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This report sets out the Care Quality Commission (CQC) activity and findings during 2023/24 from their engagement with people who are subject to the Mental Health Act 1983 (MHA) as well as a review of services registered to assess, treat and care for people detained using the MHA. The MHA is the legal framework that provides authority for hospitals to detain and treat people who have a mental illness and need protection for their own health or safety, or the safety of other people. What the report found: Systems We remain concerned that the high demand for mental health services, without the capacity to meet it, means people cannot always get the right care at the right time. Not being able to access care in a timely way can lead to people’s mental health deteriorating while they wait for support. Through our monitoring activity, we have seen how system pressures mean people are detained far from home or in environments that do not meet their needs. Many services told us that patients seem to be more unwell on admission than in the past. Services need to balance the increase in demand for inpatient beds with ensuring existing patients are not discharged too soon. Workforce In 2023/24 there were continuing problems with workforce retention and staffing shortages, as well as concerns around training and support for staff. Although the mental health workforce has grown by nearly 35% since 2019, shortages in both medical and support roles continue to have a negative impact on patient care. Shortages of doctors also continue to affect the delivery of our second opinion appointed doctor (SOAD) service. We remain concerned about the long-term sustainability of the service, with proposals in the Mental Health Bill due to increase the numbers of second opinions required while reducing the timeframes for delivery of some second opinions. Inequalities We are concerned that some of the key issues we raise in this report, including access to mental health support, are particularly challenging for certain groups of people, such as people from ethnic minority groups and those living in areas of deprivation. We identified several issues around people not understanding their rights, despite services having a legal duty to provide this information. There was variation in how well services met people’s needs. While many provided access to spiritual leaders, we remain concerned about gaps in the knowledge of staff around caring for autistic people. Children and young people Children and young people continue to face challenges in accessing mental health care. Increasing demand is leading to long waits for beds, and increases the risk of being placed in inappropriate environments and/or being sent to a hospital miles away from home. Once in hospital, we are concerned that access to specialist staff is being affected by low staffing levels, leading to patients’ needs not being met. In addition, the quality of physical environments for children and young people varies; access to food and drink, and food preparation facilities were key issues for many children and young people. Challenges in transitions of care between children and young people’s mental health services and adult mental health services remain, with many young people still falling through the gaps and not getting the care and support they need. Environment Through our MHA monitoring visits, we found that the quality of inpatient environments continues to vary. We are concerned about the impact of poor-quality environments on patients and have seen examples of how ageing and poorly-designed facilities affect people’s care. Being able to go outside brings therapeutic benefits for patients, but access to outdoor facilities varied across services. Gardens were usually well maintained, and in some services, patients were encouraged to grow plants and vegetables. However, we also found examples of unwelcoming gardens and at some services, patients’ access to outdoor spaces was limited. This issue was also raised by members of our Service User Reference Panel.- Posted
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It has long been known that a focus on early intervention and prevention in the early years can prevent ill health in the future. With the mental and physical health outcomes of children in England on a downward spiral, the new government’s commitment to raising ‘the healthiest generation of children ever’ has been warmly welcomed by the children’s sector. This blog by Jessica Holden, Policy Adviser at the King's Fund, looks at whether this sentiment will be met with the action needed to address the scale of the challenge.- Posted
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News Article
Royal College of Psychiatrists' analysis of the latest NHS England data shows a shocking 319 children and adolescents in England were forced to travel out of their area for mental health treatment from December 2023 to November 2024. This represents nearly one child every day. These children and young people (under 18s) spent a total of 35,845 days away from their local area, also known as inappropriate Out of Area Placement (OAP)2 bed days, as a result of beds being unavailable in their local area. To mark Children’s Mental Health Week, the Royal College of Psychiatrists is calling on the UK Government to set a target date to end OAPs in child and adolescent mental health services (CAMHS) across England. Extremely vulnerable children and young people with serious mental illnesses, such as eating disorders, self-harm and psychosis, are being treated miles away from their loved ones and support networks, as a result of inappropriate OAPs. With family and friends having to travel so far, visiting often becomes impossible, which only leaves unwell children feeling more isolated, lonely and can be harmful to their recovery. With so few specialist CAMHS beds available and services overstretched, many children are being treated in paediatric wards, without access to specialist mental health services during their stay, or even after discharge. These environments