Analysis
Positive effect While this is sometimes an element of their work, the NHS trust’s medical director Craig Gradden prefers to focus on the positive effect the service is having. He says that, despite the team’s small size, the nurses are making a big difference to some of the most deprived communities in the area. ‘Their work is crucial in helping to address existing health inequalities, but also to improve the health and social outcomes for future generations by embedding a culture of self-care and support.’ The set up has attracted interest from elsewhere, with the separation of the out-of-school and in-school services seen as a way of ensuring vulnerable groups are prioritised. But it remains a ‘pretty unique’ way of supporting such children, according to School and Public Health Nurses Association professional officer Sharon White. ‘Quite often school nursing services will have staff dedicated to working with these children. In some places, that works well, but that is not always the case,’ she says. ‘The result is that they do not always get prioritised as they should, even though they are extremely vulnerable. ‘This is what school nursing should be about. So, to me, this approach seems a good way of making sure these children get the support they need.’ Nick Triggle is a freelance journalist NURSING CHILDREN AND YOUNG PEOPLE
Move to improve emergency care for young people in mental health crisis Initiative centres on provision of more beds and places of safety to avoid use of police custody, writes Christian Duffin IMPROVEMENTS HAVE been promised in emergency services for young people in a mental health crisis as part of a partnership between police, mental health trusts and local authorities. The Crisis Care Concordat has been signed by 22 organisations, including mental health charity Mind and the RCN, and is intended to improve standards, so patients are not routinely admitted to hospital or held in police cells when unwell. The Department of Health’s concordat calls for health-based places of safety and beds to be available round the clock in case someone experiences a mental health crisis, and that police custody should not be routinely used. The government wants to halve the number of occasions police cells are used as a place of safety for people in mental health crisis. The concordat also states that a 24-hour helpline should be available for people with mental health problems, and crisis resolution teams should be accessible 24 hours a day, seven days a week.
Cheshire and Wirral’s crisis team typically helps young people in children’s homes, schools, their own homes or emergency departments, but only between 9am and 9pm Monday to Friday, says Mr McDougall. ‘I agree with the spirit of the concordat, that commissioners and providers need to work more closely together to meet the needs of young people. Unfortunately, the default position at the moment across the country is for young people to be admitted to hospital.’ Improved provision RCN general secretary Peter Carter says: ‘We strongly agree that a patient experiencing a crisis in mental health must receive the same level of attention, care and support as a patient experiencing a crisis in physical health. Out-of-hours mental health services are woefully lacking and improved provision is urgently needed.’ Children’s commissioner for England Maggie Atkinson says: ‘Street triage teams must be in position to respond to young people’s as well as adults’ needs, as this could prevent many of them ending up in police cells and without access to timely and age-appropriate mental health assessments. For further information go to: tiny.cc/ykawbx Christian Duffin is a freelance journalist
Disinvestment Nurse consultant for child and adolescent mental health services Tim McDougall has concerns that many NHS services have insufficient staff and finances to achieve the concordat’s goals. His employer, Cheshire and Wirral Partnership NHS Foundation Trust, he says, is ahead of the game because it has a specialist crisis intervention team for children and young people run by nurses and psychiatrists, but many other regions have nothing like this. ‘There has been a disinvestment in children’s services because of cuts in local authority budgets and in the NHS. If a 16 or 17 year old is suicidal, people seem prepared to take a risk by not providing the same services they would for adults.’
Digital Vision
into mainstream school, but the older children are likely to never return, so we are there for them until they are 16.’ Ms Perry agrees that there are challenges, adding that an important part of the job is about getting the balance right. She says that, as a service, they are always upfront with the parents of the children they work with, pointing out that – where there is a risk of neglect or abuse – they have a duty to intervene. ‘We are clear that safeguarding is part of our work and we have taken action when we have come across issues. Most of the time people welcome the help. I am not saying that we have not had some heated conversations or that parents haven’t got upset or shouted, but a lot of the time they want to change the situation.’
