network (http://www.smhrn.org.uk/).
Professor Matthews is a Member of the Clinical Advisory Group for the charity OCD action.”
Letter Strapline: DAIS annual report 2013 – 36 referrals from Scotland – a staff team of 10 – home visits – £568K/year = £15,777/person (one person getting NMD for THIRD time) – Parity of Esteem
“Dear Professor Matthews
I am writing to you about the Dundee Advanced Interventions Service latest 2013 Annual Report which I have just been reading through:
I want to commend you on its thoroughness, the detail, the graphs and the various sections which explain even to a non-professional like myself what is going on.
What first strikes me about the work of DAIS is the resources which are put in. The amount of staff, the website, the variety of medical and psychological expertise involved. For example I read that a team from DAIS will visit a person in their own home to discuss the range of therapies and treatments available.
In the everyday world of mental health services when people are in severe mental distress they can’t get teams coming to their house. I know this personally from when my youngest son was mentally distressed at Christmas time 2011 in NE Fife where we live, and remained so for a month, despite having a CPN. My son could not access the simplest of crisis support. And so he eventually was subject to “unreasonable treatment” in Stratheden IPCU. Where there is a dreadful lack of resource to treat mentally distressed patients.
The point I am making is that DAIS has the resource to send teams out to patients but in Fife the NHS doesn’t. And neither does it happen in Dundee for people in mental distress. I know this because my middle son couldn’t access any support despite turning up at Ninewells A&E on Christmas Day 2012, in mental distress. He ended up in the Carseview IPCU being medicated with up to 5 psychiatric drugs at the one time. Very risky procedure. Polypharmacy that resulted in catatonia at one point and having to take more drugs, in the form of Lorazepam. Overmedicating. Managing patients by drugging them up to the eyeballs.
Getting back to your annual report, it says for the year there were 40 assessments, 36 referrals from Scotland, one ACING undertaken. A staff team of 10 members. At what cost? I am checking back the FOI request information I received in July 2014. Where it said from 2012-2014 the cost was £568,000/annum, paid in monthly instalments. 1x Consultant Psychiatrist at £111,792. See attached document. Staff costs in total £428,499. The largest part of the cost.
In Carseview Centre the cost of a one inpatient bed per week is £3000 (Ward I has two rooms set aside for NMD) whereas in Stratheden it is more like £2000-2500/person/week. Dormitory accommodation and on occasion sub-human treatment. Compare this to adult general acute inpatient wards where the cost is more like £4500/patient/week.
Therefore I contend that if every person was given the resources in their own health board area with which the DAIS team have been given then the outcomes would be much, much better. Without having to perform irreversible brain surgery or ACING. Because, let’s be honest, it all comes down to the resource put in and the person-centred focus of the service.
I find it annoying that Scottish Government would fund a project like the Advanced Interventions Service to the tune of more than half a million a year yet they won’t do anything to bring parity of esteem to mental health services compared to physical health services. That is very unfair. To favour invasive neurosurgery for “mental disorder” (or fiddling in the brains of people for whom the drugs don’t work) over everyday crisis support I think demonstrates the failures in our government’s mental health division.
The patients who access your service will be glad of the attention they get even if it has to end in brain surgery. The fact that medical people care about them, send teams to their home, meet with them on many occasions and want to know about them individually, will be a great boost to their self esteem. I notice that one person has even come back 3 times for an ACING/anterior cingulotomy. See attached screengrab from 2013 report, the only person getting an ACING in the year to 2013.
I am copying in your colleague Dr Christmas, the NHS Tayside CEO, the Director of the National Services Division and Shona Robison, Dundee MSP and Cabinet Secretary for Health. For their information.
Chrys Muirhead (Mrs)”
from page 13 of 2012-14 Service Agreement for DAIS