A Dundee couple say they have been left fearing for their son’s life following a series of “extremely concerning” incidents at NHS Tayside facilities.
Ryan Caswell, 19, was first detained at the city’s Carseview mental health unit in January 2020.
He has been diagnosed with Autism Spectrum Disorder and a learning disability, and has significant communication issues.
Police are investigating allegations of a physical assault on Ryan last month at the centre.
His parents, Paul and Irene Caswell, also allege he has at times been sedated and restrained instead of being given proper medical treatment.
A local MSP has written to the Scottish Government-appointed independent oversight group on Tayside’s mental health services calling for their concerns to be investigated “as a matter of urgency”.
NHS Tayside says the team caring for Ryan is regularly in direct contact with the family and their complaints are being “addressed and independently investigated”.
‘Unnecessary chronic pain’
Ryan had surgery to remove his gallbladder in June 2019, several months before he was first detained at Carseview.
After obtaining his medical notes, the Caswell family discovered medication to reduce Ryan’s stomach acid production following the procedure was repeatedly lowered without their knowledge or consent.
Mr and Mrs Caswell act as Ryan’s legal guardians.
They say psychotropic drugs were used “as required” to control challenging behaviour linked to his discomfort instead of addressing the underlying issues.
Ryan is currently on a delayed discharge list waiting for a community placement.
Mr Caswell, 64, said: “I think that place needs to fundamentally change.
“You could end up with something as simple as an appendicitis where Ryan says he has a sore tummy, they sedate him and the next morning he doesn’t wake up.
“That, for me, is extremely concerning.
“I’m just perpetually worried all the time right now that something drastic is going to happen with Ryan that could be easily resolved but they’ve failed to take the appropriate action.”
Concerns over a number of incidents
An independent probe is already looking into an incident where it is alleged staff did not investigate why bloody paper towels were discovered in Ryan’s bathroom.
A further incident, in March 2021, where Ryan had to be monitored overnight after being given the wrong drugs, was only uncovered via a note in his records because it was not disclosed to his family.
The Caswells say they have serious concerns about the amount of information they are being told, along with apparent inconsistences with medical notes.
While ministers cannot comment on individual cases, we are clear that all patients must be treated with care and respect.”
– Mental Health Minister Kevin Stewart
In June 2020, a consultant wrote to Ryan’s parents and his GP to say he was eating, drinking and going to the toilet normally.
His medical notes reveal he was actually on five fibre drinks and two separate laxatives a day at the time.
Ryan’s body weight plummeted by 13% over a three-month period between July and October but the family say they were told access to a dietician was not available.
They say initial investigations by private consultants discovered a previously undiagnosed issue with his colon.
Questions over standard of care
In Autumn 2020, there were two incidents where Ryan had his foot stomped on by another patient at Carseview.
Mr and Mrs Caswell also note several examples of what they call a general lack of care.
This includes them being forced to cut Ryan’s hair with battery-operated clippers and trim his nails, both in the car park, because this was not being done by staff.
They say this was particularly troubling because Ryan had a wound on his head at the time and his hair was getting matted into it.
Ryan went on to stay at a community placement in Aberdeen that September.
Mr and Mrs Caswell say hundreds of pounds of his items were missing or unaccounted for when they went to collect his inventory.
They were also presented with a bag of Ryan’s birthday cards and presents from that July which had been kept in the office and he was not given access to.
Call for ‘urgent evidence’ to be taken
An independent oversight and assurance group was appointed to mental health treatment in Tayside following a damning inquiry into local services led by former police chief David Strang.
North East MSP Michael Marra confirmed he has written to the oversight group to ask that they take “urgent evidence around this very concerning case”.
He said: “My discussions with the Caswells have highlighted very significant but all too familiar issues.
“The lack of suitable care available at Carseview, gaps in policy, chronically poor communication and persistent understaffing – all of these issues persist years after family concerns over lost loved ones led to the Strang review.”
Mr Marra said the review has been described to him by senior figures as “the most concerning report in Scottish public life” and insisted there remain “very significant challenges in mental health services in Tayside”.
He said: “The Independent Oversight and Assurance group has a lifespan of one year and the experience of Ryan and his family show that there is a huge amount that still must be done if we are to rebuild these vital services at a time of surging demand.
“We urgently need progress if lives are to be saved and patients are to receive the care they deserve.”
Concerns ‘are being addressed’
The second quarterly report from the Independent Oversight and Assurance Group, which covers the period February to April 2022, is expected to be presented to the Tayside Executive Partners in the next few weeks.
The chairwoman of the oversight group, Fiona Lees, has visited a number of facilities across Tayside to discuss the progress being made within mental health services.
An NHS Tayside spokeswoman said: “Due to patient confidentiality, we are unable to comment on matters relating to individual cases.
“The team caring for Ryan is regularly in direct contact with the family and their concerns are being addressed and independently investigated.”
The spokeswoman added that the partnership overseeing the implementation of the recommendations of the Strang review “has re-stated its commitment to improving mental health and wellbeing services and outcomes for individuals and communities across Tayside”.
Patients must be treated with respect
Scottish Government mental health minister Kevin Stewart said: “While ministers cannot comment on individual cases, we are clear that all patients must be treated with care and respect.
He said: “The oversight group, established by the Scottish Government, has a vital role in providing scrutiny and assurance on the implementation of Dr Strang’s recommendations to improve mental health provision in Tayside.
“The group will continue working with partners, third sector and people with experiences of mental health services to deliver meaningful improvements to mental health services and achieve positive outcomes for communities in Tayside.”
A Police Scotland spokesman said: “On Sunday April 10 2022, officers received a report of an alleged assault of a man in Dundee.
“Enquiries are ongoing.”
