Admission to adult mental health wards for under 18's - adaptation for Scotland: guidance

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It would be regarded as good practice that a Consultant Child and Adolescent Psychiatrist should take consultant responsibility and/or act as the RMO if the young person is detained during their inpatient stay.

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If it is not in the young person's best interests for a CAMHS Consultant Psychiatrist to act as RMO (for example, as a result of difficulties of distance or access), an Adult Psychiatrist may take Consultant and RMO responsibility.

Note: The expectation is that the relevant Child and Adolescent Consultant and the Adult Psychiatrist should work closely together during the admission and that all staff must be aware of who the responsible consultant is.

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Ward staff are able to access a named CAMHS professional for consultation and advice throughout a young person's admission, even where the CAMH service ordinarily does not work up to 18 if the young person has left school.

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Non-medical CAMHS staff will be available to provide in-reach into the ward if the needs of the young person are such that they cannot be provided by the ward staff.

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Ward staff designated to work with young people receive supervision from a named CAMHS Consultant.

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When a young person requires one-to-one supervision, the staff provided are trained to work with young people.

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Where possible, the ward manager can access bank nursing staff who regularly work with young people.

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Staff working with young people on adult wards have joint training sessions and regular meetings with CAMHS.

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Staff designated and trained to work with young people on the ward are available on each shift throughout a young person's stay.

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There are named staff members from the CAMHS and the adult ward team who maintain links between the teams.

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There are, for each young person, staff members who take responsibility for safeguarding the rights of young people admitted.

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• Child Protection

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• Risk assessment and awareness of risk factors in abuse and abuse to others, indicators of abuse and procedures for dealing with abuse.

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• Legal frameworks concerning mental health care of young people such as the Children Acts, Mental Health (Care and Treatment)(Scotland) Act 2003 (as amended by the 2015 Act), and the Adults with Incapacity (Scotland) Act 2000.

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Where the young person has a Learning Disability, the staff should have training in Learning Disability and have access to support and Supervision from someone with CAMHS LD experience.

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• Aetiology, symptoms or range of relevant conditions.

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• Pharmacological interventions (for staff who prescribe, dispense or administer medication to young people), including the use of psychoactive medication, recognition of side effects and non-concordance.

Note: Refer to NICE/SIGN guidelines for use of medication off-license (see 4.8.1) and evidence-based psychological interventions.

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• Managing relationships and boundaries between young people and staff, including appropriate touch.

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• Issues of consent, capacity for young people, role of parental responsibility, confidentiality and advocacy.

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• Management of imminent and actual violence, age-appropriate breakaway techniques and restraint measures.

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All staff (including temporary or agency staff and ancillary staff) should have enhanced Child and Adult PVG disclosure checks before appointment.

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All staff (including temporary or agency staff) receive an induction which covers key aspects of caring for young people on the ward (e.g. observation and child protection) before they can have unsupervised access to the young people.

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There is a Board policy and written guidance available to staff about whistle-blowing, which forms part of the induction training.

Notice: Staff should know how to raise concerns about poor practice.

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Legal advice is available for practitioners when needed, specifically in relation to the Mental Health (Care and Treatment) (Scotland) Act 2003, Adults with Incapacity (Scotland) Act 2000 and Children's Acts. This can be accessed via the MWC advice line, the Central Legal Office and Clan Law.