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

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The care of all young people takes place within an agreed care plan to avoid protracted stays within an inpatient environment.

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The appropriate agencies identify and agree on the lead professional and agency that will take responsibility for coordinating the young person's care.

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The young person is allocated a named professional from the adult ward (e.g. primary nurse) who has experience of working with young people.

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The young person is informed about who these professionals are and their role in providing the young person's care is explained.

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Each young person's named lead professional and named adult ward professional liaise with each other, and the relevant agencies, to ensure the young person receives appropriate care and treatment.

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For those admitted as an unplanned emergency: during the young person's stay on the ward, a named lead professional takes responsibility for establishing and maintaining links with specialist services for:

a) Young people with learning disabilities and mental health problems.
b) Young people who have a visual impairment, hearing problems, physical disabilities and/or physical illness.
c) Young people with co-morbid substance abuse and mental health problems.

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The named lead professional, the named professional on the adult ward, and the ward team promote access to a range of services, as appropriate to the age and needs of the young people.

Note: For some young people, this admission may be their first contact with mental health services and it provides an opportunity to put them in contact (and hopefully engage them) with other appropriate agencies.

These include the following:

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• Young person's local child and adolescent mental health service;

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• Community adult mental health services;

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• Early intervention teams and/or assertive outreach teams;

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• Forensic and youth offending teams;

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• Substance and alcohol misuse services;

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• Learning Disability services;

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• Accident and emergency facilities;

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• Other medical services;

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• Voluntary sector organisations such as those for Mental Health and Black and Minority Ethnic groups and Learning Disability groups;

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• Social services;

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• Housing agencies.

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Staff wear name badges or there is a picture board of ward staff, so that young people and visitors know who they are, and for reasons of security.

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Young people and parents have access to key clinicians and members of the MDT as needed, for example outside of planned meetings.

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The young person's views are taken into account if they are not satisfied with their named adult ward professional or lead professional, and there is a process in place to deal with this.

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The parents' or carers' views are taken into account if they are not satisfied with their named adult ward professional or lead professional, and there is a process in place to deal with this.

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Young people, their parents/carers and adults using the service report that staff are friendly and approachable and that they feel respected and understood by staff.

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As far as is practical, efforts are made to ensure that young people are able to consult with a staff member of the gender of their choice.

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Young people can ask to see a professional on their own, e.g. without other nursing staff or family present, although this may be refused in certain circumstances (e.g. due to risk of violence and aggression).

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Interpreters are readily available and a minimum level of access is agreed so that relatives are not used as interpreters. This includes young people with communication difficulties relating to Learning Disability or ASD where non-verbal communication systems should be available.

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Interpreters used have received training or guidance about mental health matters and recognise the importance of a full and accurate translation.

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Young people and parents who have specific communication needs (such as those arising from sensory impairments) are given appropriate assistance to enable their participation.

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There are explicit protocols and procedures for developing and recording a joint care plan that clarifies the role of each team and outlines the level of daily input from the liaising lead agency (e.g. CAMHS team, Early Intervention Team or Community Adult Mental Health Team) and ward staff. The admitting ward should be able to access the notes/records of the young person at any time.

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The young person's assessed risk is addressed in the care plan.

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The young person's care plan shows evidence that a social care needs assessment has taken place. This includes establishing if the young person and/or parents/carers are involved with other agencies.

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Young people, and where appropriate parents/carers, are either given a copy of the management/care plan, or have ready access to it.

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Care plans include crisis plans with detailed contingencies for periods of intensive support.

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The care plan is reviewed at defined and agreed intervals during admission (e.g. a weekly ward round and review meetings).

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Regular meetings between the young person and their care team are held to discuss any issues of concern and to agree on the action required to address these (with feedback on the results of the action taken).

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Young people are involved in deciding who should be present in their care plan reviews.

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In consultation with the named lead professional, there is a multi-disciplinary written care plan for every young person that is kept with their records.

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All relevant professionals and other staff in partner agencies are invited to the care plan reviews.

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The records of the young person states the date of referral, assessments, admission, date of transfer to another service, and the date of discharge.

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The young person's legal status is recorded in the care plan. E.g. if the young person has been formally detained, the relevant section has been noted in the health record.

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Information about the date and time of discharge and the young person's address following discharge from the ward should be recorded in the young person's care plan.

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Where a Local Authority has parental responsibility as a result of a care order, the hospital should obtain the Local Authority's consent where necessary, and consult with that Local Authority on the young person's management or care plan.

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When a care order is in place, subject to advice from the Local Authority, there is also consultation with the parent with regard to the young person's management or care plan.

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Where a young person is subject to a care order, the hospital check that the local social service authority arrange for visits.

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Treatments are provided in accordance with the NICE/SIGN guidelines

See: www.nice.org.uk and www.sign.ac.uk

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• Medication

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• Individual psychological therapies

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• Group psychological therapies

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• Family support

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Where drugs are prescribed for use outside the terms of their license (off-label), the medical practitioner or prescriber complies with BNF for Children recommendations (2007), Royal College of Paediatrics and Child Health Recommendations (2007), and General Medical Council guidance on unlicensed application of licensed medicines (2006) and accesses specialist expertise where indicated.

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There are written guidelines for the use of rapid tranquilisation that specify the need to modify treatment for young people, i.e. dose calculations.

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No young person is to be deprived of their liberty, except where there is a clear legal authority to do so.

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Young people are involved in developing their programme of activities with staff throughout their stay on the ward.

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Young people are able to choose the activities they wish to participate in from a wide and diverse range of activity options.

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The activities offered to young people include opportunities to exercise, go outside.

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Activities are considered an important part of the young person's care plan by staff and are not offered as a bonus. They are not to be tokenistic and used as a reward, or withdrawn as a sanction.

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No disciplinary measures are used which includes: any form of corporal punishment; any deprivation of food or drink; any restriction of visits or communication by phone or post; any restriction of access to bathing or use of the toilet; restriction of access to recreational/communal area facilities. The Mental Health Act sets out the circumstances and requirements around communications and specified persons.