Children and young people with mental health problems are at increasing risk because they are caught between stretched community services and accessing acute beds, a survey has revealed.
The Royal College of Psychiatrists' Child and Adolescent Faculty report Survey of in-patient admissions for children and young people with mental health problems: Young people stuck in the gap between community and in-patient care, found that almost 80% of child and adolescent psychiatrists who responded to its survey had safeguarding concerns while their patients were waiting for a bed.
More than three quarters of respondents said young people they had diagnosed as being at high risk when it came to their own safety and others, and therefore needing a bed, had to be managed in the community. Meanwhile, 61.9% of respondents reported young people were being held in inappropriate settings such as paediatric wards, police cells, Section 136 suites and accident and emergency departments. Additionally, 14% of respondents cited cases of children and young people who had attempted suicide while waiting for a bed. Survey respondents described difficulties with admissions that had resulted in 'near misses' or serious incidents.
Reasons cited by psychiatrists for this increased difficulty in accessing beds included an increase in referrals, decreased community child and adolescent mental health health services (CAMHS) capacity, decreased capacity of social care and decreased in-patient capacity. Respondents also indicated that the new commissioning arrangements had resulted in less control and accountability.
To address these concerns, the survey report recommends:
• Commissioning groups and health boards should recognise the increasing pressures on community services and the increasing complexity and risk that characterises children and young people presenting to services
• Investment in community mental health services to minimise the need for admission
• Intensive outreach services should be commissioned UK-wide – including crisis assessment, crisis management, services designed to help early discharge, and planned intensive home treatments
• There should be financial incentives across the in-patient/community CAMHS boundary that promote services working together to optimise mental healthcare for children and young people, minimise length of stay in in-patient units, and allow safe, appropriate community care where this is possible
• Joint working across agencies should be encouraged locally through partnership and safeguarding boards
• Government should prioritise investment in crisis care services for children and young people. NHS England, clinical commissioning groups and social services need to ensure that adequate emergency care pathways are in place as a matter of urgency.
Dr Peter Hindley, chair of the Royal College of Psychiatrist's Child and Adolescent Faculty, said: "It is unacceptable that children and young people are stuck in this gap between community and inpatient care. This survey shows just how devastating the consequences can be.
"We need urgent action to support these individuals and their families. Ensuring the safety of children and young people should be the number one priority. Failure to improve both inpatient and community care will mean they will continue to be at risk to themselves and others."