Admission to adult mental health wards for under 18's - adaptation for Scotland: guidance

1

The adult ward, CAMHS team, Early Intervention Psychosis Team, A&E and Local Authority have jointly agreed integrated care pathways and protocols for the admission (both informal and compulsory) of young people to the adult ward, including emergency and 'out of hours' admissions.

1

For young people admitted as an unplanned emergency, the ward has agreed with relevant agencies and services that the referral letters include evidence that all other CAMHS options have been exhausted prior to referral.

1

The ward uses an approach to clinical risk assessment that is agreed with CAMHS as being appropriate for the under 18's age group.

1

Young people admitted are individually risk assessed and the risk is regularly reviewed by appropriately trained staff, one of whom has experience of working with young people in CAMHS.

2

All pre-admission clinical assessments are conducted and recorded by a staff member trained in risk assessment.

1

All young people under the age of 18 are escorted by a chaperone (whose gender they can choose) for intimate medical examinations.

1

Individualised intervention levels are determined by a multi-professional assessment of the young person's mental health needs. The needs of the young person should determine the levels of supervision recommended and take into account their potential vulnerability in an environment designed for adults.

2

One-to-one enhanced engagement is based on assessed risk and clinical need, and is reviewed regularly.

2

Prior to the admission of a young person, the admitting clinician consults with a CAMHS professional and ward manager about the suitability of the ward environment, whenever required.

Note: This applies to each young person on every admission.

2

After undertaking an assessment of risk, the admitting clinician is responsible for discussing the admission with the ward manager and admitting authority i.e. the Hospital Managers or individuals to whom responsibility has been delegated.

1

All ward staff are made aware of the young person's risk status, including the risks posed by other patients.

1

For young people admitted as an unplanned emergency, the ward staff immediately contact the named CAMHS team who initiate transfer arrangements to an adolescent CAMHS unit or another age-appropriate care option to ensure their stay is for as brief a time as is possible.

2

The CAMHS team are responsible for allocating a named lead professional for care coordination within one working day of admission.

2

The named lead professional is then responsible for arranging a transfer to a more appropriate CAMHS environment.

2

The transfer of a young person to an adolescent CAMHS unit of an age-appropriate alternative should take place within a maximum time of 48 hours.

Note: The 48 hour maximum time-frame is an indicator of good practice for unplanned emergency admissions of under 18s.

2

Young people with a Learning Disability or ASD should be prioritised for transfer out of the adult ward.

Note: All factors should be considered when arranging a transfer, for example an Adult Learning Disability ward might be more appropriate than an Adolescent Inpatient Ward.

2

When a young person needs to transfer to another mental health service, a transition care plan (TCP) must be developed with the young person and those involved in their care undertaken to ensure effective communication takes place:

https://www.nhsinform.scot/media/2254/tcp-guidance-document-july-2018.pdf

1

There are policies and protocols in place to guide the transfer of a young person to another service and the responsibilities are allocated to named professionals.

2

Throughout their stay on the ward, young people have a named lead professional who coordinates their care and attends all reviews and discharge planning meetings.

2

Assessed risk is communicated to the team caring for the young person after discharge and other relevant parties.

2

A written discharge and aftercare plan is produced with the young person and the named professional responsible for coordinating their care. If the young person was known to CAMHS before admission and is going to be transitioned to adult services due to age, a transition plan will be agreed and adhered to. The young person will not be transferred to adult services at point of admission.

1

The discharge plan names the lead agency and professional responsible for overseeing the young person's aftercare plan.

2

For those admitted in an unplanned emergency, there is an agreement with the involved CAMHS team or lead agency, regarding aftercare pathways.

1

For those detained under the MHA, discharge planning meetings are held prior to the discharge of all young people detained under a Compulsory Treatment Order of the Mental Health (Care and Treatment) (Scotland) Act 2003.

1

Are invited to care planning meetings;

1

Are involved in decisions about care after discharge from the ward;

1

Know the names of workers involved in their follow-up care and have met them prior to discharge;

1

Before discharge, know the dates and times of appointments with the workers involved in their care after discharge.