can feel overwhelming, particularly for those with neurodevelopmental conditions such as autism. In addition to setting a target to end the use of OAPs for children, RCPsych is calling for increased availability of NHS CAMHS beds in areas where there is the greatest need. This can be achieved through the intelligent commissioning of beds in areas with persistently high occupancy rates, using models like provider collaboratives. Rachel Bannister’s 15-year-old daughter was diagnosed with an eating disorder in 2014. She was sent to several hospitals far from the family home in Nottingham, including one in Scotland, hundreds of miles away. She was there for six months, including over Christmas. Rachel said: “The whole family were devastated when she went away. I felt as if my heart had been ripped out and I had failed her. We are all still processing the trauma of it all many years later. “During her time away, our telephone conversations revealed her longing for simple gestures such as a hug or a walk in the park. It was heart-wrenching for us to be unable to fulfil those basic needs. “The lack of consistency in her care and treatment have hugely impacted her recovery. Additionally, it has been difficult and often impossible to involve wider family members or her social network in treatment, which I believe is fundamental to recovery." Read full press release Source: Royal College of Psychiatrists, 8 February 2025- Posted
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When Sharren Bridges talks about her daughter’s last summer, in 2021, she chokes up and has to pause. In some ways, it was a good summer. Jen Bridges-Chalkley had a boyfriend and, like most parents of teenagers, Sharren would occasionally act as a taxi driver, taking them down to the local river to swim. On 12 October 2021, Jen killed herself at her mother’s home. She was 17. At the inquest, which concluded in April 2024, the coroner said her suicide could have been avoided if she had received the support she needed “in a timely manner”. It was “a multi-agency failure”, he concluded in the report, which is a devastating document: 81 pages of missed opportunities, bad communication and poor decision-making. “There was a failure of the agencies to work effectively together to ensure that Jen’s needs were met,” the coroner wrote. Safeguarding failure; failure by educational establishments; failure by child and adolescent mental health services (Camhs). “For much of the time between May 2018 and June 2020, she was on a waiting list for therapy from the psychology team and was awaiting assessment.” He concluded that Camhs had failed “properly to assess, diagnose and treat Jen … in order to manage her conditions and minimise her risk of suicide”. Camhs is the NHS service for children with emotional, behavioural and mental health issues. Its staff includes psychiatrists, psychologists, nurses, therapists and social workers. It aims to provide support and treatment, including therapy, medication and in-hospital care. Sharren’s assessment of Camhs, provided in Jen’s case by Surrey and Borders Partnership NHS foundation trust, is simple: “It’s not fit for purpose.” Sharren is angry when she speaks about Camhs. “Jen is a person, she’s my daughter, she’s my everything, and she’s not here any more because people didn’t do their job. They didn’t do their job when she was five, they didn’t do their job when she was 11, they didn’t do their job when she was 14, 15, 16, 17, and now she’s not going to get older than 17.” In a statement, Graham Wareham, the chief executive of Surrey and Borders Partnership NHS foundation trust, said: “We remain deeply saddened by Jennifer’s tragic death and we have expressed our deepest condolences to her family. Our investigation into the support we provided Jennifer found that while we gave care and consideration into delivering a person-centred therapeutic approach to meet Jennifer’s mental health needs, we acknowledge that there were shortcomings. Read full story Source: The Guardian, 6 February 2025- Posted
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untilThis GovConnect webinar focuses on addressing the critical issue of wrongful hospitalisation for neurodivergent youth. Often, misunderstandings of neurodivergent behaviours or lack of appropriate support lead to unnecessary hospitalisations, causing distress for young people and their families. The session will cover strategies for preventing these situations, including early intervention, effective communication between caregivers and healthcare professionals, and the importance of building robust community support systems. It will also explore systemic changes needed in healthcare and education to ensure neurodivergent individuals receive the right care in the right settings. This webinar is designed for parents, educators, healthcare providers and advocates, offering practical tools to reduce wrongful hospitalization and improve outcomes for neurodivergent youth. Register for the webinar- Posted
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News Article
The mother of a bullied 12-year-old girl has said her daughter struggled to get mental health support on the NHS in the months before she killed herself, and accused her school of failing to deal with inappropriate messages circulating among pupils. The mother of Charley-Ann Patterson, Jamie, told a hearing that despite being seen by three medical professionals, Charley-Ann had been unable to get mental health support in the months before her death. In a statement read at an inquest at Northumberland coroner’s court on 12 October, Jamie said her daughter had changed halfway through her first year of secondary school, when she was sent “inappropriate” and “shocking” messages by other pupils. The inquest heard that Jamie first took her daughter to a GP over self-harm concerns in June 2019, but she said she “did not believe that the GP took Charley-Ann’s self-harm seriously, potentially due to her age”. She took Charley-Ann to A&E in May 2020 after a second episode of self-harm, where she was referred to a psychiatric team and given a telephone appointment in which she was told Charley-Ann would be referred to child and adolescent mental health services (CAMHS), but that “it was likely that she would not be seen for three years”. In an appointment with a nurse she was told that she would be referred to the Northumberland mental health hub for low mood and anxiety, but later learned “that this referral was never made”. Read full story Source: The Guardian, 12 October 2022- Posted
