Ministers launch review over 'inappropriate' child admissions to Scots adult mental health wards

According to specialists, admissions of a young person to an adult ward should only be acceptable in rare situations while health boards have a legal duty to provide age-appropriate services and accommodation.

A shortage of beds is among the reasons given for young people being admitted to adult wards instead of getting specialist care, according to a report published today by the Mental Welfare Commission watchdog.

READ MORE: Children still being treated on adult wards

Despite a greatly increased demand on mental health services, there are currently only 48 specialist hospital beds provided by the NHS in Scotland for adolescents with mental health problems.

These are located in three child and adolescent mental health services (CAMHS) inpatient units (Dundee, Edinburgh and Glasgow) and there is a further six place unit for five to 12-year olds in the Royal Hospital for Sick Children in Glasgow. There is no in-patient provision north of Dundee.

The Scottish Children’s Services Coalition (SCSC), an alliance of leading independent and third sector providers of children’s services, which is urging the Scottish Government to "up its game" said many children and young people with severe mental health problems were being admitted to non-specialist adult and paediatric hospital wards which are in many cases "inappropriate" to their needs.

The Scottish Government said it will consider the points raised by the MWC "in full" and that it would conduct an "independently-led review" of IPCU provision for under-18s with a clinical director of Child and Adolescent Mental Health Services appointed to lead it.

The review will last approximately five months, with ministers expecting it to conclude in Autumn of this year.

“We will also publish a protocol for admissions of young people to adult wards in the coming months," said a Scottish Government spokesman.

The Mental Welfare Commission has said that a lack of provision for highly specialised care for young people with learning disability and for those who have offended due to mental health difficulties is also contributing to the problem.

It has called on the Scottish Government to prioritise providing intensive psychiatric care unit (IPCU) facilities for young people – a recommendation the Commission has been making for a number of years. Health Last summer, health secretary Jeane Freeman said she recognised the national need for secure child and adolescent mental health inpatient facilities in Scotland and a new unit was planned.

It came as a tribunal heard evidence from the psychiatrist of a 17-year-old that a secure psychiatric care unit in Edinburgh where she was being treated was an "unsuitable environment"

The teenager's mother she was "terrified" of the adult men and felt sexually vulnerable and unsafe in a mixed unit with eight adult men.

In the weeks before her admission to the IPCU, the teenager had been in an adolescent mental health unit.

The commission has called on health boards to review specialist advocacy for young people admitted to non-specialist wards. This follows the further finding that only 16% of the young people admitted to non-specialist wards had access to support that specialised in the needs and rights of young people.

It also said that while there are plans being developed for facilities to support young people requiring forensic or learning disability care in Scotland, there needed to be a "clear process" for those needing those services now.

Dr Arun Chopra, executive director (medical) at the Mental Welfare Commission, said: “Whilst it was reassuring to see that the vast majority of young people had specialist senior medical input on admission, adult wards differ in staff training and ward environment to those designed to care for young people.

“Adult intensive psychiatric care units (IPCUs) in particular can often be unsuitable environments for adolescents. They are specialised units for adults who are very unwell and present with high risk to themselves or others.

“The lack of a resource or an agreed plan on how to manage situations when IPCU care is required causes difficulties for children and young people, their families and the clinicians working for them. While the numbers of young people admitted to adult IPCUs is low, we remain very concerned about the lack of these facilities in Scotland; an issue we have raised for a number of years, and will continue to raise.”

Under the Mental Health (Care and Treatment (Scotland) Act 2003 Health Boards are required to provide appropriate services and accommodation for young people admitted to hospital for treatment of their mental disorder.

A spokesperson for the SCSC said:“We are clearly concerned about the increasing number of those being admitted to adult mental health wards, often inappropriate to their needs, both in terms of staff training and the ward environment. The Scottish Government needs to up its game on this and provide adequate facilities, ensuring that there are sufficient specialist bed numbers for those requiring them. There is also currently no provision north of Dundee and this requires to be urgently addressed.

“For children and young people who require inpatient mental health care, a lack of such services means that they frequently remain at home, often until the family reaches crisis point, leaving them feeling isolated and delaying recovery.

“These are among the most vulnerable members of our society and we owe it to them to give them the adequate care and support that they need.”

There are three specialist units for inpatient treatment of children and young people – Skye House in Glasgow which covers the west of Scotland, the Young People’s Unit in Edinburgh which covers the east of the country, and Dudhope House in Dundee which takes patients from the north of Scotland.

The National Child Inpatient Unit based in Glasgow receives admissions of children under the age of 12 years with mental health difficulties from across Scotland.