Mentally unwell children refused care at a third of NHS ‘place of safety’ units

Mentally unwell children are barred from getting care at more than a third of the NHS ‘place of safety’ services set up to assess people in crisis who have been detained by police officers for their own safety, the Care Quality Commission has found

The CQC found that 56 of the 161 NHS places of safety in England refused to admit people under the age of 16. The place of safety units allow health professionals to assess people who have been detained by police under section 136 of the Mental Health Act. If the units cannot be accessed, police officers are often left with no option but to detain the person to a police cell.

In January, an investigation by BBC News found that 305 under-18s had been detained in police cells in England and Wales in the first 11 months of 2013 because officers did not have anywhere else to take them.

The CQC said providers that restricted young people from accessing health-based places of safety should “review their local protocols”. Norman Lamb, the care and support minister, said the situation must be addressed.

“It is unacceptable for a child in a mental health crisis to be taken to a police cell because there is no health-based place of safety. Our crisis care concordat reinforces the duty on the NHS to make sure that people under 18 are treated in an environment suitable for their age, according to their needs,” said Lamb.

The CQC uncovered the restrictions on young people’s care as part a wider review it is conducting into place of safety availability.

Police and social workers have reported problems accessing the units for both adults and children in crisis. In 2012/13, police officers used section 136 powers 21,814 times. In over a third of cases (7,761) people were detained to police cells.

The CQC collected information on place of safety availability from all of the 56 NHS mental health trusts and two independent providers that run the services.The regulator found that all but one local authority area is served by at least one place of safety, although the number and capacity of local services was variable. The CQC has produced a map of the services to help police officers identify local units.

Prior research has found that even where local place of safety units exist, access to them is often undermined by short staffing or a lack of beds. The CQC has obtained data on staffing levels at each unit and will publish a stand-alone report with its full findings in the summer.

Faye Wilson, chair of the British Association of Social Workers’ mental health forum, said: “The CQC’s work highlights how fragmented and patchy place of safety provision is for adults and, particularly, for young people. It is deplorable that young people at their most vulnerable cannot access age appropriate places of safety. We want to work with CQC to get that addressed across the country.”

Ruth Allen, chair of the mental health faculty of The College of Social Work, said: “The CQC findings add to a growing national picture that child and adolescent mental health services are geographically unequal and disturbingly inadequate. Children and young people are extremely vulnerable when in mental health crisis and need access to good quality care, regardless of how they come to the attention of services.

“The College’s own survey of Approved Mental Health Professionals last year revealed a shocking lack of access to health-based ‘place of safety’ also for adults experiencing a mental health crisis. More than three quarters of AMHPs who responded to the survey experienced people being held in police cells or hospital A&E units due to the lack of access to a suitable facility to treat them. That this service deficit is replicated for young people is additionally concerning.”

Sophie Corlett, director of external relations at mental health charity Mind, said it was “shameful” that some entire counties only had place of safety capacity to admit one person at any one time.

“No wonder a third of people detained under Section 136 of the Mental Health Act end up in a police cell. This is a wake-up call for Clinical Commissioning Groups, who urgently need to look at whether the services they provide are sufficient to ensure people get the help they need in an appropriate environment,” she said.

The Department of Health and the Home Office are currently seeking views from mental health professionals, including social workers, on reform of section 136 of the Mental Health Act. An online survey can be accessed here.