Children with complex mental health problems are ‘at risk’ on general wards

Children in England with complex mental health problems are being put at risk by being placed on general children’s wards, an investigation by the Healthcare Safety Investigation Branch (HSIB) has found.

The HSIB, a government-funded body, says that paediatric wards are designed to care for patients with physical health needs, not those with mental health needs.

The report describes the situation in 18 hospitals it visited as “challenging,” and says that 13 were “not safe” for children who were suicidal or at risk of harming themselves to be on those hospitals’ paediatric wards.

The HSIB started its investigation after a young patient on a paediatric ward tried to harm themselves and staff. The child, who was waiting for a mental health assessment, managed to abscond from the ward and on two occasions took a drugs overdose.

Although the HSIB has not yet completed its investigation, it decided to publish an interim report as a mark of its concern. Saskia Fursland, an HSIB investigator, said:

“Our ongoing investigation will take a longer-term look at effective design, adaptations and risk management in the wards. A whole system response is now needed to ensure we can keep children and young people safe.”

The report says that the paediatric wards it saw contained many self-harm risks, including ligature points, and that they were busy, noisy places unsuitable for children experiencing a mental health crisis, or with sensory needs, for instance, because they have autism.

It also found that therapeutic help was limited or non-existent and children deteriorated as a result.

‘Many’ incidents where staff were assaulted

HSIB said that on one paediatric ward there were more than 70 security incidents over three months relating to children with high-risk behaviours. Most involved the young person being physically restrained.

“In just over half of the security incidents reported, the child or young person had been sedated, sometimes requiring multiple attempts (up to seven) for the sedation to become effective,” the report says.

It also notes that sometimes nearly all the paediatric nursing teams on different wards could be involved in trying to support patients whose behaviour was high risk.

Staff told the investigators they were concerned about the “negative psychological impact” it was having on other patients and their families.

HSIB said it saw “vulnerable and unwell children and babies next to or near a young person who was trying to harm themselves and/or whose behaviour could be violent and aggressive”.

The report says there were many incidents where staff were assaulted, and some hospitals, which were struggling to recruit and retain staff, described their workforce as “collapsing”.

The interim report made three key recommendations:

• Integrated care boards should facilitate a system-wide response to reduce the safety risks associated with children and young people demonstrating high-risk behaviours who are admitted to an acute paediatric ward.
• NHS organisations should ensure that systemic risks associated with caring for children and young people with high-risk behaviours on the paediatric ward, including the safety and wellbeing risks to patients and staff, are escalated to integrated care boards for consideration.
• Acute hospitals should review their practices for caring for children and young people with high-risk behaviours, using current available guidance and the findings in this interim report.

A spokesperson from NHS England said it would be reviewing the concerns raised by the HSIB.