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Mental Health Bill [HL]

It is a regrettable fact of the psychiatric provision in this country that mental health services that were formerly designated for adults are regularly employed for the reception of children and adolescents under the age of 18. Given that a number of adult psychiatric in-patient facilities can be fairly dysfunctional places on their own terms, they are unlikely to be suitable places for vulnerable children. The Mental Health Act Commission has applied its monitoring role in studying this matter in relation to detained patients. I rise to inform the Committee of some of the findings to give an indication of the scale of the problem. I must preface my remarks with a warning that I can only paint a partial picture: the Mental Health Act Commission is not empowered to collect data or monitor the treatment and care of informal patients; and I note that this amendment seeks, quite understandably, to provide protections to children and adolescents regardless of their legal status in the psychiatric system. I can only give an outline of the scale of the problem in relation to detained patients, and the Committee must be left uninformed of the total numbers of inappropriate admissions of children and adolescents across the psychiatric system as a whole. I would have that remedied for the future, but that is for an amendment later in our Committee’s deliberations. In the usual course of its visits to hospitals between October 2004 and November 2006, the Mental Health Act Commission encountered 116 adult wards where one or two children under the age of 18 were detained. In all, 132 children were accommodated in such situations. I should highlight that 18 of these wards were psychiatric intensive care units where the most disturbed and dangerous adults are treated. Counting heads on the Commission’s visits to hospitals cannot provide systematic data on the number of children on adult wards. In an attempt to get such data, the Mental Health Act Commission asked services to notify them of any occasion when a patient under the age of 18 was admitted to an adult ward under the detention powers of the 1983 Act. Between April 2003 and October 2006 we received 1,308 such notifications. That is a rough average of one admission every day over the three and a half year notification period. Furthermore, we are not at all convinced that we were notified of all such admissions under the Act. Voluntary notification exercises are inherently unreliable and, of course, these figures do not include those occasions when other routes—such as informal admission or the powers of the Children Act—were taken to ensure the admission of a minor. Just over half of these admissions to adult facilities were 17 year-olds, with most of the remainder being 15 or 16. There were rare but extremely concerning examples of younger children being admitted to adult facilities under the powers of the 1983 Act. These involved 22 14 year-olds, three 13 year-olds and two children under the age of 12. The care packages provided to these children and minors was often inadequate, despite the best intentions of staff. Let me provide noble Lords with some examples. While collating these examples, I was extremely alarmed and concerned. If I was a parent of one of these children, I would be expecting not only this House, but the Government to take immediate and urgent action. When the Mental Health Act commissioners asked ward staff whether there were any plans to transfer the young person or child to more appropriate surroundings within the next seven days, there were no such plans for nearly three-quarters of the children. That is 959 children with little or no prospect of moving from adult psychiatric wards. Only one-third of the children—421 of them—had a responsible medical officer who specialised in child and adolescent psychiatry. Of the 409 girls, more than three-quarters—322 girls—were detained on mixed-sex wards. As a parent, I find this situation completely unacceptable. Nearly one-third—412 children—did not appear to have an identified social worker. One-third—434 children—did not have an identified key worker. One in 10—126 children—did not have an identified primary nurse. It is also notable that half—that is, 648 of these admissions—were classed as emergency admissions, although only a small number—only 17—were admitted under the emergency powers of Section 4 of the Act. One such patient was 10 years old. In December 2004 the Mental Health Act Commission published a report on 18 months of data collected from April 2002. Noble Lords will recall that I spoke about some of the worrying results from this report on an earlier occasion. I highlighted the very significant over-representation of young people from black and minority ethnic backgrounds among those detained in adult facilities. Over one-quarter—27 per cent—of the young people detained on adult wards were from black and minority ethnic groups. Those of black African or black Caribbean origin appeared to be the most over-represented, with this group alone comprising 13 per cent of the notifications, compared with—according to census data—just 2.7 per cent of the child population in England. The general level of over-representation of black and minority ethnic children and adolescents detained on adult wards is in stark contrast to their representation among those accessing informal care with specialist in-patient CAMHS units, where they made up only 3 per cent of reported admissions. Very few staff working on adult wards had received any specialist training in working with children or adolescents with mental health needs. On a number of visits staff expressed concerns over their lack of skills and knowledge for working with this client group. In some cases it was reported that they felt they could only offer containment until a more suitable placement became available. There were often no arrangements for the continuation of young people’s education, even for those aged under 16 and of compulsory school age. Appropriate plans for the continuation of education during their hospital stay were in place for only about 10 per cent of the young patients visited, rising to just over 18 per cent for those under 16. Only one-third had access to a programme of activities appropriate to their age and abilities. In order to humanise those statistics, let me give your Lordships just a couple of example of patients whom the Mental Health Act Commission has met in the course of its work. Miss A was 16 years old and detained under Section 22 in an adult psychiatric care unit in central England. She had been initially admitted to an acute adult psychiatric ward as an informal patient having been transferred there from the local general hospital following an overdose. While on the acute ward, she was placed under Section 5(2) to prevent her from leaving until she was assessed for detention under Section 2 of the Mental Health Act. She was then transferred to a mixed-sex adult psychiatric intensive care unit. Although staff had sought a more appropriate placement on an adolescent unit, none was available. Ward staff felt that they were providing merely containment. Although additional staff had been allocated to provide special observation in view of her vulnerability in an adult setting, they acknowledged that her special needs were not being met. Ward staff had not received any recent training in the care of adolescents and they had no access to a specialist child and adolescent psychiatrist for advice and guidance. Miss A told Mental Health Act commissioners that, although she was generally happy with the care provided by the doctors and nursing staff, she felt frightened by the other patients, whose behaviour she described as scary at times. She was also very unhappy that male staff members were allocated to provide close observation. She found that intimidating, especially as she had recently experienced a serious incident involving sexual assault prior to her admission to hospital. The alleged incident was currently under investigation. B was a 15 year-old Asian boy detained under Section 3 on an adult psychiatric intensive care unit. Three months before the Mental Health Act Commission met him, he had been transferred there from a nearby adolescent unit after having been assessed as requiring secure care as a result of his absconding, serious self-harm and suicide attempts. Secure care was not available under the local CAMHS service and, although he had been referred to an independent hospital out of the area that would have provided a specialist locked adolescent unit, no bed was available immediately. Not all of the permanent staff on the ward had been police-checked and there was no access to a copy of the Children Act or the relevant guidance volumes on the ward. When he had been on the local adolescent unit, B had received daily education sessions. Since being transferred to the adult intensive treatment unit, he was being offered only two education sessions a week. Staff who had received no specialist training to work with adolescents were finding it difficult to cater for his needs or provide appropriate activities. They agreed that it was not a suitable environment for a 15 year-old boy for almost four months, but said that there was a serious lack of ITU beds available nationally for adolescents. I have no information on whether there were any cultural, religious, dietary or linguistic issues attended to for that young Asian boy. I hope that those illustrations of how detained children and adolescents may be treated in adult services will help to emphasise the importance of the matters raised by noble Lords. I trust that the Minister will be persuaded to take urgent action on the matter.