Mental health: Barriers to suitable care for young identified

Adult inpatient mental health services face significant staffing and training barriers to meeting their legal duty to provide age appropriate treatment for young people by April 2010.

A self-audit by 26 adult wards against government-commissioned standards drawn up by the Royal College of Psychiatrists found 70% of the more than 170 standards – and two-thirds of those deemed essential – were met. 

But 37% of staffing and training standards – and 46% of those deemed essential – were met on average.

Mental Health Act duty

Under section 31 of the Mental Health Act 2007, ward managers must ensure that patients under 18 are cared for in an environment suitable for their age and consult people with experience of working with the age group in doing so.

However, the report on the self-audits, produced by the Royal College of Psychiatrists, identified particular concerns in the links between adult services and child and adolescent mental health services.

Just 12 of the 26 wards fully met the criterion for having access to a named Camhs professional or team for advice and support. Barriers included there being no Camhs service in the mental health trust, the local Camhs team having an upper age limit of 16 or advice and support only being available for under-18s in full-time education.

Difficulties in finding trained staff

Many wards had difficulties in finding trained staff to work with young people and in establishing links with the Camhs teams attached to the young people admitted to their ward.

Less than half of the wards (42%) did three-yearly Criminal Record Bureau checks, as opposed to checks only on appointment, while many reported that staff were not checked against the Protection of Children Act (POCA) list of staff banned from working in children’s social care.

Only 16% of wards were able to meet the criterion that induction training of staff should cover safeguarding young people, and many reported that child protection and safeguarding were not incorporated into the shorter induction training they provide for bank staff. Many wards said they were reviewing this.

More positively, at least 20 of the wards had named staff members who took responsibility for safeguarding the rights of young people admitted.

Recommendations

The report made a number of recommendations to improve joint working between Camhs and adult mental health services, including:-

• For local Camhs services to designate a named team and psychiatrist to provide support to the relevant adult ward.
  
• For primary care trusts and children’s trusts to ensure contracts with Camhs and adult mental health services promote joint working. Camhs services should be adequately resourced to support adult wards while contracts with adult services should include “robust quality assurance” on meeting the needs of young people.

Commenting on the results, Paula Lavis, YoungMinds policy and knowledge manager, said: “We welcome the fact that these areas are committed to improving their services, but some of these areas still have a lot of work to do if they are going to provide the type of service that young people should expect as standard.  

“What the report also identifies is that the whole range of services, be that Camhs or adult mental health services, need to be improving their services as well.

‘Very worrying’

“It is very worrying that less than 50% of services met the criteria for the section on staffing and training, but if you look at the range of scores some areas are doing quite well, but many are doing very poorly.  This fits with what we know about the patchy nature of mental health provision in this country.”

The Royal College of Psychiatrists is due to publish a revised version of its self-assessment standards on the back of the pilots and will then be helping trusts review their performance over the coming months.

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