Clinical Under 18s Admission to Adult Mental Health Ward: Standard Operating Procedure Document Control Summary Status: Version: Author/Title: Owner/Title: Replacement. Replaces: Policy on the formal or informal admission of young people under the age of 18 years to adult mental health in-patient unit. v1.0 Date: 10 th February 2016 Sharon Conlon - Safeguarding Lead Kenny Laing - Deputy Director of Nursing Approved by: Ratified: Related Trust Strategy and/or Strategic Aims Implementation Date: Review Date: Key Words: Associated Policy or Standard Operating Procedures Policy and Procedures Committee Date: 17 March 2016 Policy and Procedures Committee Date: 17 March 2016 Demonstrate our commitment to treating and caring for people in a safe environment and protecting them from avoidable harm March 2016 February 2019 Children, Young People, admission, adult ward, under 18s Admission, Discharge and Transfer Policy Contents 1. Introduction... 2 2. Purpose... 3 3. Scope... 3 4. Admissions/Roles/Responsibilities... 3 5.0 Process For Monitoring Compliance And Effectiveness... 6 6.0 References... 6
Change Control Amendment History Version Dates Amendments V1.1 19 Jan 17 Addition of advocacy details at 4.59 1. Introduction 1.1 The legal framework governing the admission to hospital and treatment of children and young people under the age of 18 is complex, and those responsible for their care in hospital should be familiar with the relevant legislation as outlined within the Mental Health Act 1983, Mental Health Act Code of Practice 2015, Children Act 1989 and the Mental Capacity Act 2005. 1.2 When the Mental Health Act 1983 was reviewed, the Government pledged that through the introduction on 1 April 2010 of Section 132A, children and young people under the age of 18 would be treated in an environment in hospital which had suitable regard to their age, and, that the inappropriate admission of children and young people to adult acute mental health wards would be avoided. Children and young people under the age of 16 must not be admitted to adult inpatient areas 1.3 For young people aged 16/17, there are cases whereby it would be possible to admit to an adult ward. These include Atypical cases and in over-riding emergencies: Atypical case (1) 17½ year old mother with depression who would be more appropriately treated on a mother and baby unit ; Atypical case (2) 16/17 year old whose level of maturity indicates a more appropriate placement in an adult ward or who chooses voluntarily not to enter a CAMHS ward; Over-riding emergency where there are no CAMHS beds available and the young person must be placed in a mental health hospital for their own or other s safety. All Trusts should co-operate under the Children s Act 2004, and ensure that under 18 year olds are not disadvantaged by organisation refusing to admit in an emergency. Page 2 of 6
2. Purpose 2.1 The purpose of this policy is to set out the arrangements within the Trust for the provision of inpatient care to patients admitted to the adult acute mental health wards who are aged 16/17, to provide guidance to staff on how to manage such an admission, how to appropriately care for the young person, and how to appropriately facilitate their discharge or transfer. 3. Scope 3.1.1 This policy covers young people aged 16/17 admitted to an adult acute mental health ward and the following definition applies: 3.2 Who is classed as a Young Person Whilst in law anyone aged 16 to 18 is still classed as a child, the Family Law Reform Act 1969 refers to them as young persons, and gives them enhanced rights in respect of consent. 3.4 Within the Mental Health Act Code of Practice 2015 anyone aged 16 or 17 is classed as a young person. Therefore within this policy the term young person has been applied to anyone aged 16 or 17 years. 4. Admissions/Roles/Responsibilities Informal Admission consent to admission and capacity 4.1.1 16 and 17 year olds with capacity who do not consent to their informal admission to hospital for the treatment of mental disorder cannot be admitted. 4.1.2 This means that where a young person aged 16 or 17, who has the capacity to make a decision on their health care, decides that they do not want to consent to treatment for mental disorder, the young person cannot be admitted to hospital for that treatment unless they meet the conditions to be detained under the Mental Health Act 1983 (as amended 2007), even if a person with parental responsibility is prepared to consent. 4.1.3 It also means that where a young person aged 16 or 17, who has the capacity to make a decision on their health care, consents to being admitted to hospital for treatment of a mental disorder they should be treated as an informal patient in Page 3 of 6
