Focussed visit summary: Visits to young people's care facilities
Number of visits 9
Number of recommendations 27
Recurring themes and areas for improvement
1.Attention to mental health needs of young people in residential care
People with any form of disability have the right to the highest possible standard of mental and physical health (International Convention on the Rights of Persons with Disabilities). Young people in residential care setting have high rates of mental health problems. Good links with primary healthcare and specialist child and adolescent mental health services (CAMHS) are essential. We made recommendations when we found:
- Problems with access to out-of hours healthcare
- Difficulty in getting access to specialist CAMHS teams.
- Lack of training in mental health for care staff
Example of improvements following our visit:
Our recommendation where we found that staff in residential accommodation has insufficient training to meet the mental health needs of some of the people we visited:
We recommend that discussions should be undertaken with the NHS Board to seek mental health training for staff.
The unit's response:
Several developments including training for trainers by Young Minds will take place by the end of November 2010.Once this has taken place a rolling programme will be implemented that will train staff on models of risk and reliance.
2.Range of services available in NHS units
Child welfare is an important principle of mental health legislation. We wanted to see that young people had access to a full range of health and education services. This was not always the case. There were problems when young people are admitted to regional units. We made recommendations on:
- Access to education where the young person is from a different local authority area
- Access to some specialist physical health services where the young person is from a different NHS area
Example of improvements following our visit:
Our recommendation where we found young people in a regional specialist NHS unit who were having difficulty getting funding for their education while in the unit.
Managers and the Board should engage education authorities in resolving the issue of equal provision of education to all young people in the unit.
The unit's response:
The educational needs of a young person will be assessed to determine suitability for receiving education whilst an inpatient. The referrer will be involved in these discussions and the education provider notified of the outcome. Any pupil on a school role can access the school service, subject to local authority agreement. The school is run by the local authority Hospital and Outreach Teaching service and therefore pupils from Council area are taught without charge. When a pupil from outside the council area attends the school, the pupil's local authority and head teacher are informed. The local authority is then charged an hourly rate.
3.Transition and aftercare
Transition from young people's services to adult services can be difficult. Also, transfer of care from specialist in-patient services to community teams can be difficult, especially where the person's home is distant from the hospital. Our recommendations addressed:
- Use of the Adults with Incapacity (Scotland) Act 2000 when the young person reaches 16,
- Planning for aftercare when the young person leaves residential accommodation,
- Planning for aftercare when the young person is discharged from specialist NHS care
Example of improvements following our visit:
Our recommendation where we that discharging some young people was difficult because of poor links with some community teams.
The ongoing review both within the unit and with regional partners should be prioritised to ensure that all parties share a clear understanding of the goals of admission and of the responsibilities on all sides to ensure that discharge planning is a part of the process from the earliest stage.
The unit's response:
A development day has been undertaken to ensure that all parties were clear regarding the process of admission and the responsibilities of all sides to ensure the discharge planning is part of the process from the earliest stage.This process will be facilitated by continuing to have an active case manager from the locality team throughout the inpatient stay.
