Source · Select Committees · Health and Social Care Committee
Recommendation 27
27
Paragraph: 128
We therefore recommend that the Department accelerates the shift towards increased community-based provision and a...
Recommendation
We therefore recommend that the Department accelerates the shift towards increased community-based provision and a reduced inpatient bed base as a national priority to ensure that children and young people with the most complex needs receive good quality care in a setting that is right for them. A national strategy should be set out to establish jointly commissioned health and social care services. To ensure children and young people are not ‘parked’ in inappropriate in-patient care, an independent psychiatrist should sign off the need for inpatient provision on a monthly basis for all young people who have stayed for longer than three months in a mental health hospital. This should be backed up by legislative changes. It should equally apply to those with a learning disability, autism, or both.
Paragraph Reference:
128
Government Response
Not Addressed
HM Government
Not Addressed
We accept this recommendation in part. All patients detained in hospital under the Mental Health Act are continually assessed and supported, and their need for detention is regularly reviewed. The Government does not see the benefit in introducing more legislative requirements for such checks for children alone. However, the Government does accept there is a need for more reviews of detention; our planned reforms to the Act will shorten the initial detention period under section 3 of that Act, from six months to three months, meaning that there will be three formal check points in the first year of detention. The Government recognises that children and young people have particular needs and requirements, and the Act therefore already provides for certain specific rights for people who are under 18. In particular, section 131A provides a duty for providers to ensure that children and young people admitted to hospital for the treatment of mental disorder should be accommodated in an environment that is suitable for their age. The Act’s Code of Practice elaborates on what this should mean in practice: This means that children and young people should have: • appropriate physical facilities; • staff with the right training, skills and knowledge to understand and address their specific needs; • a hospital routine that will allow their personal, social and educational development to continue as normally as possible; and • equal access to educational opportunities as their peers, in so far as that is consistent with their ability to make use of them, considering their mental state.7 The Government is currently working to reform the Act, and the improvement inpatient rights that we are seeking will extend to children and young people. For example, under 18s will be able to make an Advance Choice Document to set out their wishes and preferences, their beliefs and values and what is important to them, just as adults can. The clinician will have to take this information into account and show how they have done so, if the child or young person is later detained under the Mental Health Act and lacks capacity to express these things at the time. Furthermore, we will be looking in these reforms to limit the extent to which people with learning disabilities or autistic people can be made subject to the Act.8 Of course, the Government wants fewer people to be detained under the Act and to support the move to a community-based provision of care, where children and young people are able to access support in a timely, effective, and patient centred way, close to home and in the least restrictive environment. This has been a focus of the transformation of children and young people’s mental health and continues to be a priority in the NHS LTP. This transition will be supported by the introduction of provider collaboratives to support place-based commissioning. However, we recognise that occasionally children and young people with significant mental health needs may require and benefit from short inpatient admissions for treatment, if intensive community care has not been successful or it is not feasible to deliver care in the community, for example young people with significant mental health needs serving prison sentences in the criminal justice secure estate. Further work is required to understand how the Trieste model of care could be implemented for children and young people given the differences between children and adults and the possible risks of the model.