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Boy, 17, found dead after seeking mental health help ‘had not seen GP in person’
Patient-Safety-Learning posted a news article in News
A coroner has expressed concern at the difficulty of getting face-to-face appointments with GPs and other health professionals after a 17-year-old boy suffering from mental health problems was found dead. Sean Mark, who described himself as an “anxious paranoid mess”, was desperate for help but felt “palmed off” when he asked for assistance, an inquest heard. He was found dead in his bedroom four months after a phone consultation with a GP and before he had spoken to anyone in person about his concerns. The area coroner, Rosamund Rhodes-Kemp, recorded a verdict of death by misadventure, saying she could not be sure Sean had intended to kill himself. Dr Robin Harlow, clinical director of the Willow Group, where Sean Mark was a patient, said it had increased the number of face-to-face meetings. When told that Sean felt palmed off, he said: “I would want him to be seen face to face at the second time, if not the first time. We have seen a lot more face-to-face appointments since then.” Read full story Source: The Guardian (23 August 2022)- Posted
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Child deaths expose mental health unit pressures
Patient Safety Learning posted a news article in News
Deaths, staff shortages and a culture of life-threatening self-harm are exposing deep fears about the quality of mental health care in hospitals for children and young people. Since 2019, at least 20 patients aged 18 or under have died in NHS or privately-run units, the BBC has found. A further 26 have died within a year of leaving units, amid claims of a lack of ongoing community support. The NHS said it had "invested record amounts... to meet record demand". Child and Adolescent Mental Health Services (CAMHS) units look after about 4,000 patients with many different diagnoses each year. The aim is to help them recover over a period of weeks or months through specialist care. Some patients are in and out of the units for years. The BBC has also heard serious claims regarding the unsafe discharge of patients sent home from CAMHS hospitals. Several former patients told the BBC they had serious self-harm incidents or tried to take their own life within days of returning home. Parents have described being on "suicide watch" 24 hours a day, to ensure their child's safety. Read full story Source: BBC News, 9 August 2022- Posted
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Hundreds of children suffering from mental health issues are attending A&E each day, with some waiting up to five days in emergency departments, The Independent can reveal. Internal NHS data leaked to The Independent, shows the number of young patients waiting more than 12 hours from arrival has also more than doubled in the last year. A national survey of senior A&E doctors by the Royal College of Emergency Medicine (RCEM) found in some areas children’s mental health services have worsened in the last three years, while the majority of respondents warned there were no children’s crisis services open after 5pm. One NHS trust chief executive has warned his hospital’s A&Es have seen a “real surge” in both attendances of people with severe mental health issues and a sharp increase in long waits in recent months. One parent, Lee Pickwell, told The Independent his daughter was admitted to paediatric wards several times and stayed days in an emergency “section 136” unit while she waited more than two months for a mental health bed. Dr Mark Buchanan, RCEM’s lead for children’s mental health, told The Independent that despite improvements, children’s mental health services still fall short of what is needed. Dr Buchanan said: “I’ve seen children who have been not seen by Child and Adolescent Mental Health Services (CAMHS), who been refused the referrals, despite the fact that the mum and dad were taking it in turns to sleep outside their bedroom door because they were scared that they’d run away and do some harm.” Read full story Source: The Independent, 13 July 2022- Posted
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'Urgent' changes needed for child disability care
Patient Safety Learning posted a news article in News
The mothers of two teenage boys who died after failures in their care have called on the government to make "urgent improvements" to how children with disabilities are assessed. Sammy Alban-Stanley, 13, and 14-year-old Oskar Nash both died in 2020. Inquests for both boys recorded they had received inadequate care from local authorities and mental health services. The calls were made in an open letter to the secretaries of state for health and social care, and education. Patricia Alban and Natalia Nash asked Sajid Javid and Nadim Zahawi to make fundamental changes to several care areas to prevent future deaths. The pair said they both experienced problems with support for disabled children and families. Services lacked understanding of neurological conditions like autism, they said. The pair also pointed to a lack of access to children and adolescent mental health services (CAMHS), and failure to assess or review the severity of a child's developing needs. Read full story Source: BBC News, 16 June 2022- Posted
