Why I’m asking urgent questions about the state of mental health provision for children.
Over the past week the case of Child X, graphically described in a series of judgments by the President of the Family Division Sir James Munby, has captured headlines and sparked public anger. Kept in what is basically a stripped down cell, shorn of any personal effects, decoration or entertainment, sleeping on a mattress on the floor and monitored 24/7 by two staff who must remain within arms length distance, this 17 year old girl has made repeated efforts to kill herself yet been refused a bed on a mental health unit by the NHS. As Sir James angrily concluded one of his judgments, “What this case demonstrates, as if further demonstration is still required of what is a well-known scandal, is the disgraceful and utterly shaming lack of proper provision in this country of the clinical, residential and other support services so desperately needed by the increasing numbers of children and young people afflicted with the same kind of difficulties as X is burdened with.”
But what Sir James also said in a further judgement this week bears repeating: “a mass of informed, if anecdotal, opinion indicates that X’s is not an isolated case”.
As Children’s Commissioner, I know that is true. Over the past week my office has been helping two carers desperate to secure mental health accommodation for children for whom they are responsible. One teenager, who I will call Y, has been in mental health crisis for over a month. Mental health professionals who have been working with Y said that although Y met the criteria for being sectioned, they were unable to section as there was no bed available in the country. Eventually, the situation became critical and Y had to be rushed to A&E via ambulance, remaining there for several hours while professionals tried to find suitable provision – and at which point I was called by the carer. No suitable bed was found and Y was given makeshift arrangements in A&E.
After two days in A&E, Child Y was given a temporary (emergency placement) bed in a medium secure unit while awaiting further assessment for specialist treatment. Subsequently we were informed there was pressure to move Child Y out of this bed within days, to make way for Child X following the media outcry. This is an unsubstantiated claim, but a credible one in a system under such strain that day after day one highly vulnerable child must make way for another, even more vulnerable one.
In the event, Child X has been found another bed elsewhere but Child Y still awaits a permanent placement.
The specialist beds needed for Child X, Y and many others like them – children at great risk – simply are not available: according to the judgments published by Sir James Munby, no bed in a low secure children’s unit is currently expected to become vacant in the whole of England for 3-6 months.
My office receives reports of these problems throughout the secure estate, with local authorities unable to find placements in secure children’s homes as well as hospitals. On one day this week I was told there were 23 requests for beds in secure children’s homes for children at risk, and only 3 beds available.
This is the bare tip of an iceberg: the reason many of these cases come to me is that the children are in the care of the state and local authorities and children’s homes managers know that they can contact me to ask for help. But there are parents across the land struggling to access suitable mental health beds for their very sick children. It is, as Sir James said, a disgrace to a supposedly civilised country.
And, as Sir James also said, much of the evidence about the extent of the problem is anecdotal. I want to find out exactly how acute this crisis is. I have therefore asked the NHS to provide me with data which should show for the first time how many children wait for how long, with which conditions, and then how far they have to travel to secure the inpatient mental health care they need. It isn’t only local authorities, carers and parents reporting these problems to me. I’ve been told by headteachers that schools, at the end of their tether, are ending up taking disturbed children to A&E as they simply don’t know how else to get treatment for them. We know from the NHS’s own figures that A&E admissions for children with mental health issues have almost doubled in the last five years, to over 22,000 last year.
The case of Child X caused anger, but it is not unique. My office has submitted a series of data requests to the NHS to reveal the extent of unmet demand which the cases of Child X and Child Y illustrate. Only once we have transparency about the scale of this problem, can we begin to face up to what is needed as a country to solve it.
The Office of the Children’s Commissioner has statutory powers to request data from public authorities. It has made the following data request of the NHS:
In-patient Children’s Mental Health Data Request
We have asked NHS Digital to tell us.
– How many children go into in-patient mental health care each year
– What kind of in-patient units they go into (for example there are specialist units for children who pose a substantial risk to themselves (‘secure’) or to treat eating disorders).
– How many of each type of specialist ward there are; how many beds there are and in what area the units are located.
– The home area of the children entering in-patient care for each unit. This will allow us to determine how far away from home children are being sent to access in-patient care and which areas have the biggest numbers of children sent far from home.
Low-Secure and Medium-Secure Mental Health Admissions Data Request
A child can only be referred to low-secure or medium secure if a child psychiatrist deems them a ‘substantial’ risk to themselves or others. We have asked NHS England to tell us:
– How many children were referred to them last year
– How long these children waited for an assessment, what was the outcome of this assessment and then how long they waited for admission.
– For those children who were admitted to wards, we have asked what type of wards they were admitted to.
– For those children not admitted to a ward, we have asked why this is.