Senior leaders at NHS Tayside oversaw a ‘breakdown in trust and respect’ that led to mental health care failings, a two-year long inquiry has concluded.

Inquiry chair David Strang says that changes should have been made following a critical interim report in May 2019 but warned this had only happened to a ‘limited extent’.

The former prisons chief inspector for Scotland said: “The report’s title – “Trust and Respect” – reflects the main conclusions of the Inquiry – that there has been a loss of trust in mental health services in Tayside.”

Health secretary Jeane Freeman says 'immediate action' will take place to restore faith in services, while Tayside health board chief Grant Archibald pledged a "new approach".

Campaigner Gillian Murray, who lost her uncle David Ramsay to suicide in 2016 after he had been refused treatment at the Carseview mental health centre, helped bring about the inquiry in 2018.

The final report today details dysfunctional relationships in ‘many aspects’ of mental health services in the region.

They include a shortage of consultant psychiatrists meaning patients not believing they will get the care they need, as well as some patients, families and carers being viewed by staff as ‘troublesome, antagonistic…and not to be trusted.’

Working culture within NHS Tayside also comes in for criticism, including hostility between clinicians and mangers, staff reporting a ‘culture of fear and blame’ when it comes to mistakes and some third sector groups being ‘marginalised’.

Overlapping responsibilities and confused relationships between the different agencies delivering health and social care also contributed to problems.

‘Too often,’ the report states, ‘the complexity of governance arrangements is cited as a reason why decisions cannot be made in good time.’

Mr Strang says services can only be improved if NHS Tayside moves away from a ‘defensive’ position to being more open with staff and the public.

The 51 recommendations include an ‘urgent’ focus on mental health services outside of hospital in the community and giving families and carers more information when their loved ones are admitted to mental health wards.

Paying tribute to the 1,500 people who contributed to the inquiry, Mr Strang said: “Trust needs to be rebuilt by treating everyone with respect.

“The active involvement of staff, patients, communities and partner organisations will be essential to building a new culture and approach to delivering services and treating patients in Tayside.

“The publication of this report provides an opportunity for Tayside to develop world class mental health services, where the population are served with commitment and passion.”

An interim report had warned of ‘serious challenges’ in a range of areas including 24/7 crisis support and the quality of care.

 ‘It is not clear who is responsible for leading the [mental health] service’, he said.

Last week the Scottish Government announced a range of additional support measures for Tayside mental health service, including bringing in the Royal College of Psychiatrists to oversee improvements.

Health secretary Jeane Freeman said: "The Scottish Government will monitor NHS Tayside’s progress through the continuation of the NHS Tayside oversight group and will continue to seek assurance that the required improvements are being implemented, working alongside COSLA to ensure health boards, local authorities and health and social care partnerships are supported to work together across Scotland to build on the Strang report recommendations.

COSLA health and social care spokesperson Councillor Stuart Currie said: "COSLA will work alongside Scottish Government, NHS boards, local authorities and integration joint boards to allow for learning from the Strang report to be implemented across Scotland. A continued focus on working together, and collaborating not only with each other, but importantly with those who use services and their families.”

NHS Tayside chair Mrs Lorna Birse-Stewart said: “More than 1500 people contributed to the iinquiry and the voices we hear coming through very strongly in the report are giving us a deep insight into how people are truly connected to the services we provide.

"We thank each and every one of those 1500 people, some of whom feel they have not been fully listened to in the past, and I would like to give a commitment to them, on behalf of the Board, to say we are listening to ensure we rebuild mental health services which earn the trust and respect of everyone.”

CEO Grant Archibald added: “The publication of today’s report delivers a challenging set of recommendations for mental health services across Tayside, which are based on the lived experiences of a wide range of people and extensive evidence provided to the inquiry team.

“Dr David Strang has stated that the report provides an opportunity for Tayside to develop world class mental health services, where the population are served with commitment and passion. That is the spirit in which we receive the report today and we are determined to make the significant changes needed to deliver on this opportunity and rebuild confidence in services."