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Children in mental health hospitals at risk of serious rights violations

Children’s mental health has worsened over the past three years with many young people’s wellbeing deteriorating during COVID-19, a report has said.

There has been a dramatic rise in the number of children experiencing a significant mental health problem including depression, anxiety and eating disorders with the pandemic exacerbating problems. More than 3,500 children go to hospital every year because they either cannot access adequate care in the community or cannot be kept safe in other settings. Nearly half are aged 15 or under.

However, children’s rights charity Article 39 has warned that mental health hospitals can cause further harm to children with mental health problems and lack effective safeguards to protect them.

Author of the report, Kamena Dorling, said: “These findings follow a number of reports this year, including from the Joint Committee on Human Rights, the Children’s Commissioner for England and the Care Quality Commission, which all highlight that children in mental health hospitals, including those with autism and/or learning disabilities, are at risk of very serious rights violations. Despite successive strong commitments from the government in recent years, the quality of care and treatment for children and young people who have mental ill health remains inadequate and is often scandalous.”

The report is based on the views and experiences of children, as told to their advocates. Findings include:

- Children are being kept in hospital for too long

- Young people are often placed in hospitals miles away from home – last year more than 1,000 children were placed out-of-area with some as many as 300 miles away from home

- The environments of mental health hospitals are not conducive to their needs and rights as children.

- Staggering numbers are still being placed on adult wards – 592 in 2019-20 which is three times higher than the previous year

- Children placed in adult wards are subjected to harmful restraint, seclusion and segregation – 1,049 young people under 20 were subjected to physical, chemical, mechanical restraint and/or isolated

- A child’s right to have help from an advocate when they make a complaint about their care or treatment appears to be frequently ignored.

Furthermore, the report finds that the number of children with a learning disability and/or autism in in-patient units has doubled since 2015.

Over two thirds of children are in mental health hospital as ‘informal patients’ and therefore should be free to go when they wish. However, many are kept locked up, or do not understand their rights and fear being ‘sectioned’ if they try to leave.
These children are denied the legal safeguards provided to children who are formally detained under the Mental Health Act 1983 – such as the right to an independent mental health advocate.

Kamena Dorling added: “It is time for the government to take real action to ensure that children receive the best possible care and support, close to home and always in settings designed with and for children. The government must commence the legislation passed in 2018 on use of restraint and must implement the recommendations of the Independent Mental Health Act review, also issued in 2018, as a matter of urgency, particularly around ensuring all children can access high quality independent advocacy.”

The report calls for children admitted to mental health institutions on an informal basis to have the same legal protections as those children detained under the Mental Health Act 1983. There must be a statutory presumption that children will be cared for and treated in mental health units close to home.

Article 39 urges an end to children being placed on adult wards or in other environments which cannot meet their needs. All providers of inpatient services should ensure that accessible information is available to all children and young people, whether they are informal patients or have been detained, which allows them to understand and use their rights. All staff working with children in mental health inpatient care should receive training on the relevant legal frameworks and children’s rights.

All children and young people receiving any kind of mental health support service should have an active (opt-out) offer of help from an independent advocate, the report concludes.

For all recommendations and the full report: A safe space? The rights of children in mental health inpatient care

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