Mental health inpatient settings: Supporting safe care during transition from inpatient children and young people’s mental health services to adult mental health services (HSSIB, 12 December 2024)

Summary

This is one of a series of Health Services Safety Investigations Body (HSSIB) reports on the theme of patient safety in mental health inpatient settings. This investigation explored the issue of care of people experiencing mental health problems and includes discussion about suicide, death and sexual safety. 

The aim of the investigation was to examine the impacts of transition from inpatient children and young people’s mental health services to adult mental health services on people who have experienced it, their families and carers, and on staff involved. The investigation also considered wider system implications regarding the integration of childhood to adulthood transitional services across health, social care and education.

Content

Key findings

• Young people may be discharged from inpatient children and young people’s mental health services because they have reached ‘transition age’ and not because their mental health care needs have changed.
• Adult mental health services criteria for ongoing care as an ‘adult’ inpatient may mean young people are discharged from inpatient children and young people’s mental health services to an alternative setting which is not suitable to meet their ongoing needs, for example bed and breakfast hostels, with community services providing more limited mental health care and support.
• Young people, families and carers are not reliably informed of, or prepared for, the differences in care approach between inpatient children and young people’s mental health services and inpatient adult mental health services.
• Health, social care, local authorities and education do not always work together in a consistent and integrated way to support positive outcomes for young people who are transitioning from inpatient children and young people’s mental health services to adult mental health services.
• There is currently no alignment, equity of access, or clear responsibility and accountability for children and young people’s health, education and social support that spans their transition from childhood to adulthood.
• In many children and young people’s mental health services, ‘blanket’ safeguarding measures are implemented overnight for people reaching 18. These measures are not based on a change in individual behaviours or risks. Perceived safeguarding challenges are a driver for rigid aged-based transitions.
• Young people, their families, and carers described that communication and information sharing changed when the young person reached 18. This meant safety risks were not always discussed and families and carers were not involved in safety planning or risk mitigation.
• NHS England service specifications and commissioning guidance for inpatient children and young people’s mental health services do not support needs-based flexible transitions. More flexible, developmentally appropriate needs-led transitions were seen to have more positive patient outcomes.
• Definitions of ‘children’, ‘young people’ and ‘adults’ vary across legal and professional guidance. This contributes to challenges in defining these groups across services.
• In comparison with young people in mainstream education, the education needs of young people transitioning from inpatient children and young people’s mental health services due to reaching 18 are not always being met.
• A robust training needs analysis and competency assessment of the inpatient mental health workforce is required if changes to the specifications and delivery of inpatient mental health services are made.

Report recommendations

• HSSIB recommends that NHS England reviews and updates its inpatient children and young people’s mental health services specifications and commissioning guidance to ensure they support developmentally appropriate, needs-based transitions. Any changes to service delivery will require a review of funding lines to enable successful implementation.
• HSSIB recommends that NHS England reviews and revises its guidance and policies to ensure consistency regarding the language used for age ranges (for example children, young people, young adults and adults). This is to support a consistent approach to healthcare delivery that aligns services and mitigates gaps.
• HSSIB recommends that the Care Quality Commission work with the Department of Health and Social Care to understand prioritisation for assessing transitions in mental health care within Integrated Care System assessments. Any subsequent work should include the development of a methodology to identify the challenges described in the investigation report relating to transition from inpatient children and young people’s mental health services, to adult mental health services. This is to improve the safety, quality and consistency of transitions across England.
• HSSIB recommends that the Department of Health and Social Care works across government to identify opportunities to support closer cooperation between local government, education and health systems for the safe and effective transition of young people into adulthood. This is to ensure alignment, equity of access, and clear responsibility and accountability for their health, education and social support that spans the ages of 16 to 25. Cross governmental work would be supported by the adoption of consistent language for age ranges of children, young people, and adults.
• HSSIB recommends that NHS England provides guidance regarding communication of essential safety and risk mitigation information when patients transition from inpatient children and young people’s mental health services due to reaching transition age. This is to safeguard vulnerable people and may include how to share information with families and carers, health and social care providers, and third sector organisations.