Independent investigation: Mark Blackston, Northfleet, Kent

Closer links should be developed between children’s and adult mental health services, Social Services and Housing Authorities to try to provide more stable living environments for vulnerable young people living chaotic lives.

Progress towards developing services in Kent and Medway for people with personality disorder should be monitored by PCTs and the Strategic Health Authority through the appropriate performance management processes.

The Strategic Health Authority and Kent County Council Social Services should jointly bring to the attention of the Department of Health the need for national guidance on the development of services for young people with emerging personality disorder. Such guidance should include the transition from children’s services to services for adults. This should build on the impetus created by the publication of the NIMH guidance for adult services.

Lead Primary Care Trusts (PCTs) for CAMHS and Kent County Council Social Services should produce and agree a protocol to guide the management of young people with mental health problems, including emerging personality disorders who are placed away from the local area. This should include consideration of whether the management role in complex and difficult cases like Gemma’s should be undertaken by a specialist adolescent forensic service.

The CAMHS providers and Mental Health and Social Care Trusts in Kent and Medway should ensure that a system is in place, with appropriate guidelines for the efficient and effective handover of each case from CAMHS to adult services whenever such a handover is decided to be necessary. The system should provide for the communication of information about the handover to other agencies involved in the care of the individual concerned. The guidelines should be explicit about confidentiality and information sharing.

The CAMHS providers in Kent and Medway should produce, agree and implement a protocol covering referrals of young people with mental health problems who present a risk to others to tertiary forensic services. The protocol should be shared with all other relevant services for children and young people.

Work in Kent and Medway on the commissioning of specialist (Tier 4) CAMHS should specifically identify the needs of young people with mental health problems who present a risk to others, identify the range of provision required to meet those needs, identify gaps in provision and plan, if necessary on a Regional or sub- Regional basis, to commission services to meet the identified needs. These developments may include or complement the proposed 20 bed Medium Secure Unit scheduled to open in 2005/06 in Southampton.

The responsible clinician in CAMHS in-patient units should liase with Social Services at the earliest opportunity during or after admission whenever it is considered that it is in the young person’s best interests for Social Services to be involved. The aim should be for in-patient units to involve Social Services in care planning at the earliest possible stage whenever necessary.

Social Services should ensure that referrals to Consultant Child and Adolescent Psychiatrists in private practice are discussed with the local CAMHS and that the objectives of the clinical intervention are agreed in advance and recorded. At this time the extent of or limits of CAMHS involvement and responsibility for the case should be determined and recorded.

The CAMHS providers in Kent and Medway and KCC Social Services Department should ensure that appropriate clinical advice is sought whenever key decisions are taken about whether or not to seek placements for young people in specialist mental health in patient units.