1. The Mental Health Care of Children and Young People: A Minor Issue? Camilla Parker, Partner, Just Equality 17 th October 2014 1 Just Equality: Linking Law to Life

2. Children and Adolescent Mental Health Services: Full Circle ? 2002 CAMHS “are a total disgrace” (Professor Sir David Hall, President of the Royal College of Paediatrics and Child Health) 2004 onwards - increased focus on CAMHS eg 2004 Children’s NSF and increased resources 2008 CAMHS Review: improvements but “mental health and psychological well-being not as consistent or as good as they could be” 2014 - “CAMHS is a system under siege” Children and Young People’s Mental Health Coalition (CAMHS inquiry) 2014 - Children’s mental heal health services “dysfunctional” and “crying out” for a complete overhaul, (Norman Lamb, The Independent 20 August 2014) Just Equality: Linking Law to Life 2

3. Confusions and concerns... Mrs Gillick / Lord Fraser? Assessing competence/capacity Zone of parental control (ZPC) Deprivation of liberty & the ZPC Place of safety & age appropriate environment duty Children Act 1989 or the MHA 1983? Parental responsibility & Nearest Relative The “overwhelmed young person” Access to CAMHS Transition from CAMHS Lack of CAMHS beds Just Equality: Linking Law to Life 3

4. Cinderella’s Little Sister CAMHS - under-resourced and now cuts “...under financing of CAMHS nationally....., the lack of funding risks undermining all of the progress that has been made over the past 10 years.” (LGA, 2014) 2/3 LAs (Eng) reduced CAMHS budget since 2010, Young Minds Lack of information e.g. prevalence (2004), use of MHA Commissioning - (“dysfunctional” - Norman Lamb) - NHS England: “...savings accrued as a result of early intervention may well fall to a different commissioner / agency than those providing the investment or the cost of a delayed discharge falls to a different commissioner /agency than those required to provide services to facilitate discharge services” Just Equality: Linking Law to Life 4

5. A consequence of Cuts? Increase in hospital admissions – often far from home... Survey of Royal College of Psychiatrists Child & Adolescent Faculty (2013): 77% English respondents had difficulty in accessing beds 79.1% safeguarding concerns/incidents while waiting for bed 89.2% out of area placements (furthest >500 miles) NHS England T4 report: 29% (50-100 miles) 10% (100- 200), 5% (200-250) 1% more than 250 miles CQC: ‘One parent told us that their child was “103 miles away, costing £100” to visit.’ (CAMHS report, October 2014) Evidence to CAMHS Inquiry – cuts in services (Tier 2 & 3) and lack of Tier 4 beds a recurring theme NHS England Report, July 2014 – to urgently increase CAMHS beds - by up to 50 Just Equality: Linking Law to Life 5

6. ...but often after a long, difficult, wait... Survey of Royal College of Psychiatrists Child & Adolescent Faculty: 79.1% reported safeguarding concerns/incidents while waiting for bed ‘Finding a bed has become much harder this year and we are needing to keep children longer on paediatric wards. There are no local tier 4 provisions, which means families have long distances to travel.....and longer time in hospital likely e.g. “youngsters being admitted to units in the private sector, which the local CAMHS have no links to, and often staying there for several months” Just Equality: Linking Law to Life 6

7. Mental Health Assessments: under 18s Likely to increase: Increase of referrals to CAMHS Increase in complexity of cases (self-harm, suicidal thoughts) “Rates of referrals and suicidal teens seem to be increasing. in our area we have had 5 completed suicides this year, which is unheard of.” (RCP survey 2013) Suggestions for AMHPs: Insist on CAMHS specialist as one of the medical assessors MHA Code 4.73, 36.20; previous acquaintance (section 12(2)) Enhance assessment and communication (age appropriate etc) Accessing CAMHS bed, if hospital admission required Ascertain who in your area is responsible for finding a CAMHS bed (link to NHS England) Request IMHA to visit? (6.20 draft Code) Just Equality: Linking Law to Life 7

8. Use of the Mental Health Act 1983 Likely to increase: Prevalence and complexity Change in legislation (s131 MHA 1983) & policy (MHA Code) Cheshire West’s “acid test” – Court of Appeal’s decision in RK still relevant where State involved Questions: Role of parents in decision-making on admission/ treatment? How many under 18s are being detained under the MHA 1983? What is the impact of detention under the MHA 1983? Just Equality: Linking Law to Life 8

9. Appropriate Care? S131A – “age appropriate environment duty” Pushed into the Shadows OCC, Young Minds campaign Backlash: police cells used rather than s136 facilities (CQC) Draft Code (19.103, 19.104) Under 18s admissions to adult wards May be appropriate to deal with immediate crisis CQC to be notified on admissions of >48 hours Under 16s, treated as serious untoward incident What safeguards are in place on adult wards? How many admissions? Differing data: HSCIC, BBC/Community Care, CQC – but indications are that the numbers are increasing Use of paediatric wards Staffing concerns in Tier 4 Just Equality: Linking Law to Life 9

10. Summary of Concerns CAMHS - disproportionate impact of cuts? Widespread concern -identified by providers, commissioners, local authorities & voluntary sector, e.g.: the reality on the ground is of disinvestment and disinterest (Cornwall Partnership Foundation NHS Trust) The issue of children’s and adolescent mental health should be recognised for the national issue it is, with politicians and NHS leaders raising it high on the agenda and keeping it there.” (Mental Health Commissioners Network) Costs – ineffective use of resources Major human rights concerns Long term impact on children, young people and their families – and society as a whole Just Equality: Linking Law to Life

11. CAMHS: A major issue for us all... “As a nation are doing badly for the young people of this country and we need to do better – with a focus on prevention and early intervention. Otherwise we are likely to head to a deepening crisis in children’s mental health which may well have a knock on effect not only for adult mental health services but also to the burden of ill health for the future workforce” (Royal College of Psychiatrists 2014) Just Equality: Linking Law to Life 11

12. 12 Camilla Parker Partner, Just Equality camilla@justequality.co.uk www.justequality.co.uk Just Equality: Linking Law to Life