Out of interest, I had a look through the CQC reports for CAMHS units in the United Kingdom. Although most were rated overall as ‘good’, many of these were actually rated as ‘needing improvement’ for their level of safety. Some wards, including wards that I have been previously on, have even been labelled as ‘unsafe‘. It’s quite clear that funding is insufficient for CAMHS, and here are just some of the things commonly noted down in the reports that really prove that:
- Lack of separate male and female areas – the bed crisis means that there simply isn’t enough space to keep males and females separate. Although wards are meant to have female-only areas, most CAMHS units don’t have this, and many have unisex bathrooms. This breaks the code of the Mental Health Act.
- Seclusion areas not meeting standards and not being recorded properly – some units were reported to have inadequate seclusion areas, some with bathrooms that could only be accessed if a staff member came in and unlocked the door. Patients reported a lack of dignity, and units failed to show records for reviews once in seclusion.
- Patients not being informed of their rights – some patients were not explained to them properly what being sectioned meant, and in some places informal patients were not aware that they could leave.
- Risk assessments and care plans not up to date – due to strain on staffing, the administration in units is often pushed to the side, despite this being important for patient care. Without proper risk assessments and plans in place, patient’s wellbeing is put at risk, and it is more difficult for MDT to come to decisions about leave and other advancements in care. It was also found that many units failed to make adequate discharge plans.
- High turnover of staff, with agency staff who had never worked on the ward before and had received minimum training – many units have had to cope with the difficulty of not being sufficiently staffed, and having to call in untrained members of agency staff. It takes time for staff to become accustomed to the ward, and incidents are more likely when there is a high level of inexperienced staff.
- Leave and activities cancelled due to lack of staff – disruptions to the therapeutic programme due to strains on staff are common across the board, with patients sometimes not being able to access their rooms, outside areas or education areas due to staff not being available.
- Untrained staff using prone restraints and other inappropriate restrictions – a prone restraint is when a patient is restrained with their facedown. This should not happen, and if it does it must be recorded. One unit was reported to have used emergency ties and soft handcuffs to restrain a difficult patient. Medical reviews were often not carried out after these incidents.
- Poor level of staff knowledge about the Mental Health Act and low levels of mandatory training and safeguarding – a recurring theme in reports on CAMHS beds revealed that many staff were untrained, with some not understanding basic concepts such as the Mental Health Act.
- Patients being far from home due to a lack of inpatient beds in a crisis – many patients are sent to units hundreds of miles away from home due to the lack of bed availability. Once they have been admitted to this unit, it has been noted that it is unlikely for them to be able to be moved.
- Comments and complaints not being documented or dealt with – the CQC reports reveal that many units have no proper system in place for patients, parents or staff to submit complaints, and that there is often no follow-up procedure once these have been put into place. Reports also show that patients are often unable to access basic information about the care they are being provided.
- Facilities left damaged or broken for long periods of time, including broken or absent defibrillators – units across the country are so strained that basic equipment can be left broken for months. One unit had no defibrillator and thus failed to perform an emergency drill. Others had shower facilities that were unsuitable for use, problems with fridges that meant medication would go out of date, and dangerous ligature points which were left unnoticed until the inspection.
CAMHS units save lives, and inspections and recommendations by the CQC and other examining bodies means that they are improving all the time. But what we can be sure of here is that cuts to mental health funding means putting the lives of children inside these units at risk. Lack of funding means strained staff, not enough time to fill in important documents, broken equipments and faulty, desperate procedures. We are lucky to have this service and there are so many wonderful things about it, but we must keep it going.
For more information about CQC and Mental Health: