NHS England is taking urgent action to improve access to specialised inpatient mental health services for children and young people after a report questioned whether current bed provision is sufficient to meet need.
While the report found that the number of NHS-funded child and adolescent mental health services (CAHMS) Tier 4 – inpatient – beds increased from 844 in 1999 to 1,264 in January 2014, it also found shortages in the Southwest and areas such as Yorkshire and Humber, resulting in patients being admitted to services a long way from home.
Alongside undersupply of beds in some areas, there was also evidence of patients being inappropriately admitted to specialised units. This was caused by a variety of reasons including gaps in CAMHS tier 3 services and other local health and social services provision, as well as weaknesses in commissioning and case management; Tier 4 is reliant upon the arrangements for Tiers 1, 2 and 3, which are organised at a local level.
For example, intensive outreach teams can almost halve the average length of inpatient stay, yet many areas lack them.
In response, NHS England will urgently:
• Increase general CAMHS specialised beds for young patients – there will be up to 50 new beds around the country with further beds moved according to need
• Recruit 10 to 20 new case managers working across the country responsible for ensuring that young people receive appropriate levels of care
• Improve the way people move in and out of specialised care; with consistent criteria for admission and discharge, based on best practice.
In addition, a longer-term, strategic review of CAMHS services will be carried out as part of NHS England’s wider work on specialised services; this will include further work with patients and their families and in partnership with other organisations.
Sea change needed
Sarah Brennan chief executive of YoungMinds, said: “While this review is a distressing read, we welcome its publication as it lifts the lid on a lot of major failings in the provision of children and young people’s inpatient care. This report has to be a pivotal moment where we seize the initiative and bring about a sea change in how we support children and young people’s mental health,” she added.
“It is an important first step in properly understanding why there is such a crisis in inpatient care for children and young people. A robust follow through with clear actions against the recommendations is what children and young people now need if the situation is to ever improve.
"The report describes an overly complicated, poorly understood commissioning process operating without the core basic information they need, trying to meet needs that should have been prevented much earlier on. YoungMinds has frequently highlighted the dangers of the lack of early intervention services and poor data in CAMHS, this report demonstrates the confusion and poor services that can result.
“As well as getting the system right, this report also identifies a lack of capacity and a lack of resources. We have to increase investment in children and young people’s mental health particularly in early intervention otherwise we will continue to fail some of our most vulnerable children and young people.”
Meanwhile the Royal College of Psychiatrists, with YoungMinds and the Children and Young People's Mental Health Coalition, is establishing a Values Based CAMHS Commission to examine concerns around CAMHS Tiers 1-3 in detail and make recommendations as to how the service should be developed in the UK.
To read the full NHS England report, click here