RCPCH concerned by experiences of children with mental health needs being placed in general paediatric wards

An interim report from the Healthcare Safety Investigations Branch (HSIB) into the experiences of children and young people with mental health needs being placed on general paediatric wards has highlighted the risks of placing children and young people in these environments, particularly for children exhibiting high risk behaviours.
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Royal College of Paediatrics and Child Health (RCPCH) is deeply concerned by HSIB’s interim report and its ongoing investigation on keeping children and young people with mental health needs safe on paediatric wards. Urgent and routine referrals for mental health services have increased dramatically since 2020, and children and young people with mental ill health are increasingly ending up in emergency settings and on general paediatric wards. 

In response to the findings RCPCH Officer for Mental Health, Dr Karen Street said: 

It is deeply concerning that children with acute mental health needs are being cared for in unsafe and inappropriate settings due to a lack of alternatives, with HSIB reporting that 13 of the 18 paediatric wards it spoke to are “not safe” for children with high-risk mental health presentations, and all settings face challenges in caring for these vulnerable young people. We are troubled by the findings of inappropriate physical restraint and sedation, and children who are spending up to 9 months in these environments. 

Despite the efforts of health professionals across the system, we know that paediatric teams are finding it very challenging to provide safe and appropriate support to children with acute mental health needs. This is due to staff and ward capacity, lack of training, and wards that have been designed with younger children and physical health needs in mind. It is clear that urgent action is needed.

We need to work in partnership with paediatric, mental health and social care colleagues to ensure that every child is cared for in the most appropriate place which can meet their needs.  NHSE and RCPCH have been leading the development of children and young people's Mental Health Champion roles to drive much needed change in paediatric wards, build relationships with mental health services, and ensure teams have the appropriate skill-mix and training. 

As a minimum, we are calling for a Mental Health Champion in every paediatric ward in the country, and greater investment in training, so all health professionals feel confident in meeting the needs of children and young people with mental ill health.

There is an urgent need for greater investment across the children’s mental health system so community support is strengthened, fewer children and young people reach crisis, and to develop more appropriate hospital environments for those who do need hospital care.