Fall in admissions of young people to non-specialist mental health wards during pandemic

A new report from the Mental Welfare Commission says that in 2020-21 the number of young people under the age of 18 admitted to non-specialist hospital wards – mostly adult wards - for treatment of their mental health difficulties in Scotland was 86 admissions involving 62 young people.

While there can be some instances when it might be in the best interests of a child or young person to be treated on an adult ward, this should only happen in rare situations.

Under the Mental Health Act, health boards are legally obliged to provide appropriate services and accommodation for young people admitted to hospital for treatment for their mental health. This usually means one of Scotland’s specialist adolescent units, designed to treat the needs of adolescents with mental illness.

The new figures are a fall from 2019-20 when there were 103 admissions to non-specialist wards involving 88 young people.  The Commission, however, say the numbers are not directly comparable and the fall announced today needs to be understood against the backdrop of pandemic restrictions. Hospital wards and admissions and discharges across the country were adapted in 2020-21 to help cope with the pandemic, and this had an impact on bed availability and admissions.

The data published in this report remains vital in understanding something of how services operated during that time. It also confirms that some of the issues raised in the past as requiring attention continue to exist.

Alison Thomson, executive director (nursing) at the Mental Welfare Commission, said:

“When an admission to a non-specialist ward becomes unavoidable then every effort should be made to provide for the young person’s needs as fully as possible.

“We are aware that children and adolescent mental health services (CAMHS) clinicians continue to provide support to young people in these non-specialist wards, but over recent years the proportion of young people in this situation who are able to access specialist CAMHS input that is not medical has not improved.

“We also note that of all the young people admitted to non-specialist wards, 16% were care experienced and looked after by a local authority. All young people who are so unwell they need to be treated as inpatients are vulnerable, and we clearly see a disproportionate number of young people who are in care amongst these admissions. More must be done to support these young individuals.”

“The report also found that access to specialist advocacy for young people on these non-specialist wards was limited. While 77% of young people had access to advocacy, only 13% had access to advocacy that specialised in the particular needs and rights of young people. This is just not good enough.”

Positive findings

Positive findings in the report include confirmation that a facility for young people who need forensic intensive psychiatric care is underway and is due to open in Ayr in November 2022. The Commission also welcomed confirmation that national specialist inpatient facilities for young people with learning disabilities are being developed in the Lothian area.

Recommendations for change

The Mental Welfare Commission makes three recommendations for change:

Scotland does not have any intensive psychiatric intensive care (IPCU) beds for young people. In previous years the Commission has recommended that Scottish Government resource and support the development of IPCU facilities. Today’s report repeats this recommendation, and asks that the exploratory work needed to establish the resource that might be required is completed within one year.

The Commission repeats its recommendation that health boards have specialist advocacy services for young people, and repeats its recommendation that hospital managers ensure that whenever a young person is admitted to a non-specialist ward, the right to education should be part of their care planning.

Key facts

Just over half of the admissions were short in length, however 48% remained on non-specialist wards for over a week, and there were seven admissions of over five weeks.

There was a clear gender difference in these admissions, with 57 being female and 29 male.

Reasons for young people being admitted to adult wards include a shortage of specialist beds, and a lack of provision for:

1. 1. Highly specialised care for young people with a learning disability,
   2. Young people who have offended due to mental health difficulties and require forensic care; and
   3. Young people who require intensive psychiatric care provided in specialised units.