Concerns raised over psychiatric unit admissions
Some people are being "inappropriately" admitted to Scotland's secure psychiatric units, a study has found.
An NHS audit found some Intensive Psychiatric Care Units (IPCUs) had admitted unsuitable groups, such as dementia sufferers.
The report said units provided a lack of activities and access to fresh air, and some patients even claimed prison was less restrictive.
But the study also highlighted "well-structured and compassionate care".
Scotland's 14 Intensive Psychiatric Care Units (IPCUs) usually treat patients with acute mental health problems who have been detained under the Mental Health Act.
But the actual make-up of the units was a problem highlighted in the study by NHS Quality Improvement Scotland.
The report said in some cases violent criminals and sex offenders had been mixed with vulnerable adults, such as under-18s and people with learning difficulties.
It said this could compromise patient care and feelings of safety and called for a review into every instance where this has occurred.
Scotland also has no women-only units and some female patients said mixed gender groups had made them feel intimidated and uncomfortable.
This is the first major report into provision across Scotland, which included testimony from current and former patients.
It found that the country's 147 beds were "adequate".
However, it said getting access to a place was still problematic for some people, especially in Dumfries and Galloway and Lanarkshire - the two areas with no local provision and no agreements in place with neighbouring health boards.
Although there were enough beds, the report stated: "We have good evidence of a range of unmet needs."
This was partly because only one unit in the country had dedicated input from a clinical psychologist. Other patients have to use generic psychology services, which are subject to limited availability and waiting lists.
As well as a shortage of "talking therapies", patients also complained about a lack of access to fresh air and outdoor activities.
One said: "When you come into an IPCU you are really unwell. You need time to heal and the environment is not a healing environment.
"You also need something to stimulate and exercise your brain.
"Some educational input would be really helpful. Some of the patients in this ward have been here for over a year."
Patients who took part in the focus groups and filled in questionnaires complained about a perceived "one-size-fits-all" approach in the units.
People who wanted to explore non-pharmacological options felt their wishes were not respected and others claimed restraint was sometimes forced on patients who did not need it.
Others complained that restrictive measures which were put in place for safety reasons - such as patients not being able to make a hot drink and having to ask staff for access to certain personal items - did not take account of individual needs.
The report said: "A number of service users compared IPCUs to their experience of prison and felt that prison was a less restrictive environment."
Wendy McAuslan, development co-ordinator for Vox Scotland, which took part in the study, said, "The individuals we talked to who had experience of IPCUs said that they needed psychological therapies, a range of activities and opportunities to be outside, without this they felt that improvement in their mental health would be difficult.
"This report highlights the ways in which we can move towards making the IPCU environment more recovery-focused."