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My advice and advocacy service, Help at Hand, supports many children with autism or mental health difficulties who do not have suitable accommodation, therapy, or support available to them. Sometimes this is because the provision is not readily available anywhere in the country, or it may be that there is disagreement between NHS and children’s social care services about who is responsible.

The team is contacted by parents, professionals, and children themselves, often when the situation has reached crisis point and they are in a hospital or emergency accommodation that isn’t suitable for their needs. This leaves children in highly stressful and sometimes dangerous situations, which increases their mental distress rather than supporting them to recover.

Children lacking the right therapeutic provision, or caught in the gap between health and social care, were key themes in the recent Help at Hand Report and the experiences shared by these children are central to shaping my priorities as Commissioner.

Here are some examples of children the team has supported. Their names have been changed to protect their anonymity.

Anna is 15 years old and has autism, OCD, and anorexia, which became so serious that she was hospitalised. She was placed in a general paediatric ward but was unable to move to a specialist adolescent mental health unit because there were no places available. Anna’s mother was concerned that she was not receiving appropriate mental health support while in hospital and there was no clear plan for moving her on. She contacted the Help at Hand team, who spoke to Anna directly about her wishes for her care. She said she wanted to go home or to a therapeutic setting, with the right specialist support for her needs.

Help at Hand staff attended multi-agency meetings to push for better coordination and planning for Anna, and I wrote personally to the responsible NHS and Children’s Social Care manages to highlight my concerns. The team continued to follow-up with the professionals until a plan was put in place for Anna and she was able to return home safely, with a comprehensive care package and therapeutic support for both her eating disorder and OCD.

Jenny is 17 and a looked-after child, who was placed in a secure children’s home due to due to her violent and self-harming behaviour, which were linked to her past trauma.  When the children’s home could no longer manage her needs, she was moved into unregulated accommodation, with live-in carers. However, she was exploited by criminals and began to severely self-harm, so she was admitted to hospital under the Mental Health Act. Her accommodation provider served notice, but the NHS Trust and Children’s Services could not agree on where she should go, and there were no appropriate therapeutic health or social care placements available. Jenny was moved to a house, rented by the local authority, with a Deprivation of Liberty authorisation to allow care staff to restrain her if she tried to harm herself or others.

Concerned professionals contacted Help at Hand and the team got in touch with Jenny’s independent advocate to understand what she wanted to happen.  The team then arranged and chaired a meeting between senior managers from the NHS Trust and Children’s Services to decide on a plan for Jenny’s accommodation and care which would take into account her wishes,  meet her complex needs, and keep her safe.

John was a child in care who spent more than two years in a secure mental health unit due to PTSD and complex trauma. He was approaching 18 and his clinical team at the unit felt he could move to a therapeutic residential setting in the community. However, after several months of looking, neither the Children’s Social Care team nor Adult Services had been able to find anything suitable. The long period John had spent in hospital, and the ongoing uncertainty about when he would be able to leave, were having a severe impact on his mental health and he became increasingly aggressive, so he was placed in isolation.

The hospital contacted Help at Hand to raise concerns about John’s situation and welfare, and the team spoke to him directly about his experiences and wishes for the future. They also ensured he was given an independent mental health advocate to represent his views in all care planning going forwards. Given thechildren’s urgency of John’s situation, I wrote to the directors of the NHS Trust and Children’s Social Care to recommend a multi-agency meeting, facilitated by Help at Hand. This resulted in a plan to move John to an interim community setting with intensive mental health provision. Health and social care professionals also agreed to work closely to secure a long-term supported living placement, with wraparound mental health support.

Following the meeting, the team asked directors to reflect on how this could have been achieved sooner for John, if cooperation had worked better and his welfare had been kept at the forefront of plans.I am concerned that a lack of mental health provision and therapeutic community placements is having a serious detrimental impact on some of the most vulnerable children in our society. This is why I am prioritising children’s mental health in my work as Children’s Commissioner. It is also why the Help at Hand team, in partnership with my wider office, will undertake a project focusing on those children who are left without adequate support due to disagreements between health and social care professionals. I want to see this critical issue addressed, with clear protocols in place, so that no child is left to fall between the gaps.

Children, parents, and professionals can contact Help at Hand by calling 0800 528 0731, emailing [email protected], or using our online form:

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