March 2014 | Volume 26 | Number 2
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Positive effect While this is sometimes an element of their work, the NHS trust’s medical director Craig Gradden prefers to focus on the positive effect the service is having. He says that, despite the team’s small size, the nurses are making a big difference to some of the most deprived communities in the area. ‘Their work is crucial in helping to address existing health inequalities, but also to improve the health and social outcomes for future generations by embedding a culture of self-care and support.’ The set up has attracted interest from elsewhere, with the separation of the out-of-school and in-school services seen as a way of ensuring vulnerable groups are prioritised. But it remains a ‘pretty unique’ way of supporting such children, according to School and Public Health Nurses Association professional officer Sharon White. ‘Quite often school nursing services will have staff dedicated to working with these children. In some places, that works well, but that is not always the case,’ she says. ‘The result is that they do not always get prioritised as they should, even though they are extremely vulnerable. ‘This is what school nursing should be about. So, to me, this approach seems a good way of making sure these children get the support they need.’ Nick Triggle is a freelance journalist NURSING CHILDREN AND YOUNG PEOPLE
Move to improve emergency care for young people in mental health crisis Initiative centres on provision of more beds and places of safety to avoid use of police custody, writes Christian Duffin IMPROVEMENTS HAVE been promised in emergency services for young people in a mental health crisis as part of a partnership between police, mental health trusts and local authorities. The Crisis Care Concordat has been signed by 22 organisations, including mental health charity Mind and the RCN, and is intended to improve standards, so patients are not routinely admitted to hospital or held in police cells when unwell. The Department of Health’s concordat calls for health-based places of safety and beds to be available round the clock in case someone experiences a mental health crisis, and that police custody should not be routinely used. The government wants to halve the number of occasions police cells are used as a place of safety for people in mental health crisis. The concordat also states that a 24-hour helpline should be available for people with mental health problems, and crisis resolution teams should be accessible 24 hours a day, seven days a week.
Cheshire and Wirral’s crisis team typically helps young people in children’s homes, schools, their own homes or emergency departments, but only between 9am and 9pm Monday to Friday, says Mr McDougall. ‘I agree with the spirit of the concordat, that commissioners and providers need to work more closely together to meet the needs of young people. Unfortunately, the default position at the moment across the country is for young people to be admitted to hospital.’ Improved provision RCN general secretary Peter Carter says: ‘We strongly agree that a patient experiencing a crisis in mental health must receive the same level of attention, care and support as a patient experiencing a crisis in physical health. Out-of-hours mental health services are woefully lacking and improved provision is urgently needed.’ Children’s commissioner for England Maggie Atkinson says: ‘Street triage teams must be in position to respond to young people’s as well as adults’ needs, as this could prevent many of them ending up in police cells and without access to timely and age-appropriate mental health assessments. For further information go to: tiny.cc/ykawbx Christian Duffin is a freelance journalist
Disinvestment Nurse consultant for child and adolescent mental health services Tim McDougall has concerns that many NHS services have insufficient staff and finances to achieve the concordat’s goals. His employer, Cheshire and Wirral Partnership NHS Foundation Trust, he says, is ahead of the game because it has a specialist crisis intervention team for children and young people run by nurses and psychiatrists, but many other regions have nothing like this. ‘There has been a disinvestment in children’s services because of cuts in local authority budgets and in the NHS. If a 16 or 17 year old is suicidal, people seem prepared to take a risk by not providing the same services they would for adults.’
Digital Vision
into mainstream school, but the older children are likely to never return, so we are there for them until they are 16.’ Ms Perry agrees that there are challenges, adding that an important part of the job is about getting the balance right. She says that, as a service, they are always upfront with the parents of the children they work with, pointing out that – where there is a risk of neglect or abuse – they have a duty to intervene. ‘We are clear that safeguarding is part of our work and we have taken action when we have come across issues. Most of the time people welcome the help. I am not saying that we have not had some heated conversations or that parents haven’t got upset or shouted, but a lot of the time they want to change the situation.’
March 2014 | Volume 26 | Number 2
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 04, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
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