Young People with Mental Health Difficulties
SCOPE OF THIS CHAPTER
This chapter concentrates on issues associated with the placement of children in psychiatric units. It also covers the issue of requests for a social care service being made by a psychiatric unit in respect of a child.
Separate procedures are available regarding the Child and Adolescent Mental Health Service for Children Looked After (see Child and Adolescent Mental Health Service for Children Looked After, Health Care Assessments and Health Care Plans Procedure).
AMENDMENTIn September 2016, a link to 'Tools for Supporting Children and Young People's Mental Health' was added to this chapter.
1. Request for Services by a Psychiatric Unit
Referrals made by the Psychiatric unit directly will be seen as a request to undertake a Child in Need Assessment (see Child and Family Assessments Procedure).
This assessment must be completed within the usual prescribed time-scales.
As a minimum the following must be seen as part of the assessment:
- The young person;
- The unit and head of the unit;
- The parent(s).
The Social Worker must satisfy her/himself that contact between the young person and those with parental responsibility is adequate and appropriate.
A written statement must be obtained from the unit that states that proper contact has been established and/or is being maintained or if not why not.
The completed assessment must be 'signed-off' by the Team Manager as is the case with all other assessments.
2. Placement of Children in Psychiatric Units
Duties to such children are set out in s85 of the Children Act 1989 and are summarised below:
- "If a child is provided with accommodation by a health authority, NHS Trust or LEA for more than three months on a consecutive basis or the intention is that this will happen, the health authority, NHS Trust or LEA must notify the responsible Social Services Department. The responsible Social Services Department is interpreted as being the Social Services Department for the area in which the child lives or was ordinarily resident immediately before being accommodated. Where a Local Authority has been notified (a) The responsible Social Services Department must take all reasonably practicable steps to enable them to decide whether the child's welfare is adequately safeguarded and promoted while he is being accommodated by the Local Authority (b) the Local Authority shall consider if they should exercise any of their functions under the Act with respect to that child …" (Para 13.9, Vol 6 Guidance and Regulations).
There is also a duty to inform the responsible Social Services Department when such a child ceases to be provided with accommodation.
Section 86 imposes these duties on residential care homes, nursing homes and mental nursing homes.
No young person can be placed in a psychiatric unit for longer than 3 months without the local authority being notified.
The role of the local authority is to make sure the young person's welfare is being safeguarded and promoted.
Any unit that has accepted a young person, where it is planned that s/he will remain there for 3 months or more, is legally obliged to inform the local authority of the placement.
The usual protocols regarding consent for medication apply. If the medication is for behavioural issues, or due to mental ill health, particular care should be taken. Any person including a young person can be treated compulsorily when they are detained under s3 of the Mental Health Act 1983, (Treatment Order). Otherwise, no young person can be given medication against their will and without their, or a person with parental responsibility's consent. If the child is subject of a Care Order, such consents should still usually be sought. However sometimes it will be appropriate for Children's Services to give consent. In those circumstances the Services Manager should make an informed decision on the basis of medical advice and consideration of the views of the young person and his or her relatives. Parents, and those with parental responsibility, should be informed of such decisions by the social worker. In some circumstances if a child who appears Gillick Competent or in the case of an older child refuses medication the matter can be determined by the court under the court`s inherent jurisdiction.
3. Placement in Psychiatric Units of Young People who are Looked After under S31 and S20
No young person should be placed in a psychiatric unit without a statutory review taking place. The review must be chaired by the IRT and should be attended by a clinician who is able to provide information and advice on the need for a placement in a psychiatric unit to staff, parents and those with parental responsibility and the young person.
Any young person looked after under s20, admitted as a voluntary patient or subject to s2 (Assessment Order up to 28 days)of the Mental Health Act 1983 should have his or her status as a Child Looked After reviewed at a Child Looked After review. If he or she is subject to s3 Mental Health Act (Treatment Order up to one year) his or her status as a child looked after ceases at that point and his or her legal status is s17 Child in Need.
Any young person looked after under S31 remains a child looked after, whether he or she is a voluntary patient, or detained under s2 or s3 of the Mental Health Act 1983.
If the identified placement is not a National Health Service resource the Operations Director for Specialist Services has decision making responsibility. An application must be made to HARP (see Hertfordshire Access to Resources Panel (H.A.R.P) and Delegated Authority for Resource Agreement Procedure) prior to any meeting that is going to consider this option as there will be a significant cost for this service.
In order to ensure that the arrangements for the cost of the placement are agreed, discussion with the relevant clinical staff is essential to ensure that the resource is appropriate for the young person's condition and circumstances.
There will be an expectation that at least part of the cost will be shared with the Health Trust and there must be full discussion with the appropriate budget manager prior to any planning meeting.
A report must be compiled by the young person's Social Worker which includes:
- Child and Family Assessment;
- Care Plan;
- Review Record.
This report must be signed by the Team Manager, and passed to the Services Manager who will take the case to the Hertfordshire Inter-Agency Panel when there are recommendations for placement/resources.
5. Mental Health Section s2 (Assessment Order up to 28 days) s3 (Treatment Order up to one year) Mental Health Act 1983
Where there is a need for a Looked After young person to be admitted under s3 of the Mental Health Act 1983 the Approved Social Worker must notify the Head of Service.
6. Care Planning for a Young Person who has the Status of a Child In Need, following Admission to Psychiatric Hospital
- The CIN plan will be subject to regular review (7 weeks after initial plan and at least every 3 months thereafter);
- When a child had the status of a child looked after prior to admission, then prior to the child's discharge from detention under the Mental Health Act 1983, the Group Manager should make a decision, in consultation with the child, parents (all those with Parental Responsibility) and other professionals about whether to recommend to the Head of Service and to HARP that the child's s20 legal status should be reinstated. If possible, a Safeguarding and Specialist Children's Service representative should attend the S117 Mental Health Act 1983 Care Programme Approach (CPA) meeting, prior to discharge, so that they are involved in future care planning for the young person.