Minimising the need for admission

Executive summary and recommendations 1
This survey was conducted by the Royal College of Psychiatrists. It
gathered views from child and adolescent psychiatrists about their
experience of working with children and young people at the point
of admission to in-patient psychiatric facilities. Its conclusions are
drawn from the experience of consultants working in community and
in-patient settings across the UK.
The survey resulted in some quantitative information, but has a
stronger focus on qualitative accounts of the patient journey. The
emphasis of this report is in this direction, to reflect the experience
of children and young people stuck in the gap between community
and in-patient care. The recommendations aim to address concerns
arising from this experience.
Recommendations
1 Responsible commissioning groups and health boards need to
recognise the increasing pressures on community services and
the increasing complexity and risk that characterises the children
and young people presenting to services. There are concurrent
pressures on multi-agency services, notably education and social
care, that have a knock-on effect on health services: these need
to be addressed.
2 Resource investment should target strengthening community
mental health services in order to minimise the need for admission.
This survey points to significant, recent disinvestment in
child and adolescent mental health services (CAMHS), which
are strongly affecting community services and working in the
opposite direction.
3 Intensive outreach services should be comprehensively commissioned
by responsible commissioning groups and health boards
to ensure an even distribution around the UK. These services
need to include crisis assessment and crisis management, services
designed to facilitate early discharge and planned intensive
home treatments.
4 There need to be financial incentives across the in-patient/
community CAMHS boundary that promote services working
effectively together, in order to optimise mental healthcare for
children/young people, minimise length of stay in in-patient units,
and allow for safe, appropriate community care (where this is
possible). This should be made more possible by the investment
in community services that we recommend above.
Faculty Report CAP/01
5 Joint working across agencies should be encouraged locally
through partnership and safeguarding boards. This needs to
promote the mental health of young people and to mitigate the
likelihood both of delayed discharges and delayed admission.
6 We strongly recommend that careful thought is given to services
for vulnerable and high-risk children and young people. We
welcome the Government’s recent announcement that they
will ban the use of police cells as ‘places of safety’ for children.
However, we urge the Government to prioritise investment in
crisis care services for children and young people and urge NHS
England, clinical commissioning groups and social services to
ensure that adequate emergency care pathways are in place as
a matter of urgency.