Bernadka Dubicka, consultant child and adolescent psychiatrist at Greater Manchester Mental Health Trust, told a BMA patient liaison group symposium last week there is ‘no clear association with outcomes or quality’ and ‘no consistency’ in units’ staffing levels.
She pointed out the UK was ranked last of 24 European countries, pre-COVID, for children’s well-being and has the second largest socio-economic inequality in Europe, according to the Children’s Society.
The effect of COVID-19 has led to 77.5% more referrals in April to October 2021 than in the same period of 2019. Emergency referrals 44% were up in October 2021 against October 2019, NHS England data shows.
Professor Dubicka explained the correlation between mental health problems and poverty in the UK, how emotional disorders were more common for girls than boys and that the number of self-harm admissions has ‘strikingly’ doubled in the 10 years to 2021.
She said roughly a third of inpatients were at risk of self-harming while a third had learning disabilities or autism and ‘need services in the community’ but that ‘there is nowhere else for them to go’.
‘Admission can be very helpful for some young people in the right circumstances,’ she added. ‘But if we are going to admit young people we need to be clear about what we are trying to achieve and if it’s going to be useful to that young person.’
Alternatives to admission include evidence-based pathways for community care, and intensive home treatment where appropriate, said Professor Dubicka. ‘It’s all about moving away from admissions to prevention.’
Charli Clement, a participation and engagement assistant at Birmingham Women's and Children's NHS Foundation Trust and a lived experience consultant for the British Institute of Human Rights, told the session about her experiences in CAMHS (child and adolescent mental health services).
It came as a result of panic attacks which she said were caused by mounting pressure that ‘eventually came from being undiagnosed and unsupported’ for autism.
About 60 per cent of CAMHS inpatients are autistic, according to the NDTI (National Development Team for Inclusion). There are no autism-specific wards in the UK.
Ms Clement said that, when she was admitted: ‘It became very evident that a CAMHS unit was not the right place for me, but at the time there was no other services for me.’
With one of her primary triggers being noise, alarms going off multiple times a day did not help.
‘It’s clear I would have benefitted more from some kind of community care,’ she said. ‘I’m still dealing with this six years later and I’m sure I’m not the only inpatient who would say that.’
Vacancies in child psychiatric consultants are at 14.8%.
Speaking after MPs rejected the Health and Social Care Bill amendment which would have ensured transparency about the number of staff NHS services in England need, Professor Dubicka said: ‘We have no plan about how we are going to recruit that workforce. The Government has said it is committed but we have no blueprint for how that’s going to be achieved.’
And she added: ‘The fewer staff we have the longer young people are staying in hospital.’
Other lived-experience speakers at the BMA’s symposium talked of how units being short-staffed affected the level of care they received.
Zaynab Sohawon, a young ambassador for The National Autistic Society who has lived experience of autism, psychosis and personality disorder, said it was only when she was ‘trauma informed’ during a stay at a low secure unit, one of eight units she spent time at over four years of treatment, that staff asked her ‘what happened to me rather than what’s wrong with me’.
‘I experienced really good holistic care when there was good staffing levels,’ she said, explaining how she was able to go to the gym every day. ‘They realised it wasn’t just an activity but vital to my recovery.’
Stuart Dodzo, co-production and people coordinator at Healthy Teen Minds, has experience of physical and mental health conditions, with only the former diagnosed at first.
Recalling his time on a mental health ward, he said: ‘When we found out in the morning that the ward was short-staffed you can tell there is a worry among staff, and then everything feels rushed and the atmosphere around the ward is one of stress.
‘It trickles down and you feel like you are part of the problem and that if you weren’t there the staff levels could be optimum. It leads to more behaviour that is high risk and then more exclusions.’
Main image: Lewisham CAMHS in south-east London. Credit: Chris Patterson