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A mother who has seen her suicidal 12-year-old daughter shuttled between placements and then held in a locked and windowless hospital room says she is frightened for her child’s life. Since going into care in Staffordshire nine months ago, Becky (not her real name) has attempted to take her own life on several occasions. Her case throws fresh light on the chronic nationwide shortage of secure accommodation for vulnerable children. “I am constantly told there is nowhere for her,” said her mother, who cannot be identified for legal reasons. “I fear I’ll soon be arranging her funeral due to the systemic failings in health and social care.” Becky has been alone in a locked hospital room since 27 January. The room has no window or access to the outdoors, no furniture except for a bed, and she is permitted no belongings. All human contact is conducted through a hatch. The child’s court-appointed guardian told the high court at a hearing to discuss Becky’s case that she considered “the risk to Becky’s life to be catastrophic”. Read full story Source: The Guardian, 7 February 2023- Posted
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- Self harm/ suicide
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Content Article
This report by NHS Digital presents findings from the third in a series of follow up reports to the 2017 Mental Health of Children and Young People (MHCYP) survey, conducted in 2022. The sample includes 2,866 of the children and young people who took part in the MHCYP 2017 survey. It looks at the mental health of children and young people aged 7 to 24 years living in England in 2022, as well as examining their household circumstances, and their experiences of education, employment and services and of life in their families and communities. Key findings In 2022, 18.0% of children aged 7 to 16 years and 22.0% of young people aged 17 to 24 years had a probable mental disorder. In children aged 7 to 16 years, rates rose from 1 in 9 (12.1%) in 2017 to 1 in 6 (16.7%) in 2020. Rates of probable mental disorder then remained stable between 2020, 2021 and 2022. In young people aged 17 to 19 years, rates of a probable mental disorder rose from 1 in 10 (10.1%) in 2017 to 1 in 6 (17.7%) in 2020. Rates were stable between 2020 and 2021, but then increased from 1 in 6 (17.4%) in 2021 to 1 in 4 (25.7%) in 2022. 11 to 16 year olds with a probable mental disorder were less likely to feel safe at school (61.2%) than those unlikely to have a mental disorder (89.2%). They were also less likely to report enjoyment of learning or having a friend they could turn to for support. 1 in 8 (12.6%) 11 to 16 year old social media users reported that they had been bullied online. This was more than 1 in 4 (29.4%) among those with a probable mental disorder. 11 to 16 year old social media users with a probable mental disorder were less likely to report feeling safe online (48.4%) than those unlikely to have a disorder (66.5%). 1 in 5 (19.9%) 7 to 16 year olds lived in households that experienced a reduction in household income in the past year. This was more than 1 in 4 (28.6%) among children with a probable mental disorder. Among 17 to 22 year olds with a probable mental disorder, 14.8% reported living in a household that had experienced not being able to buy enough food or using a food bank in the past year, compared with 2.1% of young people unlikely to have a mental disorder.- Posted
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Core20PLUS5 is NHS England's approach to reducing health inequalities at both national and system level. The approach defines a target population cohort and identifies five focus clinical areas that require accelerated improvement. This infographic outlines the specific Core20PLUS5 approach to reducing health inequalities for children and young people.- Posted
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- Health inequalities
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In this Guardian article, parents reveal their heart-wrenching struggles to access NHS services, which have sometimes been too late to help their children.- Posted
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Restrictive practices are things that limit the rights of a person, like being able to move around freely. Restrictive Practice is used to stop a person from doing behaviours of concern. These Specialised Services Quality Dashboards (SSQD) are designed to provide assurance on the quality of care by collecting information about outcomes from healthcare providers. SSQDs are a key tool in monitoring the quality of services, enabling comparison between service providers and supporting improvements over time in the outcomes of services commissioned by NHS England. Dashboards include: Restrictive Practice - CAMHS Low Secure Restrictive Practice - CAMHS Medium Secure Restrictive Practice - CAMHS PICU Restrictive Practice - CAMHS T4 Restrictive Practice - D/deaf (Adults) Restrictive Practice - D/deaf CAMHS Restrictive Practice - Eating Disorders (Adults) Restrictive Practice - High Secure (Adults) Restrictive Practice - Low Secure (Adults) Restrictive Practice - Medium Secure (Adults) Restrictive Practice - Obsessive Compulsive Disorder and Body Dysmorphic Disorder Service Restrictive Practice - Perinatal Restrictive Practice - Tier 4 Personality Disorder- Posted
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Young people and expert mental healthcare staff say patients are unlikely to receive in-patient mental health care unless they “have attempted suicide multiple times”, according to a new report published by Look Ahead Care and Support. Launched in the House of Lords, the report – funded by Wates Family Enterprise Trust and produced by experts Care Research – argues Accident and Emergency departments have become an ‘accidental hub’ for children and young people experiencing crisis but are ill-equipped to offer the treatment required. Based on in-depth interviews with service users, parents and carers, and NHS and social care staff from across England, the findings from the Look Ahead Care and Support report draws on experience of treating depression, anxiety, self-harm, suicidal thoughts and suicide attempts, eating disorders, addiction and psychosis. Key findings Report commissioned by Look Ahead Care and Support finds increasing demand for children and young people’s crisis mental health services amidst challenges with existing services. Yet researchers heard from professionals, service users and their families and carers found that you “had to have attempted suicide multiple times to be offered inpatient support". Interviewees say A&E departments have become an ‘accidental hub’ for children and young people experiencing crisis but are ill equipped to offer the treatment required. Private sector providers now deliver the majority of support for hospitalised young people with mental health difficulties at “exceptionally high” cost. Report recommends alternative community crisis services, including supported housing away from hospital settings to reduce pressure on A&E and reduce costs by more than 50%- Posted
