26th July 2017

Inpatient provision for children and young people with mental health problems

In this report, the Education Policy Institute (EPI) has examined the state of child and adolescent mental health inpatient services in England. The analysis explores the latest evidence and NHS data on admissions, quality of care, staffing and capacity.

The report can be downloaded in full here.

Key findings

The research highlights 5 challenges to raising standards in young people’s mental health provision:

Workforce shortages

  • 1 in 9 (12 per cent) inpatient units fail to meet basic requirements for staff to patient ratios.
  • Nearly a quarter (24 per cent) of units struggle to employ permanent staff – up from 17 per cent since 2014/15. Temporary bank and agency staff make up 19 per cent of child mental health inpatient pay costs.
  • Staffing shortages affect the quality of patient care, therefore to improve inpatient care there must be a sustained focus on recruitment of skilled staff to work in child and adolescent mental health services.

Minimum standards not met 

  • Inpatient mental health services for young people on average fail to meet 7 per cent of minimum standards, meaning this provision represents “a significant threat to young people’s safety, rights or dignity”.

Provision of beds

  • There were 1,440 child and adolescent mental health service (CAMHS) inpatient beds in the NHS in England in December 2015, a 71 per cent increase since 1999.
  • There is however a wide disparity in access to beds across regions:
    • the North East has the greatest provision of beds, with 3.03 per 100,000 people
    • the lowest is in the South West, which offers just 1.1 per 100,000 people – falling below the recommended standard.
    • Yorkshire and Humber also fails to meet this benchmark – with 1.6 beds per 100,000 people.
    • This can lead to children with mental health problems being admitted to adult wards, despite a duty to prevent this under the Mental Health Act (2007). Between October and December 2016 there were 83 under 18s treated on adult wards – translating to a total of 2,700 days spent in adult hospitals.
    • Experimental NHS data also shows that, in 2016, children under 16 spent a total of 1,657 days on adult wards.
  • In response to this regional disparity the NHS has this year announced it will provide more beds, and will redistribute them more uniformly.
  • Inpatient beds must be more effectively monitored in future to ensure young people who need to be admitted to hospital can be seen in the right place at the right time.

Young people in inpatient care

  • Eating disorders were the most common reason for a young person being admitted to hospital in 2015/16.
  • Overall, there were 2,434 admissions of children and young people aged 18 or under with mental health conditions into hospital between October and December 2016, falling from 4,399 admissions in April – June of 2016 when the data was first collected.

Young people are being left in hospital for longer than necessary due to a lack of community services

  • Between October 2015 and February 2017 children spent nearly 9,000 days waiting to leave mental health hospitals, yet were unable to do so due to lack of subsequent support. This was often because the right mental health or social care support package was not available in their local community.
  • The trend is negative, with the number of delayed days in December 2016 – February 2017 42 per cent higher than in the same period the previous year.
  • The evidence shows intensive community treatment can be an effective alternative to hospital admission – but despite government commitments to increase access to such support, 64 per cent of inpatient care providers recently reported that they did not have an intensive outreach team.