Lack of mental health support leaving children stuck in hospital – thinktank

Children with serious mental health problems are becoming trapped in NHS psychiatric units, unable to leave because care is unavailable outside hospitals, a thinktank has said.

NHS figures show that between October 2015 and September 2016 children and young people in England spent almost 9,000 days in hospital after being declared fit to be discharged. Some end up stuck in units for several months.

NHS England did not tell the Education Policy Institute how many patients were involved in the 9,000 days, despite being asked this in a freedom of information request. But the thinktank said data showed the problem was growing.

The total number of what the EPI termed “wasted days” was 42% higher between December 2016 and February 2017 than in the same period in 2015-16. In January alone this year, under-18s spent 804 delayed days in mental health inpatient units, compared to 553 the previous January.

Delayed discharges of such patients can occur because their home area cannot provide the specialist support they need to ensure they remain safe.

Sarah Brennan, chief executive of the charity Young Minds, said: “Far too many young people are being left in limbo in mental health hospitals because the right support isn’t available in their community. In some cases they may have to wait weeks or even months before they are discharged.”

Javed Khan, the chief executive of Barnardo’s, said: “Intensive community mental health support should be available for every child regardless of where they live, to prevent their issues escalating and avoid them being admitted to hospital.”

Emily Frith, the author an EPI report on children’s mental health, urged NHS England to ensure there were enough teams of specialist staff in the community to help discharged patients. Government policy is to increase the number of intensive outreach teams offering under-18s help with mental health conditions, but in 2014 just 64% of providers of inpatient care said they had one.

“Being in hospital for a mental health condition can be a disturbing experience for a young person. For example, there is the risk that they will witness frightening incidents such as another patient’s self-harm or that their condition gets worse due to being separated from their friends and family,” said Frith.

“Being in hospital also disrupts their education. Young people should therefore remain in hospital for no longer than is necessary.”

EPI research also found that, despite pledges to ban the practice, children and young people are still being treated in adult psychiatric units because of a shortage of beds.

Eighty-three under-18s were treated on adult wards for a total of 2,700 days in the last three months of 2016 – an average of 33 days each.

The number of child and adolescent mental health services (CAMHS) beds available for inpatients has risen by 71% since 1999 to around 1,440, although almost half of these are provided by the private sector, not NHS trusts.

Despite the increase, the NHS South region ran out of CAMHS beds on two occasions during 2016-17, and the London region did so once.

CAMHS units are have been affected by serious staff shortages. One in nine units is failing to provide staff-to-patient ratios regarded as the minimum acceptable, 24% are struggling to employ enough staff and 19% of the outlay on CAMHS pay goes to temporary bank and agency staff.

Janet Davies, the chief executive of the Royal College of Nursing, said: “The youngest and most vulnerable are being let down by a lack of beds and nursing staff in all parts of the country. Mental health and community care are two of the areas hardest hit by the severe shortage of nurses.”

NHS England said the EPI report “recycles old data [and] ignores the fact that children and young people’s mental health services are now expanding at their fastest rate in over a decade, including new eating disorders clinics, shorter waits for specialist care, and a major increase in specialist inpatient facilities for underserved parts of the country. Rear view mirror commentaries are all very well, but services are now changing fast – for the better.”

It highlighted an article in Tuesday’s New York Times which described the NHS’s efforts to improve mental health care as “the world’s most ambitious effort to treat depression, anxiety and other common mental illnesses”.