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The Royal College of Psychiatrists Improving the lives of people with mental illness

Lack of access to acute mental health beds and stretched community services, put children and young people at risk to themselves and others, Royal College of Psychiatrists’ survey finds

Embargoed 00.01am 10 March 2015

RCPsych press release: Lack of access to acute mental health beds and stretched community services, put children and young people at risk to themselves and others, Royal College of Psychiatrists’ survey finds

Child and Adolescent Faculty recommends commissioning improvements to prevent children being ‘stuck in the gap’ between inpatient and community care

Children and young people with mental health problems are at increasing risk because they are caught between stretched community services and accessing acute beds, a survey from the Royal College of Psychiatrists has revealed.


The College's Child and Adolescent Faculty report Survey of in-patient admissions for children and young people with mental health problems: Young people stuck in the gap

between community and in-patient care, found that almost 80% of child and adolescent psychiatrists who responded to its survey had safeguarding concerns while their patients were waiting for a bed.

Over three quarters of respondents said young people they had diagnosed as being at high risk when it came to their own safety and others, and therefore needing a bed, were having to be managed in the community. More than half of respondents (61.9%) reported young people were being held in inappropriate settings such as paediatric wards, police cells, Section 136 suites and accident and emergency departments. And 14% of respondents cited cases of children and young people who had attempted suicide while waiting for a bed. Survey respondents described difficulties with admissions that had resulted in 'near misses' or serious incidents.

For example, one young person tried to hang herself in an acute paediatric ward. Another young person admitted to a paediatric ward following a suicide attempt, despite concerns, did not have access to an acute inpatient bed. When it was suggested that they be discharged back home, the mother then threatened suicide because she felt unable to cope with the severity of her child's condition.

Reasons cited by psychiatrists for this increased difficulty in accessing beds included an increase in referrals, decreased community CAMHS capacity, decreased capacity of social care and decreased in-patient capacity. Respondents also indicated that the new commissioning arrangements had resulted in less control and accountability.

To address concerns arising from young people being 'stuck in the gap' between inpatient and community care, the survey report recommends:

  • Commissioning groups and health boards should recognise the increasing pressures on community services and the increasing complexity and risk that characterises children and young people presenting to services.
  •  Investment in community mental health services to minimise the need for admission.  
  •  Intensive outreach services should be commissioned UK wide - including crisis assessment, crisis management, services designed to help early discharge, and planned intensive home treatments.
  • There should be financial incentives across the in-patient/community CAMHS boundary that promote services working together to optimise mental healthcare for children and young people, minimise length of stay in in-patient units, and allow safe, appropriate community care where this is possible.
  • Joint working across agencies should be encouraged locally through partnership and safeguarding boards.
  • The Government should prioritise investment in crisis care services for children and young people.  NHS England, Clinical Commissioning Groups and Social Services need to ensure that adequate emergency care pathways are in place as a matter of urgency.

Dr Peter Hindley, Chair, Royal College of Psychiatrist's Child and Adolescent Faculty, said: "It is unacceptable that children and young people are stuck in this gap between community and inpatient care. This survey shows just how devastating the consequences can be.

"We need urgent action to support these individuals and their families.  Ensuring the safety of children and young people should be the number one priority. Failure to improve both inpatient and community care will mean they will continue to be at risk to themselves and others."

For further information, please contact:
Hannah Perlin
Senior Communications Officer
Telephone: 020 3701 2738
Nick Hodgson
Media Manager 
Telephone: 0203 701 2593
Twitter: @rcpsych
Out-of-hours contact number: 07860 755896


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