Accident and emergency departments now act as a hub for young people experiencing a mental health crisis, even though they are unsuited to providing appropriate treatment, a report has found
"This research shows how much more needs to be done to redirect funds towards early intervention and prevention, in particular through intensive supported housing as an alternative to hospital. These are the community services that can help people before they reach crisis point.” Chris Hampson, chief executive, Look Ahead
Young people are unlikely to receive inpatient care for mental health problems unless they have reached a crisis point such as attempting suicide multiple times, according to a new report from Look Ahead Care and Support.
The report, which is based on in-depth interviews with service users, family members, and NHS and social care staff, found that increasing demand from children and young people requiring crisis support has put severe pressure on mental health services. “Parents and young people found the high thresholds for support in a time of crisis particularly challenging,” the report says. This “put particular strain on parents, some of whom themselves struggled with their mental health whilst trying to get access to services for their children.”
According to interviewwees, A&E departments are now an “accidental hub” for young people in crisis, even though they are often ill-equipped to provide appropriate treatment. Sometimes, the report says, young people experiencing mental health problems are put in general paediatric wards alongside younger children.
Many of the interviewees spoke about the challenges of moving through the health system. The transition from child to adult services was regarded as “especially traumatic,” the report says. The challenge of moving through the health system was repeatedly highlighted by those interviewed, with the transitioning of services from young person to adult as being especially traumatic. One person quoted in the report said: “…my biggest fear before I turned 18, was that they will stop caring because I’m not a child anymore”, while a child and adolescent mental health services (CAMHS) nurse stated: “18 is very young. Then, they’ll go to an adult psychiatric ward, which is just different. They’re not going to get the hand holding, the hugs”.
Because of the high demand, more than half of support (55%) for young people hospitalised with mental health difficulties is now delivered by private sector providers. The cost of this to the taxpayer, the report says, is “exceptionally high”.
Chris Hampson, chief executive of Look Ahead, said of the report’s findings: “The deep challenges in mental health care crisis provision for young people [are] setting up a ticking timebomb for mental health services in the future – as young people become vulnerable adults.”
The principal recommendation of the report is the creation of new accommodation-based or community in-reach services that support young people at a time of mental health crisis. These services would be: delivered by a collaboration of the NHS, supported housing and local authorities; funded jointly using new integrated care structures; located in a geography that works for the young people, their families and carers; and sensitive to the age a young person would need to leave, ideally up to the age of 25.
“The NHS is doing all it can in impossible circumstances, but the result is a service that both costs more than it should and helps too few of those in crisis,” Hampson said. “This research shows how much more needs to be done to redirect funds towards early intervention and prevention, in particular through intensive supported housing as an alternative to hospital. These are the community services that can help people before they reach crisis point.”
This report is further evidence of the enormous stress that mental health services are under, particularly in the case of children and young people. Young people experiencing crisis should not have to undergo multiple suicide attempts to gain admission to inpatient care. They should also be able to receive specialist care when in crisis rather than going to A&E. We agree with the report’s recommendation that we need more residential, community-based crisis services to provide care more appropriate to the needs of young people.