A new report from the Healthcare Safety Investigation Branch (HSIB) says there are “significant risks” associated with caring for children and young people who exhibit certain high-risk behaviours on paediatric wards.
These risks affect not only the safety and wellbeing of those with high-risk behaviours, but also of other patients, family members and staff on the ward.
The number of children and young people with mental health needs has risen since 2017. In 2022, roughly one in five (18%) children aged 7 to 16 years and around a quarter (26%) of young people aged 17 to 19 years had a probable mental disorder.
Given this increase, paediatric wards in acute hospitals are increasingly caring for children and young people with mental health needs. However, these wards are not designed to keep those with mental health needs safe.
Indeed, of the 18 acute hospitals investigated by the HSIB, 13 of the hospital were deemed as “not safe” for children at risk of harming themselves. This is predominantly because many of the wards contain ligature risks, and the environment tends to be crowded, busy and noisy, making it unsuitable for people with sensory needs and those experiencing a mental health crisis.
In some paediatric wards it was also relatively easy for a child or young person to leave without permission or engage in other high-risk activities because the ward layout meant that lines of sight could be limited.
The remaining five hospitals tried to make the environment as safe as possible but felt that more could be done to ensure their patients were kept safe.
Autistic young people and children and adolescents with learning disabilities may be placed in paediatric wards if they display high-risk behaviours such as attempts to die by suicide, self-harm, attempts to leave the hospital without permission, and episodes of violence and aggression.
They may also be admitted if they have a physical healthcare need and/or to provide them with a ‘place of safety’.
However, suitable residential accommodation for people with complex needs can be hard to come by, and many children and young people remain stuck on hospital wards for prolonged periods of time.
For example, the BBC recently reported that a 16-year-old autistic girl was kept in a side-room of the children’s ward for nearly 200 days due to a lack of appropriate support from mental health services.
Molly said the loud, bright, busy hospital environment was like “living in hell”, and she was restrained numerous times as a result. Molly was kept under close observation by three nurses and there were often security guards stationed outside her room.
In Molly’s case, the hospital environment not only harmed her mental and physical wellbeing, but also impacted on other patients, and towards the end of Molly’s hospital stay, the children’s ward closed to other patients because she became so distressed.
The HSIB is now calling on integrated care boards (ICBs) to facilitate a system-wide response to reduce the safety and wellbeing risks associated with children and young people demonstrating high-risk behaviours who are admitted to an acute paediatric ward.
The Branch says it may also be beneficial for acute hospitals to review their practices for caring for children and young people with high-risk behaviours, using current available guidance and the findings published in the report.
“Where possible, immediate actions should be taken to appropriately reduce the risks to children and young people with high-risk behaviours staying on the acute paediatric ward,” they say.
