Rise in number of young people with mental illness being treated in non-specialist wards

The number of young people under the age of 18 admitted to non-specialist hospital wards – mainly adult wards - for treatment of their mental illness in Scotland in 2018-19 rose for the second year running. There were 118 admissions involving 101 young people. 

This is an increase on the 2017-18 figures which were 103 admissions involving 90 young people. Admission of a young person to an adult ward should only be acceptable in rare situations.

The Mental Welfare Commission published the figures today in a report that made three recommendations for change – two for government, one for health boards.

The first recommendation calls on the Scottish Government to prioritise providing intensive psychiatric care unit (IPCU) facilities for young people – a recommendation the Commission has been making for a number of years. Currently there are no such facilities in Scotland.

The second recommendation calls on health boards to review access to specialist advocacy for young people in adult and paediatric wards.

The third recommendation relates to young people requiring forensic or learning disability care in Scotland. The Commission notes that plans are being developed for these facilities, but asks for a clear process for young people needing those services now.

Dr Arun Chopra, executive director (medical) at the Mental Welfare Commission, said:

“Whilst it was reassuring to see that the vast majority of young people had specialist senior medical input on admission, adult wards differ in staff training and ward environment to those designed to care for young people.

“Adult intensive psychiatric care units (IPCUs) in particular can often be unsuitable environments for adolescents. They are specialised units for adults who are very unwell and present with high risk to themselves or others. 

“The lack of a resource or an agreed plan on how to manage situations when IPCU care is required causes difficulties for children and young people, their families and the clinicians working for them. While the numbers of young people admitted to adult IPCUs is low, we remain very concerned about the lack of these facilities in Scotland; an issue we have raised for a number of years, and will continue to raise.”

Reasons for young people being admitted to adult wards include:

• a shortage of specialist beds 
• the lack of IPCU facilities for young people in Scotland,
• a lack of provision for highly specialised care for young people with learning disability, and 
• a lack of provision for young people who have offended due to mental health difficulties and require forensic care. 

In this report, the Commission also asks health boards to review specialist advocacy for young people admitted to non-specialist wards. This follows the finding that only 16% of the young people admitted to non-specialist wards had access to advocacy that specialised in the needs and rights of young people.

Other findings in the report include – 

• Health board areas differ in relation to their admission figures, with some achieving similar results to the previous year and others admitting more young people to non- specialist units. 
• Of all the young people admitted to non-specialist wards, 21% were ‘looked after and accommodated’ by a local authority. This is a higher percentage than in previous years. 
• Nursing staff with experience of working with young people were available to work directly with the young person in only 56% of admissions.  This may reflect workforce issues within Child and Adolescent Mental Health Services (CAMHS).
   

Note to editors
Health boards have a legal duty to provide age-appropriate services and accommodation. 

There are three specialist units for inpatient treatment of children and young people – Skye House in Glasgow which covers the west of Scotland, the Young People’s Unit in Edinburgh which covers the east of the country, and Dudhope House in Dundee which takes patients from the north of Scotland. 

The National Child Inpatient Unit based in Glasgow receives admissions of children under the age of 12 years with mental health difficulties from across Scotland.

Mary Mowat
Mental Welfare Commission for Scotland
Mary.mowat@nhs.net
18 March 2020