In-patient provision for young people with complex needs
Services for young people with a learning disability
This themed visit did not focus on services for young people with a learning disability, but because meetings were arranged with all the mainland CAMH services the opportunity was taken to ask about services in place for young people with a mental illness combined with learning disability. In all areas now some form of dedicated community service is provided, but it is recognised that in all parts of Scotland the service is limited, and services are very rarely multi disciplinary. We were also advised of significant issues about the lack of specialist in-patient facilities for this group of young people.
This sometimes results in admissions of a young person with a learning disability to a general adult ward, where they are potentially even more disadvantaged by the absence of specialist skills or to an adult learning disability ward., We know of a small number of highly intensive "bespoke" packages in place for individual young people in some of these other settings. In some cases specialist placement outside Scotland is sought.
Services for young people with a history or risk of violence or sexual offending
There are currently no adolescent IPCU beds in Scotland, nor any forensic in-patient service. Young people who have a mental disorder and who require treatment in a secure setting, because of risk to self or others, are either transferred to an adult IPCU, or to low or medium secure adolescent units outwith Scotland.
In an adult IPCU these young people are invariably cared for under enhanced observation, and often with a very significant degree of isolation, because of very real concerns about their vulnerability within this particular adult setting. This often means young people are excluded from therapeutic and diverting activities. For any young person subject to an assessment order or treatment order, or any other mental health section of the Criminal Procedure (Scotland) Act 1995, there is no legal mechanism which would allow for transfer to a service outside Scotland. At present there is no secure age-appropriate service for them.
This raises significant issues about estrangement from family and community of origin, where it results in a child being detained for a significant time far from home, which may impact negatively on outcome. Additionally the young person may be educationally disadvantaged because of non-compatible education and examination systems.
Across Scotland community CAMHS teams have limited specialist learning disability or forensic provision. In Greater Glasgow and Clyde there is a team in both specialties, elsewhere development of CAMH services for people with learning disability is ahead of specialist forensic services. All are still mainly single practitioner rather than multidisciplinary teams.
Recommendation
There are no in-patient beds to meet the needs of young people with learning disabilities or of young people who require treatment in IPCU units. We recommend that regional commissioning groups give consideration to providing appropriate facilities in Scotland.