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Samuel Howes was 17 when he died by suicide in September 2020. Samuel had ongoing mental health issues including anxiety and depression. This led to his use of drugs and dependency on alcohol, which in turn further worsened his mental health. This blog by his mother Suzanne details her experience of the final day of the inquest into her son's death, which found multiple failings on the part of Child and Adolescent Mental Health Services (CAMHS), social services and the police.- Posted
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Niche Health and Social Care Consulting (Niche) were commissioned by NHS England in November 2019 to undertake an independent investigation into the governance at West Lane Hospital (WLH), Middlesbrough between 2017 up to the hospital closure in 2019. WLH was provided by Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) and delivered Tier 4 child and adolescent mental health services (CAMHS) inpatient services. This review initially incorporated the care and treatment review findings of two index case events for Christie and Nadia who both died following catastrophic self-ligature at the unit. The Trust subsequently agreed to include the findings of the care and treatment review of Emily which related directly to her time at West Lane Hospital, even though Emily did not die at this site. This is to ensure that optimal learning could be achieved from this review. Summary of recommendations Recommendation 1 (TEWV): It is clear from the research that patients and their families (and some staff) were ignored and that their concerns and complaints are now found to be, on the whole, justified. The Trust must seek assurance that complaints, concerns and feedback are taken seriously and managed in line with The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 particularly in relation to recording receipt of a formal complaint. Additionally, feedback and concerns on a service must be comprehensively reported and reviewed on a frequent basis, and importantly, that feedback is acted upon. Recommendation 2 (TEWV): Formal corporate decision-making processes and outcomes were difficult to trace and evidence. The Trust should seek assurance that there is a ratified minute of key organisational decisions. Recommendation 3 (TEWV): Action plans relating to West Lane Hospital were not connected to improvement programmes or risk registers. The Trust should ensure that there is strategic oversight of actions through the Board, Committee or working group where multiple interventions are involved. This will ensure that actions are not duplicated with other activities or overlooked. Using a programme approach around improvement plans and risk registers increases the accountability and enforceability around actions. Recommendation 4 (TEWV): There were issues with the consistent application of Duty of Candour at the Trust. The Trust should seek assurance that there are now mechanisms in place to assess that the Duty of Candour Policy is effectively implemented. Additionally, where there has been a death in a service, whether through self-harm/suicide or homicide, that families are given appropriate, meaningful, timely and compassionate family liaison and support through personal contact with a nominated officer of the Trust. Recommendation 5 (TEWV, CNTW, North East & North Cumbria ICB, Middlesborough Council, NHSE and provider collaborative, and CQC): TEWV, CNTW and System Partners need to seek assurance that they have resolved the problems associated with the clinical transitions phase (between services and child to adult). A compound recommendation is required to address this deficit: a) TEWV must provide assurance that a full gap analysis between the 2018 Healthcare Safety Investigation Branch (HSIB) investigation and its own position has been completed. As the Trust still delivers Tier 3 CAMHS services they should expedite a review of processes and procedures in relation to transitions. b) CNTW need to expedite a review of processes and procedures in relation to transition of CNTW young person inpatient to adult services. c) Patient as well as stakeholder feedback associated with transitions between CAMHS and other services (such as AMHT) should be sought and incorporated into service redesign by all parties. d) Effective governance surrounding transitions was not always in place. The good practice relating to transitions which is described within NICE Guidance should be translated into practice and delivered by all parties. e) Where a young person is in receipt of T4 care and transferring back to T3, there must be a joint response between health and the relevant local authority children’s services (in this case Middlesborough Council) so that the young person is prepared for life in the community and can be properly supported and their risks appropriately managed. f) ICBs, NHSE and provider collaboratives must ensure that providers with a PICU have a written protocol that details the pathway for discharge, including timescales for involving in arrangements, the families and the young person. This will ensure that, wherever possible, a young person is not suddenly transferred without adequate preparation. Recommendation 6 (TEWV): There was a gap between the development and successful implementation of important care initiatives (such as least restrictive practice), plans and evidence-based changes