We must improve mental healthcare for children
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We must improve mental healthcare for children

Kath Evans Director of babies, children and young people’s (BCYP) nursing, Barts Health NHS Trust, North East London Integrated Care Board

Without specialist input from children’s nurses, mental health services are failing to meet young people’s needs

Readers of this journal will need no convincing that nursing makes a difference in society. When nurses are trained and educated to meet the population’s needs, their knowledge, skill, compassion and expert care result in transformational care that contributes to desired outcomes.

Nursing Children and Young People. 35, 6, 8-9. doi: 10.7748/ncyp.35.6.8.s3

Published: 02 November 2023

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Picture credit: iStock

I trained as a general nurse. My passion for caring and advocating for children became clear in my second year of training during a paediatric placement. On qualifying, I secured a job on a paediatric ward and went on to undertake my children’s nursing qualification at Great Ormond Street Hospital in London.

The time I spent studying child development, the physiological differences in caring for children, along with how to communicate with them and their families was essential knowledge that had not been covered to the necessary depth in my generic nurse training. What was also important was the range of clinical environments, professionals and role models I encountered during placements. Immersing myself in the world of child health was invaluable and it shaped the way I advocate for children today.

Our babies, children and young people (BCYP) deserve access to professionals who are trained to meet their developing needs and to champion them at every opportunity.

When I came into my current role as director of nursing for BCYP at Barts Health NHS Trust and the BCYP clinical lead for NHS North East London Integrated Care Board, I wanted to look beyond the walls of the hospital and think holistically about how the needs of BCYP were being met.

Therapeutic benefits of play

I visited several mental health trusts and child and adolescent mental health services (CAMHS). What challenged me was the variation in care in children’s mental health provision in comparison to services that predominantly focus on children’s physical care.

There were several things that struck me, I am used to having parents who stay on the ward and are partners in their child’s care, yet this was not an approach routinely encouraged in mental healthcare. One children’s inpatient mental health unit I visited could accommodate 14 young people, yet it had only one parent room.

Paediatric wards are used to having resident parents at the bedside and in many units charities also support the provision of parent accommodation close to or on site.

‘Play specialists are increasingly the norm in teams that focus on physical care, but not in mental health services’

Due to the limited numbers of inpatient mental health settings for this patient group, the distances children and young people are placed away from their families when requiring mental healthcare makes the need for parent/family accommodation even more significant. With the increasing mental health needs of younger children, particularly those who are under 12, where placements are incredibly limited, residential support to facilitate co-location of families needs to be championed.

Play specialists and youth workers are increasingly the norm in multidisciplinary teams that focus on physical care, but they do not seem to have become embedded in mental health services.

Occupational therapists, art, drama and music therapy are of course common, but in paediatric services, play is integral – it is the bedrock of how children learn, explore and understand the world around them.

Article 31 of the United Nations Convention on the Rights of the Child reminds us that all children have the right to engage in play and recreational activities appropriate to their age.

The therapeutic benefits of play in preparation, understanding and distraction are integral to all our interactions in healthcare. Who is championing this in children’s mental health settings? On probing the qualifications of staff running our CAMHS units, I realised they are run predominantly by nurses trained in adult mental health.

‘In paediatric services, play is integral – it’s the bedrock of how children learn and understand the world around them’

When exploring experiential learning of staff, many have not been able to access BCYP placements, which has limited their exposure to what good (or poor) children’s care and leadership can look like in a range of settings.

I had been mulling over these reflections for a while, but they were brought to the surface when the children’s commissioner for England Dame Rachel De Souza made a speech to the directors of children’s services. It makes for uncomfortable reading.

Re-traumatising environments

Dame Rachel said: ‘My team and I have visited children living in mental health wards, sometimes for months at a time and miles away from home. Often these are re-traumatising rather than therapeutic environments, with children experiencing and witnessing restraint, loud alarms going off, feeding through nasogastric tubes and living in dirty and soiled segregation rooms. Children describe these settings as frightening and distressing.

‘I think of the child in a mental health ward who told my team that the four members of staff who accompanied her at all times only referred to her by her initials, not her name. She said she felt like she was treated like an animal.

‘Another girl living in a mental health ward, quoted here, said she has “been in the system for so long that getting let down has become normal”. We are not only taking away children’s childhoods, we are dehumanising them.’

I am under no illusions about the pressures of staffing in mental health services, but what is clear is that mental health nurses need much better support in caring for children and young people. Having placements during mental health training in CAMHS is essential, we need to encourage more universities to offer dual registration/integrated training of registered child and mental health nurses, and providers must open up these placements.

Shortened courses for nurses with mental health qualifications in child health should be developed, along with second registration opportunities. We also need to continue to expand our knowledge of mental healthcare in settings that predominantly focus on physical healthcare. Brilliant work has been done by Robin Barker and the We Can Talk project, but there’s more to do here.

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Picture credit: iStock

Specialist input is needed

In mental health settings we need children’s nurses working alongside mental health nurses so that they can contribute their skills and expertise in complex situations.

It is heartening to see this beginning to happen. One mental health provider has appointed a children’s nurse as its matron. Examples such as this can help to challenge and inform ongoing quality improvement.

There’s a famous quote from Maya Angelou: ‘Do the best you can until you know better, then when you know better, do better.’

We can and must do better for the children and young people who are receiving mental healthcare. Ensuring we have staff who have been appropriately prepared to meet their needs should be a priority if we are to change the shocking experiences the children’s commissioner is rightly calling out. We need to keep challenging, advocating and asking: ‘What’s right for children?’ We must expose the current situation and work to resolve it as a matter of urgency.

Find out more

Children’s Commissioner (2023) Speech to the Association of Directors of Children’s Services.

We Can Talk. wecantalk.online

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