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No suitable places for young people in mental health crisis, warns Children’s Commissioner

Wales needs ‘sanctuaries’ for young people when they’re experiencing a mental health crisis, according to the Children’s Commissioner for Wales.

Professor Sally Holland said young people who reach a point of crisis with their mental health have nowhere suitable to turn. The only option for those at immediate risk of harm is to go to A+E departments or to call 999. The problem is most acute in the evening and weekends when community mental health teams are usually not available.

There are currently no dedicated mental health crisis centres in Wales for young people.

A crisis centre for adults has recently opened in the Swansea University Health Board area.

‘A breakdown in the middle of the waiting room’

Her annual report, published today (5 October), details the experiences of a young person who experienced a mental health crisis.

(Report extract) A 16-year-old wrote to the Commissioner to share their story of experiencing a mental health crisis. The young person attended A&E as they had been advised to. They were then sent on to the adult emergency unit. After 2 hours the young person was triaged before being told they could go home. The young person refused as they felt unsafe. The young person was told to wait until morning to see a professional. While waiting overnight in the waiting room, the young person witnessed restraints on grown men by police and an adult cause damage to the building. The young person then had a breakdown in the middle of the waiting room.

The young person told us that they believe there should be somewhere that teenagers can go when in a crisis which isn’t the adult A&E setting.

‘No other option’ except A&E or calling the police

The Children’s Commissioner said the story highlighted a gap in provision in Wales, and noted that a number of other young people and their families had also shared similar experiences with her office.

“Right now in Wales if a young person has a mental health crisis, there isn’t a suitable place for them to go for the support they need. As the case in our report shows, many will go to A&E or dial 999 because they have no other option. If they are aged 16 or over they will have to wait in an adult A&E waiting area.

“It’s important to say that when young people do go to A+E, they will be supported by professionals. But we have to consider the environment that those young people are in.

“Many of us will have experienced an adult A+E department. At night and on the weekends they can get very busy with distressed adults who are often under the influence of alcohol or drugs. Despite the best efforts of healthcare staff, they aren’t the calming and reassuring places that you’d want a young person experiencing a mental health crisis to go to for support.

“Everyone I hear from about this issue: young people, parents, clinicians – they all want somewhere suitable for young people to go to get this help when they desperately need it. They need somewhere accessible, calm and welcoming that offers help around the clock. They need a place of sanctuary where they can get the immediate help they need.

“They would be able to help the young person through their immediate distress in a suitable setting, and then refer that young person on to the right specialist long-term support.”

‘No wrong door’ to mental health care

The Children’s Commissioner also used her annual report to reiterate her long-term calls for children and young people’s mental health care to be easier to access, and to provide help that meets children’s individual needs.

She said that too often, children and young people are expected to fit into rigid pathways that don’t always work for them, and face long waiting times.

Regional Partnership Boards (RPBs) (local partnerships between health boards, local authorities and the third sector) are responsible for planning joined up health and social care available to their local population.

Professor Holland added:

“The target for Wales has to be a system that gives children the help and support they need, whenever they need it, and wherever they are on their mental health journey.

“On the lowest rung of the ladder this means effective early interventions to get to grips with problems before they worsen; on the highest rung it means safe places to go when a child is at a real crisis point. In between, children need tailored support from a wide range of professionals, where their very specific needs are discussed and tackled; as opposed to them being sent down a path that might not necessarily meet their needs.

“And the way in to getting this help shouldn’t be difficult for them, as it often is now. They should be able to get referred to this help from a range of sources, from their GP to their school, so that there is No Wrong Door into the help they need.

“We’ve seen real positives in recent years. Schools now have a statutory duty to take a whole-school approach to mental health and well-being, with the help of other services. Several regions are joining up their services to provide clearer pathways to support. I’m pleased to see that improving care for children with complex needs is now on every Regional Partnership Board’s agenda, and that generally there is a commitment to the No Wrong Door approach across Wales.

“However, no region has yet got an alternative to A&E, a place of sanctuary, for young people in the midst of a mental health crisis. This is an urgent area to be developed.

The pandemic has made it more important than ever that we get this right for children.”

Other calls

The Children’s Commissioner made several other recommendations to the Welsh Government in her report, including:

  • Publishing concrete plans to remove profit from children’s social care
  • Continue funding beyond next March for the Together for Children and Young People national programme so that progress can be made on supporting neurodiverse children and their families.
  • Urgently introducing new legislation to make sure all children who are home educated are accounted for, are receiving a suitable education and their other human rights, and have the opportunity to be seen and have their views listened to
  • Swiftly bringing in a new law to make sure all professionals who work in children’s education have to be registered with the Education Workforce Council

The Commissioner’s work

 The Commissioner highlighted her office’s year in numbers, as well as other major achievements:

  • Engaged in person with at least 694 children and young people across Wales at online events, workshops and meetings
  • Gathered the views of 44,000 children and young people across Wales through ‘Coronavirus and Us’ surveys
  • Gathered the views of 167 head teachers and college principals in one week in January on digital inclusion
  • Hosted online children’s rights lessons for 864 children and young people
  • Secured nearly 10,000 votes in the country’s first parallel Senedd election for 11-15 year olds.
  • Hosted training sessions on children’s rights for over 800 participants
  • Responded to at least 30 Senedd, Welsh Government and other organisations’ consultations, creating tangible change in a number of new policies and legislation.
  • Managed 663 cases through their Investigations and Advice service

Major achievements

 Major achievements between 1 April 2020 and 31 March 2021 include:

  • Played a major role in data gathering with children and young people during the pandemic: Two Coronavirus & Me surveys, a listening day report and a digital inclusion survey and report.
  • Influenced a wide range of measures including children’s return to school, changes to qualifications arrangements and enabling children in care to have contact with their families.
  • Created and hosted an information hub with accurate, current and accessible information about the pandemic.
  • Undertook the first formal review by the office of the Welsh Government’s exercise of its functions.
  • ‘Building Blocks’: This report highlights the findings of our investigation of exclusion in Foundation Phase education (ages 3-7) across Wales, which revealed that, on average, nine Foundation Phase children per authority had been excluded more than once, with one child having been excluded 18 times in a one-year period.

The Commissioner’s annual report will be debated in the Senedd on 12 October.

ENDS