to practice. The Trust must seek assurance that there are implementation plans for new initiatives, policies or procedures and that these are evidence-based, being implemented correctly within services and monitored appropriately. Recommendation 7: There was a lack of systematisation in relation to the identification, mitigation and actioning of known risks at a ward, service and corporate level. A compound recommendation is required to address this deficit: a. TEWV must ensure that risk assessments for young people in CAMHS are based on a psychological formulation and are developed by a multidisciplinary team in conjunction with the young person and their family. b. TEWV must ensure that proper training is provided to staff around clinical risk management and how to ensure that action is taken consistently. c. TEWV must provide assurance that it meets the requirements of the new Patient Safety Incident Response Framework by 2023. d. The North East & North Cumbria Integrated Care Board (ICB), NHSE, and provider collaborative must seek assurance that TEWV has a robust environmental and ligature risk assessment process and the ability to respond effectively and urgently to mitigate risks identified through this process (including risks identified on Tunstall Ward). e. North East & North Cumbria Integrated Care Board must assure themselves that CNTW are following the NHS Child and Adolescent Mental Health Services Tier 4 (CAMHS T4): General Adolescent Services including specialist eating disorder service specification and the QNIC standards for use of mobile phones and social media access in inpatient environments. f. The application of robust risk assessment forms part of the CQC regulatory framework. The CQC should routinely examine the quality and consistent application of TEWV’s clinical risk assessment, clinical risk training and the relationships to local and corporate risk registers. Recommendation 8 (TEWV): The function of Executive team meetings in terms of operational involvement lacked clarity. The Executive team meetings must clearly define and record actions which they are directly responsible for, or, where actions have been delegated. The ET should recognise that it has the mandate to form task and finish groups. Recommendation 9: Safeguarding between mental health providers and system partnerships was insufficient to protect young people in West Lane Hospital. Despite the availability of Working Together Guidance, responsibilities and obligations internally and externally between agencies (providers and system colleagues) were confused, interpreted differently by individuals and consequently gaps developed. A compound recommendation is required to address this deficit: a. NHS England Specialised Commissioning, the North East & North Cumbria ICB and provider collaborative and the South Tees Safeguarding Children Partnership Board and LADO should now all reflect upon matters raised within this report and determine whether further internal review is required to ensure proper learning occurs within each respective agency. All relevant Safeguarding Children’s partnerships need to ensure that there are sufficient mechanisms in place to prevent a recurrence of the same. b. The North East & North Cumbria ICB and provider collaboratives should obtain assurance that provider organisations have sound systems and processes to safeguard young people in mental health facilities, and these provide regular robust assurance to NHS England Specialised Commissioning of effective working. c. Middlesbrough Council and Health providers/ key partners must ensure that there is clarity about the roles and responsibilities of each agency in the planning and delivery of care to young people in Tier 4 CAMHS provision to ensure that support is holistic and meets the educational; social; physical health and emotional needs of children and young people as well as their mental health needs. d. Local Authorities and Health providers must provide appropriate challenge where there are concerns about unsafe discharge arrangements from Tier 4 inpatient care, including appropriate escalation up to chief officers where concerns for children’s safety are high. e. Durham County Council must ensure that responses to referrals are completed within expected time frames, and subsequent assessments always incorporate the views of the family and young person. f. North East and North Cumbria Integrated Care Board and the Provider Collaborative must consider the impact and risks on Tier 4 CAMHS if a local Safeguarding Board is found to be weak or inadequate, or a local provider is found to have a major staffing issue. g. Where Safeguarding concerns are raised about a child, these must include a formal consideration of other vulnerable family members for the lifespan of care. h. Middlesbrough Council must respond formally to serious concerns raised about the care and treatment of a young person under their care and explore concerns with the family and the young person. Recommendation 10 (TEWV): Reporting structures were disconnected between various tiers of governance, and this prevented the ‘drill-down’ required for effective oversight and effective learning. The Trust must ensure rounded reporting arrangements to support proper Board assurance consisting of both hard evidence and soft intelligence. This should include a ‘trigger tool’ when a ward or department is experiencing ‘stress’, such as failing to complete training, debriefs, high sickness absence, low staff morale and this should be viewed alongside patterns of incidents, harms and complaints. Recommendation 11: There were gaps in relation to both the commissioning of effective services and in relation to the regulatory oversight in relation to West Lane Hospital. Assurance seeking activity was weak with a lack of sufficient scrutiny of both hard and soft intelligence. A compound recommendation is required to address this deficit: a. NHS England Specialised Commissioning and the Care Quality Commission (CQC) must ensure that when there is enhanced surveillance of services following quality concerns, the themes and patterns