Mental health unit deaths show pressures facing overlooked service

Deaths, staff shortages and a culture of life threatening self-harm are exposing deep fears about the quality of mental health care in hospitals for children and young people.

Since 2019, at least 20 patients aged 18 or under have died in NHS or privately managed mental health units, the BBC has found. A further 26 have died within a year of leaving units, amid claims of a lack of post-treatment community support.

Child and Adolescent Mental Health Services (Camhs) units care for about 4,000 patients with a range of different diagnoses each year. While the aim is to help them recover in a stay of a few weeks or months through specialist care, some patients are in and out of the units for years.

BBC data requests found 18 of the deaths in Camhs wards since 2019 were in England with 14 in NHS wards and four in private sector units. There was one death in Scotland, and one in Northern Ireland.

Charity, Inquest, which provides expertise on state-related deaths and their investigation to bereaved people, said data it had obtained showed there had been at least nine deaths in Camhs wards in England and Wales between 2010 and 2014.

The BBC says that it has also heard serious claims about the alleged unsafe discharge of patients sent home from Camhs hospitals. Several former patients told the broadcaster they had serious self-harm incidents or tried to take their own life within days of returning home.

At least 26 patients in the UK have died within 12 months of being discharged since 2019, figures obtained from NHS Trusts show. Parents have described being on "suicide watch" 24 hours a day, to ensure their child's safety. 

Editor-in-chief of the Journal of Child and Adolescent Mental Health, Dr Bernadka Dubicka, says that Camhs wards can be a "lifeline" for many patients, and that while there is "an awful lot of variation in standards of practice, there are a lot of excellent staff who are really striving to do their best."

But she adds that, despite evidence showing "post-discharge is one of the most risky periods in a young person's life", in large parts of the country there is not enough intensive support from community Camhs teams for patients returning to their homes.

The NHS says it is facing "record demand" for services and has invested ‘record amounts’ to meet this. There has been a 77% rise in the number of children needing specialist treatment for severe mental health crisis, previous analysis for the BBC has shown.

Dr Dubicka says that this was fuelled by the Covid-19 pandemic and adds that the number of young people presenting to A&E or Camhs services with mental health difficulties is rising each year.

She believes this has led to a "perfect storm", and that "chronic underinvestment in the Camhs system over the years" is leading to a staffing shortage that must be addressed by government.

Dr Dubicka, adds that people are waiting "month on month, year on year" for help but not receiving the intensive community support they need. "So, by the time they are seen, their mental health problems are really entrenched."

A Camhs inpatient bed costs about £230,000 per year on average, which is money that Dr Dubicka says would be better spent on community provision in many cases.

In spite of this, she believes that, with a good standard of care, there are generally positive outcomes for patients supported in units.

Teenager Chelsea Mooney was among 20 children and young people who have died at inpatient units since 2019.

She was first sent by the NHS to a Camhs ward when she was 15 after struggling with an eating disorder. She was in the system for two years, across multiple units and her father, Steve Blackford, says that her mental health deteriorated during this time.

He says that while she entered the system with "superficial" levels of self-harm, Chelsea quickly began to learn increasingly dangerous methods from other patients.

In her final unit in Sheffield, an NHS-funded placement at a specialist unit run by Cygnet Health Care, she self-harmed in a way that put her life in danger 250 times in 18 months.

Steve Blackford says that, despite repeatedly asking for updates about his daughter, he was not informed by staff of the scale of Chelsea's self harm.

He says: "We used to tell them, 'If there's an incident, no matter if it's four o'clock in the morning, let us know'. But it didn't happen."

Chelsea did not recover after a serious instance of self-harm In April 2022. She was meant to have been observed by staff every 10 minutes to ensure her safety, but an inquest found there had been an unjustifiable two-minute delay and, when she was discovered, staff were too slow to respond.

The coroner said she had seen "no evidence" of ongoing attempts by staff to discuss with Chelsea why she self harmed, which might have affected her level of risk.

Cygnet Health Care said it worked to "involve families and carers in care decisions and to reduce incidents of self-harm" with an inspection earlier this year finding it followed best practice in safeguarding patients.

There are also fears that patient safety in the sector is being put at risk by an overreliance on temporary staff. New data collated by the BBC, from 32 of the 41 UK areas with NHS-run Camhs wards, suggests spending on agency nurses per bed rose by 72% between 2017 and 2021.

One former patient in Birmingham, Zaynab, 21, said staffing pressures could be "dangerous."

She was first sent to an inpatient unit at the age of 14 following multiple self-harm admissions to A&E. During the next four years she was in and out of multiple hospitals run by both NHS and private providers.

Zaynab said that within one privately run unit, agency staff "would just turn up on the day" and, being unaware of individual patient care plans, would give them objects they asked for that they could use to self-harm or take their own life.

She said that, in some units there was little psychological support and she used to wake up each morning and spend the day planning how she would self-harm.

Zaynab says other patients would "collude" with one another, sharing self-harm objects, or organising collective self-harming.

She adds: "The units are built to be reactive when self-harm happens, not proactive and stopping it from happening in the first place."

One patient, she says, would self-harm at the same time every day but, rather than intervening beforehand with psychological support, staff would wait for the incident to occur, ring the alarm and then deal with the self-harm once it had taken place.

Zaynab says in her final unit she was able to build relationships with staff, engage with psychological treatment and work towards a return to the community. She is now studying at university with the aim of becoming a psychiatrist herself

The Department of Health and Social Care said it was "working to recruit an additional 27,000 mental health professionals by 2024.”

The NHS said there had been an expansion of community services during the pandemic, that it is investing in training for inpatient staff and that all providers should have a clear plan for discharging patients when they are admitted.

CNCI comment:

The Covid-19 pandemic placed huge stress on society in general and especially the NHS. Mental health services may ultimately be one of its longer-term casualties.

Provision to support patients with mental health services have been a ‘Cinderella service’ in terms of funding and resources for so long that many units were under significant pressure when the pandemic started - they simply could not cope with the sudden additional workload.

The pandemic may also have been tougher for young people who were unable to attend school and university and have face to face contact with friends at a time in life when socialising is particularly important for personal development and welfare. 

It is a cause for concern that many of the young people who have suffered mental health problems in the recent past are going to need continuing support and treatment as adults - from a part of healthcare that has been, for some time, underfunded, under resourced and understaffed. Proposals for additional recruitment are very welcome ... but training takes time and, sadly, the problems with mental health service provision are unlikely to be resolved in the near future.