Sending patients to England leads to distress, says Sophie Pilgrim
The Scottish Government aims to lead the way in promoting the wellbeing of children and young people, going as far as to set the ambition that Scotland will be the best place for children and young people to grow up.
This is an important commitment and draws on the best traditions in Scottish culture.
I very much hope that we are able to make that vision a reality. But, in order to get there, we need to radically improve the way that we currently provide and care for children and young people with mental health issues.
For those children and young people under the age of 18 with mental health conditions, there is no secure provision north of the Border.
All three Scottish adolescent inpatient psychiatric units are open wards and none of these facilities is adequately equipped for those with a severe learning disability.
There are also no specialist inpatient services for children with autism.
As a result, those with challenging behaviours and learning disabilities are often being treated in unsuitable adult or paediatric wards, or being sent miles away from their families to England, a clearly distressing situation not only for the young person, but for their family as well. I have witnessed first hand, on a number of occasions, the devastating effect that this has upon all involved.
This practice is clearly a relic of outdated attitudes towards mental health and should be a major concern for all organisations upholding the rights of the child in Scotland.
As well as this lack of secure facilities, according to figures from the Mental Welfare Commission (MWC) the number of children and young people being admitted to non-specialist units such as adult and paediatric wards has increased from 177 last year to 202 (174 in adult and 28 in paediatric wards) meaning that they may not be getting appropriate support.
Under Section 23 of the Mental Health (Care and Treatment) Act 2003, a responsibility is placed on NHS boards to provide accommodation and services to meet the needs of persons under the age of 18. If a young person is admitted to an adult mental health ward there is clearly a real risk that this will not happen.
Furthermore, generic child and adolescent mental health services (CAMHS) are not able to meet the needs of children with autism. At present, children who do not have a learning disability are not adequately supported because they do not meet the criteria for specialist CAMHS.
This anomaly leads to the severe deterioration of the child or young person because of inappropriate care and planning.
Specialist inpatient services need to be established in Scotland so that very vulnerable children with the most severe mental illness are not sent hundreds of miles from their families.
The current situation adds to the deep distress experienced by families who are not adequately compensated for their travel and accommodation, and meet endless bureaucracy and insensitivity to their situation.
Ideally, we need to see improvements in provision of CAMHS in the community, particularly the availability of “intensive behavioural support” so that inpatient treatment is reduced to a minimum. At present, waiting times for assessment and treatment by CAMHS are unacceptably long. Such delays would not be tolerated in other NHS services. Having said this, it is clear from what we know of services in England that there will always be a need for hospital care for acute crisis and for assessment and diagnosis.
When we have such great ambitions for all children in Scotland, how is it that we provide so poorly for those who are most unwell?
I think it must be that the public and even politicians are not aware of this matter. If people in Scotland knew that we were banishing children with the most severe mental health conditions to hospitals far from home then surely this would not be tolerated. For those of us who do know that this outdated practice continues, it is our responsibility to do everything we can to bring about change.
Let’s make 2015 the year in which we see an end to the practice of sending mentally ill young people to England. How about that for a New Year resolution?
• Sophie Pilgrim is a member of the Scottish Children’s Services Coalition and director of Kindred Scotland