Rise in teens admitted to adult psych wards

A still from a TV programme showing a teenage girl wearing a pink cardigan and light blue jeans, sitting with her knees up and her arms wrapped around them, her face obscured.It was reported today that there has been a rise in the number of teenagers under 18 admitted to adult psychiatric wards, and that these were sometimes hundreds of miles from home and often proved to be highly unsuitable places for them. The BBC reported this here and there is a video clip of a young girl recounting her experience of being sent away (the other reports at present are just wire copy rewrites.) I have seen other reports of this sort of thing happening because of local inpatient facilities closing, notably this disturbing report of a young girl from Hull with Asperger’s syndrome who had been raped, who was sent to a secure unit in Cheshire after her local unit was closed to inpatients and there were no beds on other units in Yorkshire.

The case in Hull demonstrates that in fact unsuitable adolescent inpatient care can be as bad as putting a teenager in an adult ward, particularly if it is far from home. Putting a group of teenagers with different mental illnesses in one small section of a building and locking them in can make it an extremely hostile environment for some of them if the unit staff are unable or unwilling to protect the weaker children. The report notes that “the social care regulator had received an alert about a 12-year-old being admitted to an adult psychiatric unit”, but the majority of 12-year-olds are children, not adolescents, and putting them on a ward with 16-year-olds could have been every bit as traumatic as 16-year-olds, in our culture, have less responsibility for their actions than 22-year-olds.

The report also shines a light on the policy of banning visits by “children” (i.e. under-18s) to wards, even when the patient is under that age. (This is one of the ‘blanket policies’ that restricts the freedom of people in mental health wards, often beyond what is necessary; these include, for example, bans on accessing the Internet; see chapter 3 of this PDF from the Care Quality Commission.) I am not sure what the reason behind it is, but when I was a child I visited my uncle (who was in his 40s, and I must have been about eight) at a psychiatric hospital near Croydon (now closed), and although the environment was grim (dark and smoky) and it was a bit upsetting, neither my sister nor I came away traumatised by it. Looking on the website of Southern Health, which runs a number of mental health inpatient units in southern England, visitors under 18 are not allowed to visit one of them at all, and are only allowed into the visitor area at another. As one of these units admits people from age 18 up, this means that younger siblings of younger patients would not be allowed to visit, and nor would patients’ children (this is also true at their learning disability inpatient units, including the scandal-ridden STATT unit in Oxford). No reason for this policy is given anywhere.

Some might argue that it could traumatise children to be on a mental health ward, and when I mentioned this to a friend on Twitter, she told me that her son had never forgotten seeing his grandmother in a nursing home; but surely this is a decision parents have to make, and in any case, children are not banned from visiting nursing homes, and there needs to be a distinction made between children and adolescents, particularly those over 16. It sounds like a policy made to minimise ‘risk’, i.e. the liability of the unit, rather than for the welfare of the patients or the visitors. If under-18s can be admitted to these units, surely they should be allowed to visit. As one of the former patients interviewed said, it made it a lot harder that her friends were not allowed to visit, and she was on the adult ward (at age 17) for eight weeks before being moved to an adolescent unit.

There is no secret that mental health is considered a “Cinderella” service, i.e. one that is hidden from view and not glamorous, rather like the long-term care of people with learning disabilities. It seems that the only money available is for crisis care, which is all very well but people need something to move on to and just going back to the status quo ante is not always possible — it may have been what caused the crisis. It is good that in the UK we do not use hospitals for the long term care of these people — a situation like that of Astrid van Woerkom, the Dutch autistic blogger who has been in institutions since 2007 because the state will not provide the care she needs in the community, would be extremely unlikely to happen here — but the more we cut inpatient mental health beds and community services for both these groups of people, the more we end up with people in crisis being sent miles away from home to units that are completely unsuitable and which make bad situations a lot worse.

(The image is a still from the BBC series Don’t Call Me Crazy, which was broadcast on BBC Three in summer 2003. Reviewed here; one of the participants is interviewed here.)

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