Channel 4 recently showed a documentary discussing problems in Child and Adolescent Mental Health Services, focusing mainly on the country’s overall lack of child inpatient psychiatric beds and lack of early intervention provision. Over the past year I have noticed many news articles and reports on these subjects. But there is one thing I think they missed.
Yes there aren’t enough CAMHS inpatient beds, but there also aren’t enough staff to cover the ones we’ve got.
In both CAMHS inpatient units I have been to there have been serious problems with staffing. Friends of mine have confirmed experiencing the same problems in other units. There are often not enough regular staff who work on the ward on shift, so numbers have to be topped up with bank or agency staff. Sometimes these workers become regulars on the unit, thus getting to know patients. However a lot of the time they are coming on to the unit for the first time, know none of the patients and have very limited experience of the setting. In one of the CAMHS units I went to, which was a closed unit, patients used to use the ignorance of the agency staff to break the rules. One of the most notable examples I remember of this was a member of agency staff being persuaded by patients that the toaster could be plugged in in various bizarre places around the ward. This resulted in patients being found smoking in an ensuing after lighting cigarettes from the toaster. It’s funny but there are many other examples I could give ended with a patient getting hurt.
Having a team of regular staff covering a shift is vastly different to having numbers topped up by agency or bank. Funnily enough patients, often with complex past relationships with adults, tend not to open up to relative strangers. Though these workers count as bodies on the ward a lot of their work is observation and directing regular staff to the young people who need them.
If there were enough staff in each unit the quality of care and patient turnover would be much higher. The increased knowledge built up over time of patient’s case alone can make a huge difference to care. Bank and agency staff get a short handover about the ward and the patients however the information given is based on what has happened recently. Staff nurses and health care assistants who work on units regularly will build up the trust and the life story (often quite complicated) of a patient; thus helping them identify crisis triggers, early warning signs and risks.
The documentary did portray really well other points, such as how children and young people can be moved all over the country from hospital to hospital and how this is often a fast decision based on their condition fluctuating. I felt sorry for parents who had to deal with their child being passed around, sometimes hundreds of miles away from home. Dealing with relapse is hard enough but if it results in more moves and being further away from home it will be even more devistating for patients.
Some psychologists are campaigning for CAMHS services to cover up to the age of twenty five. I will probably write another blog about this soon as it is something I believe passionately in. The move from children to adult services is drastic and for many traumatic. The attitude appears to shift from CAMHS teaching you to cope with what you have to adult telling you to just deal with it. There is a huge difference.
A mother expressing her concerns over her daughter becoming institutionalised made me think of the many, many, young people I have met for whom moving from unit to unit has become a way of life. I have met patients who have been in hospital for years at a time. That is years of living away from home, years out of education and years without socialising with people who are mentally healthy. Who can blame these young people for becoming comforted by the safety and routine? Especially when many will have had bad experiences with outpatient care or have difficult home lives. These units are vital but there needs to be clear paths for patients to move on.
To sum up:
- We need to staff the beds we have appropriately to improve the safety and the treatment of young inpatients. Then we need more beds.
- Families should not have to wait for a young person to deteriorate in order for them to become an inpatient to get the treatment they need. Early intervention must improve.
- Ideally every region should have some sort of provision for mentally ill young people.
- Where possible young people should go directly to the most suitable security level provision to avoid more moving, and disrupting other patient’s care in lower security units.
- Young people should be covered by children’s and a transitional service until the age of 25. The 18 – 25’s bracket could be used as a transitional stage between the two services and their massively different approaches.
- There are so many things that need to change. 6% of the Mental Health budget is not enough to support the country’s mentally ill young people.