Mentally unwell children subject to a “form of torture” by being put on wrong wards

The review of provision for mentally unwell children by the HSSIB found that they were being admitted to inappropriate general wards

23rd May 2024 about a 3 minute read
“Burly gentlemen in high vis with all the security gear come striding into the ward …we’ve had security guards that straddled her which is completely inappropriate.” Parent quoted in HSSIB report: Keeping children and young people with mental health needs safe - the design of the paediatric ward

Children with mental illness are being forced to stay on wards that are not fit to care for them, the Health Services Safety Investigation Body (HSSIB), a health regulator, has warned in a report.

Children with mental health conditions were admitted to general hospital wards, rather than specialist mental health wards, nearly 44,000 times in 2021 and 2022, HSSIB said.

General wards, which are “noisy, busy and brightly lit,” are often inappropriate for children who require mental health care, the investigation found.

The watchdog is calling for new guidance for hospitals on how to adapt their general paediatric wards for children who have mental health support needs.

HSSIB said it found that, in some hospitals, patients were placed in rooms with “little or no consideration of therapeutic elements” and which were “stripped of everything” including window blinds and shower curtains. In one hospital, staff said that even the mattresses are removed.

“Evidence indicated that removing items and creating a more restrictive environment can create more conflict situations including increased aggression, physical and verbal abuse, rule breaking, medication refusal, leaving the hospital without permission (absconding), and self-harm,” the report said.

Patients should have access to outdoor spaces

One patient told HSSIB that, when they were placed in a general hospital ward while suffering from a mental health crisis, they “felt they had no hope” and that to have no human contact on the ward was a “form of torture.”

The regulator has said improvements must be made to hospital wards that admit mentally unwell children, including offering them single private rooms, access to outdoor spaces and daylight, as well as activities to occupy them.

According to 2023 data, one in five young people in England aged 8 to 16 years showed signs of having a probable mental health disorder. Between 2021 and 2022, 11.7%, or 39,926 admissions to paediatric wards, for physical health, were for children who had a mental health condition.

HSSIB’s report was triggered by the story of a 17-year-old girl in care referred to in the report as Leah.

She had a history of trauma including expressing suicidal thoughts and had received mental health support. Following numerous visits to A&E, she was admitted to a paediatric ward where police had to stay overnight with her, during which time she was handcuffed when she attempted to leave.

More police were called to the ward when she tried to flee and was brought back, as she was making attempts to self-harm. Hospital staff told HSSIB the ward was “not safe” for children and young people with mental health needs and that it was difficult to stop patients from fleeing.

During the investigation, staff at another hospital said their paediatric ward for children and young people with mental health needs was “not nice”, while images shared with the regulator showed “stark” rooms with nothing in them. Other children were placed on open wards with other patients, the investigation found.

One young person who had an eating disorder was force-fed with a tube in front of others with only curtains separating her from other children.

One parent told investigators: “Burly gentlemen in high vis with all the security gear come striding into the ward …we’ve had security guards that straddled her which is completely inappropriate.” The investigation is aware that national work has just started in relation to restrictive practices on acute paediatric wards.”

FCC Insight

The HSSIB investigation into the experiences of mentally unwell children being placed on general paediatric awards has uncovered some shocking practices. In most cases, general wards are not appropriate for children with mental illness, because they lack privacy and are often not secure. The wards lack therapeutic elements and some children experienced them as a “form of torture.” Children whose mental illness is so severe that they need to be admitted to hospital are an exceptionally vulnerable group, and deserve to be treated with kindness and dignity. The recommendations made by HSSIB – that children should have access to outdoor spaces and to therapeutic activities – are not necessarily difficult or expensive to carry out. We hope that NHS hospitals take the recommendations seriously and put in place steps to implement them.