The phrase catch 22 could have been tailor-made for the world of
secure accommodation and the mental health issues facing children
and young people in such units.
As part of its campaign to highlight improvements needed in mental
health services for children and young people, Community
Care carried out a survey of 30 secure children’s homes. The
results show how difficult it can be to gain services and the
paradoxes that are part of life in a secure children’s home (see
case study below).
They also reveal the high number of children with mental health
problems in secure accommodation and raise serious concerns over
staff training and the provision of child and adolescent mental
health services. Forty-seven per cent of homes pointed to the need
for more staff training in mental health issues, while 29 per cent
wanted better liaison with and services from local CAMHS.
Just over one-third of homes say none of their staff have received
any formal training in mental health issues. Respondents also say
they struggle to afford available training and face the difficulty
of covering staff absent on courses.
However, if CAMHS provided more effective services to homes, then
the issue of lack of staff training might be less acutely felt.
While some homes are happy with their local CAMHS, many find
services either patchy or non-existent. Mary Graham, manager of the
Atkinson Unit, a secure accommodation unit in Exeter, says Devon
CAMHS is three or four people short, and that in “practical terms”
the unit has no access to services because of insufficient
The unit contracts a psychiatrist for half a day once a fortnight
and has recently acquired some input from a community psychiatric
nurse. But Graham’s “ongoing battle with psychiatric services” is
that psychiatric services will not provide long-term services for a
child or young person in secure accommodation, because it is in an
environment they do not control.
The other battle, she adds, is funding and providing services for
children placed out of their own localities. Given there are only
32 secure units in England and Wales, all of which are
oversubscribed, problems are commonplace and need to be addressed
rather than becoming a block to service provision.
Roy Walker, chairperson of the Secure Accommodation Network, an
organisation for managers of secure children’s homes, points to
further problems in government guidance that states young people
should not be kept in secure accommodation solely for the purpose
of receiving treatment. “But sometimes it’s the only place they can
access treatment,” says Walker.
Once they are in secure accommodation, services must intervene
quickly given the short stays – often less than six months – of
many children. However, it can take four to six weeks to identify
the type of intervention needed, then the child leaves before a
course of treatment is completed. “It just seems such a waste of
two or three months,” says Juliet Oridge, manager of Birmingham’s
Earlswood Secure Unit. “If you do lock up a child you need to get
those services working immediately.”
One solution might lie in the community homes health team model of
services, as exemplified by Merseyside’s Redbank Community House.
Manager Andrew Copp describes how, early this year, three secure
children’s homes and the health authority pooled budgets of some
£220,000 per annum and launched a staff team to address the
individual homes’ frustrations in gaining access to health and
mental health services. Copp says the team is used on a daily basis
with much success already. “It’s the best way that I am aware of
for obtaining the necessary type and level of services for young
people in secure accommodation,” he adds.
But for Walker, care in secure accommodation for children is still
the “Cinderella service” in health and social services. He wants to
see more specialist workers supporting social workers, although he
says that both parties could learn more from each other.
He also wants more resources and better joint working. “Given that
secure accommodation should be the last resort and is very
expensive, it is surely beholden on us to give young people in
special placements, the best help we can,” he says.
In February 2002, a secure children’s home admitted a
young man, aged just under 16, who was experiencing the onset of
schizophrenia. He was sectioned following a day-and-a-half of
The home looked after the young man for a week. During this
time, it incurred £3,500 in additional costs because of the
young person’s need for 24-hour supervision owing to his
inability to sleep and the damage he caused by urinating and the
smearing of faeces. He could not be given medication to suppress
his symptoms because that would have required 24-hour nursing
In trying to secure an appropriate place, the home dealt with
the Home Office, the Youth Justice Board, a variety of adolescent
psychiatric units, an NHS secure accommodation unit and three
In the case of adolescent psychiatric units, once they heard the
young person was sectioned, they would not take him on the grounds
that they would only deal with a young person who wanted to
Adult psychiatric hospitals would not take him because he was
only aged 15.
The NHS secure unit tried to use county psychiatric services
where two potential NHS trusts were identified. However, one did
not take adolescents, while the other did not have the facilities
to treat him.
After a week, he was placed in a regional adult forensic
psychiatric unit. After two months, he was transferred to an
appropriate adolescent psychiatric unit.
Case study courtesy of Andrew Copp, manager, Redbank
Community House, Merseyside.
Of the homes which responded to the Community Care survey:
- All reported young people demonstrating mental health problems
such as anxiety, depression, emotional and behavioural
- 53 per cent reported mental disorders such as psychosis or
- 47 per cent said young people in their homes had eating
- All had witnessed self-harming.
- 47 per cent had experienced suicide attempts.
- 47 per cent had sectioned a young person in the last year.
- 82 per cent said young people in their homes needed in-patient
- 82 per cent said they were “sometimes” able to meet the mental
health needs of young people in their unit.
- 35 per cent said none of their staff had received any formal
- 59 per cent said their staff “sometimes” felt equipped to
assess whether a young person had a mental health problem.
- 65 per cent said they had access to the local CAMHS, but 47 per
cent said they had difficulties in their relationship with the
service, while only 29 per cent said there were no
- 76 per cent said the young people they worked with were not
generally reluctant to use mental health services.
- Homes were split 50:50 on whether labelling young people as
“mentally ill” meant they would not receive treatment.