This is HSJ’s fortnightly briefing covering quality, performance and finances in the mental health sector. Feedback and comments are welcome - email me in confidence.

In the last couple of weeks, HSJ has reported on two dark corners of the mental health sector.

First was our investigation that found hundreds of young people assessed as needing specialist care had waited more than a year for treatment.

And second, we revealed that the number of staff and patients reporting being sexually abused by mental health patients had increased by nearly a fifth, over five years.

Both of these issues are troubling reminders that although there has been new money and many improvements, there are still serious problems.

Reading between the lines

The Care Quality Commission launched an investigation earlier this year into how mental health patients are protected from sexual abuse and is due to report back later this month.

It is not clear what the watchdog will recommend, but it has flagged up mixed sex wards as a concern before.

The patients HSJ spoke to who had suffered sexual abuse while being treated for mental health problems both agreed mixed sex wards were a problem.

But there is no way to tell how many of the 3,100 reported sexual assaults and 15,800 incidents reported between 2013-14 and 2017-18 took place on mixe sex wards.

One chief executive pointed out that sexual assaults also happen on single sex wards, and it is worth noting that it is not known how many of the reports were proven.

Much of the spike could simply be down to better reporting of incidents.

But the numbers raise the question of which trusts should we be worried about – those reporting lots of incidents, or those not reporting any?

Familiar criticisms

While HSJ’s investigation into Tier 3 child and adolescent mental health services showed huge numbers of children waiting for treatment, it cannot give an indication of how many were offered care, but failed to attend.

This is potentially a massive issue. If children are given appointments but their parents do not take them then it is potentially a safeguarding issue and means at risk youngsters are not getting the help they need. The key question is how should mental health trusts investigate no show youngsters and when should they close their cases?

Despite the promise of more than £1.4bn for children and young people’s mental health services in 2015, many campaigners say there’s a mounting crisis in these services.

Leaders have often been criticised for a lack of ambition for the sector – for focussing only on increasing the number of children accessing care from a quarter to a third, or for rolling out new improvements too slowly, it is becoming a familiar criticism for the sector.

With the long term plan due in November it is becoming apparent that leaders must make a sensible long term offer for children and young people’s services. Campaigners say this must include at least matching the £1.4bn for the next five years, and maybe going further.

But there will be other calls on the £20bn pot of new cash. The £1.4bn for CAMHS and £400m for the CYP green paper proposals accounts for nearly a tenth of it. Will ministers agree to this?