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Children and Young People under 18 on Adult Mental Health Units – What’s Really Happening?

23 Nov 2021

My name is Martha, I am 18 years old and in 2020 I was placed on an adult mental health unit after just turning 17. That experience has led me to researching how often this has happened to other people under 18, and the effects it has had.

Before I get started, I’m going to be using some acronyms, so here is a quick jargon buster:

CYP- Children and Young People

CAMHS- Child and Adolescent Mental Health Services

AMHU- Adult Mental Health Unit

FOI(A)- Freedom of Information(Act)

LHB- Local Health Board

WR- Ward Round

CPA- Care Programme Approach

PCT- Primary Care Trust

For this research young person refers to people up to the age of 18. This is because at the age of 18 young people transition to adult mental health services and are treated in adult services.

There is very little information about the experiences of children and young people and the families of children and young people who have been placed on adult mental health units. There is also little to no acknowledgement by services, governments, and people in power that this is a very real problem. As a result, many people are unaware of the fact that children are still being placed on adult mental health units.

So how big is the problem?

Since 2019 there have been 970 children and young people admitted to adult mental health units in England and Wales.

Now let’s break these figures down geographically.

Wales

Due to there being no publicly available data in Wales regarding how many CYP are admitted to adult mental health units I had to request 7 FOIAs. I asked all the LHBs in Wales the for the following:

1. The number of children and young people under 18 admitted to an Adult Mental Health Ward between 1/1/2019 to 31/12/2019, and the duration of each admission in days.

2. The number of children and young people under 18 admitted to an Adult Mental Health Ward between 1/1/2020 to 31/12/2020, and the duration of each admission in days.

3. The number of children and young people admitted to an Adult Mental Health Ward between 1/1/21 to the current date, and the duration of each admission in days.

Here are some of the key findings from the responses I received:

In Wales there has been at least 156 admissions of CYP to adult mental health units since 2019.

Here is a breakdown of the number of admissions every year. These are only the minimum numbers and due to the way the data has been presented we know there are more.

2019 – 62 Admissions

2020 – 67 Admission

2021 – 27 Admissions (as of 17/06/21)

Now let’s look at how long children are staying on adult wards. To do this, let’s look at figures from three of the Welsh LHBs. (the other 4 LHBs did not provide reliable data/any data)

For these LHBs, since 2019 under 18s have occupied at least 586 bed days on adult mental health units. This means that the average length of stay is 7 days. The Welsh Governments Admissions Guidance says that, “Once admitted to the designated bed, if it is considered a CAMHS bed is appropriate the expectation is that CAMHS responsibility to identify a tier 4 bed is secured within a timescale of 72 hours or sooner”. However, this does not accurately represent the length of some admissions, with some children and young people staying for over 100 days on an AMHU.

England

In England there is publicly available data on the numbers of CYP admitted to adult mental health units. NHSE releases the number of CYP on adult mental health units every quarter of the year. Here is a brief overview of the data since 2019:

There has been at least 814 admissions of CYP to adult mental health units since 2019.

During that time there has been 7,649 bed days occupied by under 18s on adult mental health units. This works out to 9 days being the average length of stay.

Survey Results

As part of my research, I created a survey for CYP who had been admitted to adult mental health units. I also created a survey for parents/carers of CYP admitted to adult mental health units. Here’s what I found out.

CYP Survey

· 50% of those surveyed were between 12-15 during their admission and 50% were between 16-17.

· 67% of those surveyed did not have access to an advocate whilst on an AMHU. 33% did have access to an advocate.

· 100% of those surveyed did not have a CPA meeting.

· 100% of those surveyed did not have regular contact with their CAMHS team.

· 100% of those surveyed felt that staff did not have good training/knowledge of looking after young people.

· One young person surveyed was encouraged not to eat by a staff member.

· One young person surveyed said that the staff on the unit were unprofessional and rude.

· One young person said that they were unnecessarily restrained which had led to them not wanting to sleep in their own bed out of fear. They also said that they had been hurt whilst in restraints multiple times.

· One young person said that they would like to see better care in the community and that they would like nurses to be trained to understand and listen better.

Parent/Carer Survey

· 57% parents/carers said that their child was between 16-17 at the time of their admission. A further 43% said that their child was between 12-15 at the time of their admission.

· 58% said that their child stayed on an AMHU for over 4 weeks. 28% said that their child admission was between 1-3 weeks and while 14% said it lasted less than 72 hours. One child was kept on an AMHU for 4 months and another was kept for 56 days.

· 86% of parents/carers said that they were informed of the reason why their child had been placed on an AMHU whilst 14% were not. Some of the reasons why CYP were placed on an AMHU were:

1. “there was nowhere in the country that would accept them”

2. “there were no CAMHS beds available”

· 100% of parents/carers were not made aware of where they could seek advice during their child’s admission

· 86% of parents/carers were not invited to CPAs or WRs during their child’s admission. 14% responded other, saying that they were asked to leave if they got upset.

· 86% of parents/carers were not kept up to date/informed of their child’s care whilst on an AMHU. 14% responded other, saying that they only received information if they pushed for it.

