Urgent calls to stop sending children to adult mental health ward

Friday 03 September 2021

Home treatment and better community support for children and young people in crisis must be put in place as soon as possible, as "inappropriate" admissions into Jersey's adult mental health facility are "no longer an exception", a mental health advocate has said.

Patricia Winchester, the CEO of My Voice Jersey, made the call ahead of a meeting of Directors from the Health, Children and Child and Adolescent Mental Health Services today, in the hope that a solution may be found.

She told Express she has become increasingly concerned about the “inappropriate admission of children in the adult unit” - something she says never used to happen when she first started in her role.

Over the last two to three years, Ms Winchester said that admissions of children and young people into Orchard House had become more frequent and were "no longer an exception". 

Sometimes up to five children have been on the ward at the same time, with the youngest one she is aware of having been 14.

Pictured: Patricia Winchester, CEO of mental health advocacy charity My Voice Jersey.

STAC minutes from June recently revealed how three under-18s had been admitted in one week amid a 20% rise in demand for Child and Adolescent Mental Health Services (CAMHS).

“There should be no children on an adult ward,” Ms Winchester said.

“It’s supposed to be a 'never event'. Because we have nothing else, it has become acceptable, but it is not acceptable. Children should be supported by specialist nurses who are qualified in children and adolescent care, not an adult mental health nurse, they are not given the level of support they need.”

Pictured: Ms Winchester says children are not being given the support they need to get better.

Being in a mental health unit can be harmful for children and young people, Ms Winchester explained, as they might learn behaviours from other patients, or start to see themselves as “a person who needs hospital treatment”.

In some cases, an admission can also start a vicious circle that is then difficult to interrupt. 

“When somebody is discharged, they are scared about being in the real world,” she said. “Some young people get used to being in a ward and it becomes hard to be in the real world. You should come out as soon as possible and be supported to stay out but there does not seem to be enough support for them to stay in the community. They feel unsupported and do something to make sure they end up there again.”

A local mother, whose 17-year-old daughter spent time at Orchard House, told Express that her daughter's experience of the facility had not been positive, adding she believed it had actually made her worse.

“It’s a horrible place for a young girl,” she said. “I went there and there are adults with really big problems. I noticed a physical change in her - she started developing tics and her self-harm got worse.

“I raised a lot of concerns, but it took a while for my daughter to have someone to talk to.”

Pictured: A local mother said Orchard House was a "horrible place for a young girl".

The mum explained that even though she was promised her daughter’s placement at Orchard House would only be for a short while, she spent several months there.

“They were always telling me they would find another place,” she said. “My daughter deserves a good place to go to to be able to talk and fully open up. She needs someone to sit with her and talk to her.” 

The situation, Ms Winchester said, has arisen not only due to the absence of a suitable alternative facility but also because there is little support available in the community.

“There is insufficient thought given to how these young people can be better supported rather than being effectively contained. There should be more support in the community and more alternative placements.

“Some will display some risky behaviours but that does not mean they should be in hospital. What you want is to have more home treatment, and more support in the community, a variety of placements, rather than putting them automatically in an adult hospital.”

Pictured: The number of children readmitted to the adult ward has increased.

In addition to a higher frequency of admissions, the mental health advocate says that, in the past year, the number of readmissions has increased whilst discharges have been delayed as “there is never a clear pathway” for them. 

“There are three services involved - CAHMS, the Health services who pay for the admission, and the Children Services,” Ms Winchester explained. “They all argue about who pays for what because funding is an issue and neither party are providing the right services.”

Ahead of the meeting taking place today, Ms Winchester shared the hope that Directors will come up with a way to prevent admissions and facilitate a quick discharge with support in the community, as well as giving proper resources to CAHMS. 

“Saying we do not have anything else is not good enough, we are still a rich island,” she said. “Admitting a child in an adult ward should only be done in extreme situations and we are failing with that again and again.

“It’s not where young people should be going, the discharge is prolonged and there’s not enough home treatment. Most young people are very distressed, and they cannot manage their emotions, that’s not something you make better with a pill, that’s something you make better with support. We need a number of therapeutic units where people can be supported to get their lives back on track.

“They should not be on the adult ward and in anyway, if there were better resources, they would not need admitting on the ward.”

Pictured: Ms Winchester campaigned for improvements in Orchard House.

Having previously campaigned for investment into the refurbishment of Orchard House, which she had at the time described as “Cinderella in rags”, Ms Winchester says she has seen the positive impact of such calls. 

“We have seen when we have called for improvements, it’s been acted on,” she said.

“Orchard House is not perfect, but it is far better than it was. They put lots of support into it and they need to do the same for children. We can see the benefits of resources being invested and children need to be given the same.”