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Child and Adolescent Mental Health Services

Volume 496: debated on Wednesday 15 July 2009

The Government have made two commitments in recent years on the treatment of children and young people aged under 18 years on adult psychiatric wards. I wish to report to the House on the progress made on these commitments.

The first commitment, made in November 2006, was that within two years no child under the age of 16 would be treated on an adult psychiatric ward.

The second commitment is to commence section 31(3) of the Mental Health Act 2007 in England by April 2010. This provision, which applies to voluntary (informal) patients as well as formal (detained under mental health legislation) patients, places a duty on hospital managers to ensure that patients aged under 18 are treated in an environment in hospital which is suitable having regard to their age (subject to their needs). The hospital manager has to consult a person who appears to them to have knowledge or experience of cases involving patients who have not attained the age of 18.

In its 12th Biennial Report the Mental Health Act Commission welcomed these commitments and commented that

“the ending of admissions of children and adolescents to unsuitable adult facilities is an ambitious undertaking”.

In order to prepare for these two commitments £31 million capital was made available in 2007-08 to 17 projects specifically designed to eliminate the inappropriate use of adult psychiatric wards by children and young people. I can report that five projects have been completed with further projects, which will provide 31 new beds, 35 refurbished beds, and 13 beds relocated to purpose-designed facilities, in various states of completion.

In addition, the Department commissioned the National Mental Health Development Unit (NMHDU) to work on children and young people’s issues within the Mental Health Act 2007 implementation programme. One of the main objectives of this work has been to support local areas to prepare for section 31(3) of the Mental Health Act 2007.

A number of products have been produced including:

The Legal Aspects of the Care and Treatment of children and Young People with Mental Disorder : A Guide for Professionals

A guide that describes the interaction between mental health legislation, the Mental Capacity Act, and children’s legislation and which, for example, will assist adult mental health services clinicians to understand the issues they should take into account when working with under 18s.

The Safe and Appropriate Care Standards for Young People on Adult Wards

Standards prepared by the Royal College of Psychiatrists Research and Training Unit, in conjunction with young service users, parents, Adult and Child and Adolescent Service providers and commissioners, which provides guidance to trusts on how to assess the safety, environment and treatment offered to young people on adult wards.

In Our Words DVD

A training aid which includes contributions from young people, their parents, mental health advocates and health professionals on the treatment of young people with mental health problems.

Working Together to Provide Age Appropriate Environments for Mental Health Patients Aged under 18

Briefing to support adult mental health services (AHMS) and child and adolescent mental health services (CAMHS) commissioners to work together to develop more effective services to maintain young people in the community when it is safe to do so, and appropriate inpatient resources to meet their needs in a crisis or for medium to long-term treatment.

The Age Appropriate Environment System Dynamic Planning Tool

A model aimed at CAMHS and AMHS commissioners, providers, planners and analysts to enable them to devise and test plans to improve services to meet the needs of under 18s with severe mental health problems is available to download for free.

The Mental Health Act— essential information for Parents and Carers

NMHDU commissioned a leaflet for parents and carers from Rethink which has been distributed to CAMHS and AMHS and which is available to download for free.

Headspace Toolkit

The widely praised Advocacy in Somerset self advocacy toolkit has been updated, distributed to all CAMHS in-patient services and is available to download for free.

Additionally a series of training workshops aimed at CAMHS staff have been provided across England.

Year-on-year figures of bed days for under 18s show that consistent progress is being made. The number of bed days for under 16s and 16-17-year-olds on adult psychiatric wards has significantly reduced. In 2006-07, 12.2 per cent. of bed days for under 18s were on adult psychiatric wards whereas the figure for 2008-09 was 8.1 per cent. I would like to congratulate strategic health authorities, commissioners, and providers on the progress made.

The bed day figures for under 16s on adult psychiatric wards dropped to zero in Q3 2008-09 meeting the Government’s commitment. However, the latest quarterly figures (January-March 2009) for bed days for under 18-year-olds receiving mental health treatment in England show three instances of under 16-year-olds having been treated on adult psychiatric wards, each for one day only.

It is not acceptable for young people to be put in this situation and those few areas where these latest cases have arisen must take action to prevent this happening again. In all these cases action has been taken to investigate the circumstances leading to an under 16-year-old being placed on an adult psychiatric ward and to press those responsible to put arrangements in place to ensure that in future similar situations are dealt with in line with the Government’s commitment. The appropriate place for vulnerable young children is in an environment which is designed for children and young people. In the case of under 16s our view is that the appropriate place is a CAMHS ward.

To conclude, over the past five years the Government have been committed to improving access for children and young people with mental health problems in universal and specialist settings. What these incidents highlight are the need for continued efforts to improve access to emergency and specialist age appropriate inpatient services for under 18s which are close to young people’s homes, and services to maintain young people in the community when it is safe to do so, following the example in adult services of outreach and crisis teams. The Government remain committed to developing mental health services further.

Bed days for under 18 year olds receiving mental health treatment in England within the NHS.

Quarter

Under 18- year- old on NHS CAMHS ward

16 to 17-year-old on NHS Adult Psychiatric Ward

Under 16- year- old on NHS Adult Psychiatric Ward

2006-07

1

34,609

4,697

75

2

28,171

4,780

25

3

34,430

4,679

38

4

39,409

4,511

53

2007-08

1

38,359

3,954

81

2

37,935

3,893

112

3

41,184

4,255

49

4

40,072

4,926

133

2008-09

1

37,003

4,019

16

2

36,973

3,713

4

3

39,534

2,854

0

4

42,065

3,101

3*

Note:

The figures shown above include the latest revisions to past quarterly returns and therefore differ from those previously published.

*This figure does not include a case which has come to the Department’s attention in a whole life eating disorder unit and which was not reported to the Department by formal channels. Action is being taken to ensure that eating disorder units abide by the Government’s commitment.