of all incidents are rigorously scrutinised and analysed. b. NHS England Specialised Commissioning, the provider collaborative and the North East & North Cumbria ICB, should work together with the Directors of Children's Services in the North East region. This is to ensure that services are commissioned which will meet the needs of the growing number of young people with complex needs and challenging behaviours that require integrated health and social care responses. c. A demand and capacity review (under the provider collaboratives programme and in association with each local authority) should be undertaken to ensure services have the appropriate capacity locally to minimise placing children out of area and to ensure the availability of suitable specialist care. d. TEWV/NHS England, the provider collaborative and Middlesbrough Council must provide assurance that all looked after children specifically with a diagnosis of autism have care provided that is in line with the NICE guidance on autism spectrum disorder in under 19s: support and management, recognising the challenges in the system. Recommendation 12: (NHS England) A full assurance review of progress against the recommendations contained within this report must be completed in 6-12 TEWS response to the report TEWV-assurance-statement-20-March-2023.pdf- Posted
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Content Article
This blog by the Centre for Mental Health looks at data about young people's mental health in 2022 from NHS Digital, highlighting the urgent need for effective mental health services and support for young people. It looks at what needs to change to improve the picture for young people's mental health including addressing child poverty, implementing whole school and college approaches and investing in early intervention support. Key findings One in four teenagers aged 17-19 have a mental health difficulty, an increase from one in six in 2021. Poverty continues to have a strong link to young people’s poor mental health. Reversed patterns of probable mental health difficulty for boys/young men and girls/young women highlights the need for specific gender-specific approaches. Young people with a mental health difficulty are more likely to have negative experience of social media. Young people with a mental health difficulty are more likely to miss school and feel unsafe while at school.- Posted
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- Mental health
- Mental health - CAMHS
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Content Article
Last week, one of the country’s largest child and adolescent mental health services, Forward Thinking Birmingham, run by Birmingham Women’s and Children’s Foundation Trust, was rated “inadequate” by the Care Quality Commission. The inspection report makes for concerning reading — not least because it speaks to a range of issues being experienced by other providers of CAMHS services across the country. CQC inspectors warned there were not enough nursing and support staff to keep people using community services from avoidable harm. Nurses told the CQC that vacancies in the service impacted on people being allocated a care coordinator — and staff were leaving largely due to handling caseloads they felt were unsafe. Part of HSJ’s Mental Health Matters fortnightly briefing, covering safety, quality, performance and finances in the mental health sector.- Posted
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- Mental health
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Event
The Restraint Reduction Network is a movement of people who want to eliminate the use of unnecessary restrictive practices, protect human rights and make a positive difference in people's lives. This webinar is an opportunity to find out more about participating in this project, which goes live in September 2022. The session will help you understand your practice in relation to use of psychotropic medication with children and young people and will give you the opportunity to compare your practice to other inpatient units through a benchmarking dashboard. Register for the webinar- Posted
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- Restrictive practice
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News Article
Almost 70,000 children missing out on mental health treatment
Patient Safety Learning posted a news article in News
Almost 70,000 children are missing out on mental health care they should be eligible to receive as the NHS falls short of key targets, The Independent has revealed. An internal analysis, seen by The Independent, shows in England the NHS has fallen short of a target, set in 2019, for 818,000 children to receive at least one treatment session from Child and Adolescent Mental Health Services (CAMHS) in 2023. The actual number of children who received treatment in the 12 months to December was 749,833, falling short of the target by around 9%. The figures came as the government announced this week it would expand the number of early access mental health hubs for children to cover 50% of the country by 2025. However, campaigners urged ministers to commit to covering the entire country to help “turn the tide on the crisis” in children’s mental health services. The NHS analysis shows, as of December, CAMHS in the South West was furthest away from its targets with 78% of children seen out of those eligible. In London, 80% of the target was achieved and in the North West 105%. Laura Bunt, chief executive at YoungMinds, said: “Referrals to mental health services are at a record high with more young people than ever in need of support with their mental health. We know that many young people are struggling in the aftermath of the pandemic, facing intense academic pressure to catch up on lost learning, a cost of living crisis and increasing global instability. “Every young person should be able to access mental health support when they need it, but too many don’t get it until things get much worse. Services continue to be significantly underfunded and the number of young people receiving treatment falls woefully short of what is needed. To turn the tide on this crisis, the government must prioritise young people and their mental health by investing in prevention and early intervention.” Read full story Source: The Independent, 2 March 2024- Posted
