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Children with mental health crises get raw deal in emergency care departments

Long waits, poor availability of specialist staff, and lack of age-specific facilities

Caroline White

Wednesday, 11 July 2018

Children and young people with a mental health crisis are getting a raw deal in emergency care, reveal the results of a poll* of UK emergency departments, carried out by the Royal College of Emergency Medicine (RCEM).

Provision is characterised by excessively long waits, poor availability of staff outside office hours, and a lack of age-specific facilities and expertise, show the 93 responses (out of 240 UK emergency departments).

Services for children and young people who arrived in emergency care with an acute mental health problem were rated as poor by over half (53%) the respondents. Fewer than one in 10 (8%) rated them as good, while 12% rated them as awful.

Nearly two thirds (62%) of respondents said they had specialist child and adolescent mental health (CAMH) services available during working hours, but for less than eight hours a day and nearly a third (31%) had services in the evening. But at weekends, these proportions dropped to 27% and 15% respectively.

When asked how long a patient would wait to be seen by any mental health decision maker if they presented between 3pm and 7pm, around half (48%) estimated the wait would be between 12 and 24 hours. Only around one in five (22%) thought they would be seen by four hours.

When asked if their emergency department followed NICE guidance to normally admit every child/young person for mental health assessment the next day, some 9% said they admitted everyone and felt it was helpful, while around a quarter (26%) did so, but said they didn’t think it was always helpful. But around two thirds (65%) said they didn’t always admit.

Very few respondents said their emergency department had specific facilities or expertise for adolescents.

When asked how long a patient might wait for a psychiatric bed in their hospital, some 41% estimated that it would take more than 48 hours, while one in five (20%) said less than 12 hours.

“This survey provides further evidence of a huge gap in service provision for a complex group of patients who are currently getting a raw deal if they come to an emergency department with a mental health crisis,” concludes the report.

“There has been much talk of improving mental health provision both in crisis and in crisis prevention. Our results show that there are a few green shoots of improvement in a handful of places, but that the general picture is very poor for this age group. [Emergency departments] need to look at their own facilities and training and start to provide a better environment for adolescents.”

In light of the findings, the College plans to add specific adolescent competences to the curriculum for emergency medicine trainees.

*RCEM national survey on mental health services for children and young people in the emergency department. Royal College of Emergency Medicine, June 2018.

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