· 71% of parents/carers did not feel that staff were able to provide compassionate and appropriate care for their child. 29% responded other with one saying that staff had stated that they had requested training from CAMHS, but it had not been provided

· 86% of parents/carers felt that staff did not have the appropriate training and knowledge of child mental health/illness and could not keep their child safe. 14% responded other. One parent/career stated that their child was repeatedly restrained, there was no access to education or therapy and that they were able to self-harm.

· 57% of parents/carers said that their child was discharged from the AMHU into the community. 29% said that their child was transferred to an out of area CAMHS unit and 14% responded other.

· One parent said that they’re experience was shambolic and that they(the AMHU) had gone against their wishes despite them having parental responsibility.

· One parent said that they were not informed that their child had been transferred to an AMHU until the transfer had taken place. They also said that their child was physically and chemically restrained multiple times.

· One parent said that their child did not receive any help whilst on the AMHU and was just watched 24/7.

· One parent said that there was no joined up thinking between adults and CAMHS and a lack of therapy and assessments which made the situation far more traumatic for their child and themselves.

As you can see, staying on an adult mental health unit can be a negative experience for CYP and parents/carers.

So, what should be happening when a child is admitted to an adult mental health unit?

In January 2007 the Children Commissioner of England published a report named “Pushed into the Shadows”. The report is about CYP being admitted to AMHUs. In the report there are 20 recommendations relating to:

– preventing the inappropriate admission of young people onto adult psychiatric wards and,

– measures that must be taken to safeguard those young people who are admitted to adult wards.

Here are some of the recommendations of what should be happening versus the reality of what is happening

Recommendation 1 says “PCTs and mental health trusts should ensure that adult wards are not used for the care and treatment of under 16s and, wherever possible, adult wards should be avoided for 16 and 17 year olds unless they are of sufficient maturity and express a strong preference for an adult environment.” In both the parent/carer survey and the CYP survey we can see that children under 16 are still being admitted to adult mental health units.

Recommendation 7 says “Mental health trusts (CAMHS and adult mental health services) and PCTs work together to ensure they have in place a joint policy and/or protocol to ensure the safety & protection of young people admitted to adult wards”. 71% of parents/carers did not feel that staff were able to provide compassionate and appropriate care for their child. Furthermore, one young person said that they were hurt by staff during restraints.

Recommendation 8 says “Mental health trusts and PCTs should work together to ensure that health care professionals involve children and young people (and their families where appropriate) fully in all aspects of their mental health care”. In both of the surveys 100% of parents/carers and 100% of CYP said that they had not been invited to a ward round or CPA meeting.

Recommendation 9 says “All young people admitted to adult wards should have regular access to a named keyworker/lead professional who has received training in working with young people and who has responsibility for liaising with CAMHS”. Many of the parents/carers (86%) surveyed felt that staff did not have the appropriate training and knowledge of child mental health/illness and could not keep their child safe. Additionally, one young person thought that staff were unprofessional.

Recommendation 12 says “All staff who are working with young people on adult wards should be trained in child and adolescent mental health”. The general consensus from both surveys is that both CYP and parents/carers feel that staff do not have the appropriate training/knowledge of child and adolescent mental health. 100% of CYP felt that staff did not have good training/knowledge of looking after young people. One parent/carer said that the staff on the unit had stated that they were not CAMHS trained, and they had asked CAMHS for training but never received it. One young person said that only a few of the staff had mental health training.

Recommendation 13 says “On admission to an adult ward, all young people and their families must receive information (both written and oral) in an appropriate format about what will happen to them and about their rights (including how to complain and, where applicable, the provisions of, and their rights under, the Mental Health Act 1983)”. 100% of parents/carers were not given information about where they could seek advice during their child’s admission.

Recommendation 14 says “All mental health trusts should ensure that any young people admitted to adult inpatient mental health wards are advised of, and have access to, independent advocacy advice and support”. Despite this 67% of CYP surveyed were not able to access an advocate despite a number being sectioned under the MHA. One young person said that they had not even been offered an advocate despite being on the unit for over a month.

Recommendation 15 says “Mental health care trusts and PCTs should ensure that all decisions are documented in a written Care Plan that has been discussed and written jointly with the young person and, if appropriate, discussed fully with their family/carers”. In the parent/carer survey 86% of people said that they had not been invited to a CPA or ward round. Meanwhile in the CYP survey 100% had not been invited to a CPA.

Recommendation 17 says “Mental health trusts and PCTs should ensure that any adult in-patient wards admitting young people under-18 should provide appropriate facilities and daily activities for young people including games, music, books, computer equipment and access to sports and physical exercise”. One young person who had been on an adult mental health unit said that they were only allowed in one room during their stay and that they were not allowed to go to the units activity room. They also said that they were not allowed into the units garden.

Recommendation 18 says “Mental health trusts and PCTs should ensure that all adult in-patient wards have resources in place to assess and respond to the educational needs of any young people under 18 admitted to the ward”. One parent/carer said that their child was not offered any education or therapy despite being on the unit for a long time.

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