accordance with section 131 of the Mental Health Act 1983 (as amended 2007) even if a person with parental responsibility is refusing consent. 4.4 Consideration of the young person s capacity should be considered in the same way as for an adult service user, in line with the Mental Capacity Act (2005) All young people admitted to Adult Mental Health wards 4.5 When a decision has been made to admit a young person to an adult ward then the following action must be taken:- Ward staff responsibility 4.51 Hospital coordinator/ site manager must be informed of the decision to admit 4.52 An incident must be logged on the trust incident reporting system at the point of admission. 4.53 Young person must be nursed on observation level 4 if an alternative observation level is deemed appropriate then this must be clearly documented in the records and the rational for the lowering of observation recorded. 4.54 The person with parental responsibility** must be identified and clearly documented within the young person s records. (Capacity and consent must be considered in relation to sharing information) ** Those with parental responsibility will usually, but not always, be the parents of the child or young person. Other people may acquire parental responsibility. Where the parents are not married it will be necessary to ascertain whether the father has gained parental responsibility. Practitioners should always check with those caring for the child or young person whether any child arrangements orders, parental responsibility agreements or orders, or special guardianship orders have been obtained. 4.55 The young person must have a single room with en suite facilities or access to single sex bathroom facilities. 4.56 A care plan must be developed considering Risk to self Risk of harm from others Maintaining young person s safety on adult ward Page 4 of 6
4.57 Any staff member working directly with the young person must have completed the trusts advanced safeguarding training. 4.58 All staff who may come into contact with the young person must have DBS clearance. 4.59 The nurse responsible for admitting the young person to the ward must provide them with details for advocacy support. In Staffordshire our CYP Advocacy is NYAS https://www.nyas.net/. The helpline number is 08088-081-001. 4.6 Hospital coordinator responsibility 4.61 Inform on call manager of admission of under 18 4.62 Ensure ward staff have completed all appropriate action and young person is being nursed in appropriate accommodation. 4.63 If tier 4 CAMHS bed is identified as most appropriate facility, hospital coordinator must initiate NHS England Tier 4 admission protocol (Appendix 1,2,3 see separate associated documents) 4.7 Consultants responsibility 4.71 All young people aged 16 and 17 admitted whether detained or informal will fall under the responsibility of the Adult Consultant Psychiatrist. 4.72 It is the responsibility of the Adult Consultant Psychiatrist to seek assistance from and consult with the Consultant Psychiatrist from the appropriate young people service, whether this is CAMHS or EIT or other service. 4.8 CAMHS Responsibility 4.81 The age appropriate (e.g. CAMHS or EIT) service has responsibility for providing Consultation and communication pertaining to the young person upon being requested to do so. 4.82 CAMHS teams should offer advice and support regarding care planning for a young person admitted to an adult ward. 4.83 When the young person is already known to CAMHS/EIT any existing care plans should be reviewed and further plans constructed and initiated by adult in partnership with CAMHS clinicians who should visit the next working day and review on a regular Page 5 of 6
basis (Monday-Friday) to assess the young person, review their treatment, liaise with the adult psychiatry staff and offer support as needed. 4.9 Safeguarding Team are responsible for 4.91 Upon notification the safeguarding team must make contact with the ward to offer support and advice regarding the arrangements for maintaining a young person s safety on the ward. 4.92 Safeguarding team must identify if the young person is known to Local Authority and ensure that the LA are aware of the admission and are liaising with the ward staff as appropriate. 4.93 Safeguarding team must notify the designated nurse for safeguarding of any admissions of under 18s. 4.94 The safeguarding team must maintain contact with the ward until the point of discharge and take action to escalate any concerns regarding delay in discharge or the wards ability to maintain the young person s safety. 4.10 Mental Health law Teams Responsibility 4.11 The trusts mental health law team are responsible to informing the CQC of any under 18 admission under the Mental Health Act. 5.0 Process For Monitoring Compliance And Effectiveness The safeguarding team will maintain a log of all young people admitted to adult wards and monitor the length of admission. This will be included in safeguarding quarterly reports. 6.0 References Mental Health Act 1983 Mental Health Act Code of Practice 2015 Children Act 1989 Mental Capacity Act 2005. Page 6 of 6