Child and Adolescent Mental Health Services: Follow-up Review of Safety Issues

Children and young people accessing mental health services in Wales continue to be put at risk. This is the conclusion of our joint follow up review with the Wales Audit Office published today.

The review focuses on action taken by the Welsh Government and health boards in response to the safety concerns identified in the Child and Adolescent Mental Health Services (CAMHS) report which was published in 2009.

The follow up report acknowledges that the Welsh Government and health boards have made some progress in addressing the safety issues highlighted in the 2009 report. The improvements made include revised policies and procedures, strengthened training, and expanded community support services.

However, despite improvements the risks identified in the 2009 report remain: some children and young people are still being inappropriately admitted to adult mental health wards, health professionals are failing to always share information and act on their safeguarding duties, and unsafe discharge practices persist.

Community services providing intensive support have been expanded in recent years, and there are plans to expand these services further. However, they will still not be available in all parts of Wales, and in those areas which lack this service there is greater dependence on inpatient services. Young people continue to be admitted inappropriately to adult mental health wards, and measures to reduce the risks faced by young people in these circumstances have not been completely successful. A lack of capacity at the two specialist CAMHS units in Wales is also resulting in children and young people having to be placed out of the area in which they live to receive treatment.

The report also concludes that although revised policies and procedures and strengthened training have been put in place to improve safeguarding and information sharing amongst health professionals, they have not led to improvements in practice on the ground.

Safe practices are also still not in place for young people who miss appointments Many young people who do not attend appointments are being discharged without sufficient attention to the risks involved, and health boards have not developed arrangements for checking the safety of their discharge procedures. A “not brought protocol” has been developed by the Welsh Government, but the impact it is having on the safety of discharges is not yet known and needs to be monitored.

The report makes a number of recommendations for the Welsh Government, which are intended to:

• Improve the reporting by health boards of admissions of young people to an adult mental health ward, including the steps taken to reduce the risks to the young people concerned.
• Clarify the circumstances where an admission to an adult mental health ward would be appropriate or acceptable.
• Strengthen systems for routine monitoring of compliance by staff with their safeguarding and information sharing responsibilities, and with the all Wales “was not bought” protocol intended to ensure safe discharge practices.

The Auditor General for Wales, Huw Vaughan Thomas said: 

Despite the steps taken to address the safety concerns raised in the 2009 report, children and young people continue to be put at risk. The Welsh Government therefore needs to take a stronger grip to ensure that health boards are designing and delivering services which protect children and young people and minimise the risks to them.

Chief Executive for Health Inspectorate Wales, Kate Chamberlain said:

The problems with delivering safe mental health services for children and young people identified in 2009 still remain, and there are considerable challenges for Health Boards to address in developing services and changing professional practices on the ground. Health Inspectorate Wales will continue to monitor progress being made across Wales in improving the effectiveness and safety of services delivered to children and young people.