Scotland's only centre for seriously mentally ill patients has been criticised for its 'autocratic and unyielding' leadership style.
The Scottish Health Advisory Service report acknowledges that since SHAS last visited the State Hospital, Carstairs, 'considerable work has been done to move from a custodial regime to a more therapeutic milieu'.
It says this has been achieved by changes in the physical environment and the recruitment of additional specialist clinical staff.
It says this means the hospital should be able to 'increase training and provide more treatment opportunities'.
However, the report finds, 'some staff consider the pace of change too fast:
they feel ill prepared and unsupported and that their concerns are not listened to.
'Others feel frustrated by the constant emphasis on high security and want to see custodial practice reduced to an absolute minimum.'
The report concludes: 'This is a culture that 'split' in the psychological sense, with a risk therefore of scapegoating and of misinterpreting communication.
'The positive steps already taken to provide better communication are acknowledged but more needs to be done.'
It also says: 'It was striking that on several occasions people said something privately to SHAS but contradicted it publicly, or asked that their comments not be attributed.'
A spokeperson for the State Hospital said: 'We welcome the report. It is saying many positive things about the delivery of patient care.
'There are two sets of opinions in this. One says that the management style is great and the other says the management style needs to change.
'Therefore, that is a matter for the hospital.
'That always happens and I don't think you'll find this any different in any hospital.'
Mental Health Services in the State Hospital .
Scottish Health Advisory Service, Elliott House, 8-10 Hillside Crescent, Edinburgh, EH14 5EA. Free.