‘No capacity anywhere’ to deal with unprecedented surge in children’s mental health demand

Last week, multiple children with eating disorders were understood to have been left on children’s wards in general acute hospitals, due to specialist mental health units across England being full.

This appears to be a deterioration from the situation last month, when several areas of the country were reporting an extreme shortage of specialist beds.

Rory Conn, a member of the Royal College of Psychiatrists’ children and adolescent mental health division, told HSJ that specialist inpatient beds were full nationally.

He added: “We are seeing a greater number of children restricting [their food and drink] intake for a variety of reasons, often to extreme degrees.

“Some are stopping eating and drinking entirely, in a clinical pattern that we haven’t traditionally seen. For example, they might not have an identified eating disorder like anorexia, but their restriction seems to be a response to their uncertain social environment during the pandemic.

“Whilst sadly it is not uncommon for young people to travel long distances for an admission, and there can be delays to access beds, this is typically in the order of days, rather than weeks or months. We are now hearing there is no capacity anywhere, and this will be for the foreseeable future.”

This means larger numbers of patients are having to wait for long periods in paediatric wards in general acute hospitals, and Dr Conn added: “Some young people are sadly needing to be restrained to be naso-gastric fed, and acute paediatric wards are not properly resourced to offer such interventions.”

Another senior clinician based in London, who asked to remain anonymous, confirmed there were no CAMHS beds available nationally last week, and that some children had been waiting on paediatric wards in general acute hospitals for nearly a month. They said it was not a unique occurrence for there to be no beds available, although it has only happened a handful of times in the last few years.

NHS England said in a statement: “The NHS is treating record numbers of children and young people for mental health conditions and acute and mental health providers are working together to deliver tried and tested plans to provide the very best care for patients including through mutual aid.”

It added that 24/7 all age crisis services had been developed in the last year and support is being increased in the community.

Subsequent to this statement, Claire Murdoch, NHSE’s national director for mental health has this morning told a parliamentary committee that child and adolescent mental health beds were available last week. HSJ has asked NHS England to provide specific details to support this, but has yet to receive anything.

Dr Karen Street, from the Royal College of Paediatrics and Child Health, said: “Whilst paediatric wards have an important role to play in the short-term physical stabilisation of young people with food and/or fluid restriction, we do not have sufficient training or resource to manage complex cases who are on our wards because of the current lack of resource in community or specialist inpatient CAMHS eating disorder services.”

Dr Agnes Ayton, chair of the Royal College of Psychiatrists’ eating disorder faculty, said there had also been a 20 per cent increase in demand for adult eating disorder services, alongside units having reduced capacity due to infection control.

She said the number of adults and children being admitted to general acute wards has “massively increased” during the pandemic.

She said there was insufficient funding to implement National Institute for Health and Care Excellence guidelines from 2017, adding: “We have the NICE guidelines but if we haven’t got the funding to deliver them, they’re pretty much useless.”