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- Children and Young People
- Mental health - CAMHS
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News Article
Swamped NHS mental health services turning away children, say GPs
Patient Safety Learning posted a news article in News
Children and young people who are anxious, depressed or are self-harming are being denied help from swamped NHS child and adolescent mental health services, GPs have revealed. Even under-18s with an eating disorder or psychosis are being refused care by overstretched CAMHS services, which insist that they are not sick enough to warrant treatment. In one case, a crisis CAMHS team in Wales would not immediately assess the mental health of an actively suicidal child who had been stopped from jumping off a building earlier the same day unless the GP made a written referral. In another, a CAMHS service in eastern England declined to take on a 12-year-old boy found with a ligature in his room because the lack of any marks on his neck meant its referral criteria had not been met. The shocking state of CAMHS care is laid bare in a survey for the youth mental health charity stem4 of 1,001 GPs across the UK who have sought urgent help for under-18s who are struggling mentally. CAMHS teams, already unable to cope with the rising need for treatment before Covid struck, have become even more overloaded because of the pandemic’s impact on youth mental health. Mental health experts say young people’s widespread inability to access CAMHS care is leading to their already fragile mental health deteriorating even further and then self-harming, dropping out of school, feeling uncared for and having to seek help at A&E. “As a clinician it is particularly worrying that children and young people with psychosis, eating disorders and even those who have just tried to take their own life are condemned to such long waits”, said Dr Nihara Krause, a consultant clinical psychologist who specialises in treating children and young people and who is the founder of stem4. “It is truly shocking to learn from this survey of GPs’ experiences of dealing with CAMHS services that so many vulnerable young people in desperate need of urgent help with their mental health are being forced to wait for so long – up to two years – for care they need immediately. Read full story Source: The Guardian, 3 April 2022- Posted
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- Mental health - CAMHS
- Children and Young People
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News Article
Transgender teenager's death preventable, coroner says
Patient Safety Learning posted a news article in News
The death of a "vulnerable" transgender teenager who struggled to get help was preventable, a coroner has said. Daniel France, 17, was known to Cambridgeshire County Council and Cambridgeshire and Peterborough Foundation Trust (CPFT) when he took his own life on 3 April 2020. The coroner said his death showed a "dangerous gap" between services. When he died, Mr France was in the process of being transferred from children and adolescent mental health services (CAMHS) in Suffolk to adult services in Cambridgeshire. The First Response Service, which provides help for people experiencing a mental health crisis, also assessed Mr France but he had been considered not in need of urgent intervention, the coroner's report said. Cambridgeshire County Council had received two safeguarding referrals for Daniel, in October 2019 and January 2020, but had closed both. "It was accepted that the decision to close both referrals was incorrect", Mr Barlow said in his report. Mr Barlow wrote in his report, sent to both the council and CPFT: "My concern in this case is that a vulnerable young person can be known to the county council and [the] mental health trust and yet not receive the support they need pending substantive treatment." He highlighted Daniel was "repeatedly assessed as not meeting the criteria for urgent intervention" but that waiting lists for phycological therapy could mean more than a year between asking for help and being given it. "That gap between urgent and non-urgent services is potentially dangerous for a vulnerable young person, where there is a chronic risk of an impulsive act," Mr Barlow said. Read full story Source: BBC News, 25 February 2022- Posted
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- LGBTQI
- Young Adult
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News Article
Children with mental health problems are dying because of failings in NHS treatment, coroners across England have said in what psychiatrists and campaigners have called “deeply concerning” findings. In the last five years coroners have issued reports to prevent future deaths in at least 14 cases in which under-18s have died while being treated by children’s and adolescent mental health services (CAMHS). The most common issues that arise are delays in treatment and a lack of support in helping patients transition to adult services when they turn 18. Coroners issue reports to prevent future deaths in extreme cases when it is decided that if changes are not made then another person could die. Dr Elaine Lockhart, the chair of the Royal College of Psychiatrists’ faculty of child and adolescent psychiatry, said the findings were “deeply concerning” and every death was a tragedy. She said there were too often lengthy delays and services were under strain as demand rises and the NHS faces workforce shortages. “In child and adolescent mental health services in England, 15% of consultant psychiatrist posts are vacant,” Lockhart said, calling for more support, investment and planning to grow staff levels. Read full story Source: The Guardian, 3 February 2022- Posted
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- Mental health
- Children and Young People
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