RCPCH responds to HSSIB’s recommendations for safer mental health environments on paediatric wards

The Health Services Safety Investigations Body (HSSIB) has published an independent report calling for improvements and changes in the design of paediatric wards to ensure they provide a safe and therapeutic environment for children and young people with mental health needs.
Health professionals in scrubs walking down hospital corridor

The report highlights that paediatric wards were traditionally designed for the treatment of physical health needs and have not been designed to keep CYP with acute mental health needs safe, let alone provide a therapeutic environment for those children. Increasingly however, children and young people are being admitted to acute paediatric wards with mental health needs, including high-risk presentations such as self-harming behaviours.

The interim report from this HSSIB investigation highlighted that many paediatric wards are currently ‘not safe’ for children with high-risk mental health presentations and outlined a range of considerations around the physical environment, staff training, and joint working. 

This final report, published on 23 May 2024, explores how the paediatric ward should be adapted to provide an environment which is safe, appropriate and has therapeutic benefit.

Recommendations include: 

  • NHSE should develop guidance on how acute paediatric wards should be adapted to support CYP with mental health needs, with a focus on improving the therapeutic environment 
  • NHSE should update the ‘Health Building Note’ guidance on designing hospital accommodation for children and young people, so includes providing a therapeutic environment for CYP with mental health needs 
  • The CQC should  ensure healthcare providers and ICBs implement a robust way for risks to be escalated and managed

RCPCH Officer for Mental Health, Dr Karen Street, said:

Despite the best efforts of health professionals across the system, we know that staff in paediatric settings are finding it challenging to provide safe and appropriate care for 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. Urgent action is needed.

As a college we support HSSIB’s recommendations to improve the design of paediatric wards, so they better meet the mental health needs of children and people and take into account the increase in children and young people presenting with acute mental distress. This should be a clear priority for the New Hospitals Programme, with additional investment for existing settings to improve their paediatric wards and emergency settings. 

The investigation rightly recognises that there are multiple factors that impact the care of young people with mental health needs, alongside the physical environment, The College has also been calling for improvements to out of hospital crisis centres, greater investment across mental health services and improved support for child health teams, The paediatric profession is committed to holistic care for children and young people, which necessarily includes both their physical and mental health, and adapting to the changing challenges for children and young people to give our patients the best quality care and support – however we now need Government to follow suit. 

If we are ever to get out of this dire situation then we need meaningful support for health services and staff, as well as child focused polices that can improve the physical, emotional, social, and educational wellbeing of young people. The responsibility to tackle this growing mental health emergency cannot be left to healthcare professionals alone.


We urge the next UK Government to prioritise child health services and the workforce that supports them, as outlined in the RCPCH Manifesto for the next Government.