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Psychiatric Units: Child and Adolescent Patients

Volume 771: debated on Wednesday 13 April 2016


Asked by

To ask Her Majesty’s Government what assessment they have made of the number of deaths amongst child and adolescent patients in psychiatric units, in the light of the investigation conducted by the charity Inquest.

My Lords, every death of a young person in in-patient psychiatric settings is a tragedy. It is essential that each case is fully investigated and lessons learned. Four children have died in in-patient child and adolescent mental health services since NHS England came into existence in 2013. The Minister of State for Care Services plans to meet Inquest to consider what more can be done.

My Lords, I am grateful to the noble Lord for that response. It is obviously at odds with the comments made by his honourable friend the Minister of State, who told “Panorama” that the department simply did not know how many young people had died in psychiatric care. Does the noble Lord accept that he and his ministerial colleagues have a duty of care under Article 2 of the European Convention on Human Rights towards those in their care in psychiatric units? If so, as he said he was in favour of the principle of all those deaths being adequately investigated, will he ensure that in future there is a requirement on psychiatric units to report on premature deaths of all patients and that they are independently investigated by a body separate from the psychiatric unit concerned? He and I have discussed that in the past in his previous incarnation as chair of the Care Quality Commission.

My honourable friend Alistair Burt, the Minister for Care Services, and I accept that the lack of clear knowledge on how many deaths there have been in psychiatric care settings is not satisfactory or acceptable. I think the difference from the figure of nine in the “Panorama” programme is partly because the figure of four is from 2013 whereas the figure of nine probably goes back to 2010. Nevertheless, it is essential that we clear that up and get those facts straight. Alistair Burt has agreed to meet Inquest to do so.

As far as investigating these awful tragedies when they happen and learning from them, where someone is detained under the Mental Health Act and a suicide happens there is a requirement to inform the CQC, as the noble Lord will know. For example, where a child is not detained under the Mental Health Act, there is no such requirement. We are looking at this very thoroughly and when my honourable friend in the other place has completed his work I will write to the noble Lord with our findings.

My Lords, I want to carry on the discussion about admission to psychiatric hospitals. During the passage through this House of the 2007 mental health legislation, we identified that more than 350 children were placed inappropriately on adult psychiatric wards every year. One assumes that, almost 10 years on, that figure should have dramatically dropped and we should not see children placed on adult psychiatric wards. Can the Minister shed any light on whether we know how many children are still placed on adult psychiatric wards and what is being done to stop that happening?

My Lords, I think the figure for children on adult psychiatric wards is 391. It is far too high. It was described in the “Panorama” programme as the Cinderella service of a Cinderella service. What has come to light in the work done by the Sunday Times, “Panorama” and Norman Lamb in the other House is that we have a very serious problem here. It is not going to be solved overnight. The Government have committed to spend £1.4 billion over this Parliament to improve child and adolescent mental health care, but we have a long way to go.

My Lords, part of the answer to this difficult problem must be to ensure that we get the very best mental health care for young people at the earliest stage possible. I notice that earlier this week a report was published by the think tank CentreForum pointing out that mental health providers turned away 23% of the referrals of under-18s made to them. That includes illnesses such as anorexia, and sometimes young people are turned away because at that stage they have an insufficiently low BMI to justify being treated, despite the evidence that early diagnosis and treatment produce the best results. In the light of that, can the Minister reassure the House that Her Majesty’s Government are keeping under review the criteria by which people are able to access these mental health services, to ensure that we get the best outcomes?

My Lords, there is no question but that early intervention is critical. There is a huge amount of unmet need. I expect that everyone in this House will know someone who has a child who has suffered from mental health problems, whether anorexia, self-harm or other aspects of mental ill health. It is a complete disaster, and for anyone who watched that “Panorama” programme it will have been brought very close to home. What the right reverend Prelate says is absolutely right. As I said in answer to the earlier question, we have a long way to go.

My Lords, the recent research highlighted on the “Panorama” programme also highlighted the deeply disturbing fact that there is no single body responsible for collecting, analysing and recording these data. What plans do the Government have to ensure that this information is centrally collected and publicised?

If I may, I will write to the noble Baroness on this matter. For me, the two profound issues in that “Panorama” were, first, that the parents of that poor girl, Sara Green, had to travel for over five hours to visit her in the in-patient setting that she was in; and, secondly, that she was found to be ready for discharge after three months in that setting but it was six months later when she took her life in the home, because there was no community resource in place closer to her home. The whole thing is a tragedy, but those two aspects in particular were very disturbing.