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Young people in mental health crisis putting pressure on children’s hospitals, nurses say

Rising numbers of young people in mental health crisis are putting growing pressure on acute services, say nurses at children’s hospitals.

Rising numbers of young people in mental health crisis are putting growing pressure on acute services, say nurses at children’s hospitals.


Self-harm, suicidal ideation, depression and psychosis are among the reasons
children with mental health issues are attending ED. Picture: iStock

There has been at least a 25% increase in the number of children attending the emergency department (ED) for self-harm at Southampton Children’s Hospital (SCH) in the last few years.

The hospital saw 150 cases in 2013, and 200 cases in 2016 – although the real number is likely to be considerably higher, according to SCH divisional head of nursing and professions Kate Pye.

She said this is because the figures reflect only weekday presentations related to self-harm, rather than other mental health issues.

‘One on every ward’

Nurses have told Nursing Standard that other than self-harm, suicidal ideation, depression, psychosis are among the reasons children with mental health issues are attending ED.

‘During the Christmas period, we had at least one young person with mental health problems on every ward in the children’s hospital,’ Ms Pye said.

‘Some of the situations are heartbreaking. This is a vulnerable group and we do what we can to support them.’

This situation in Southampton only reflects the bigger picture, in which acute services across the country are dealing with increasing numbers of young people in crisis and a lack of beds and resources in child and adolescent mental health services (CAMHS).

Figures soaring 

Figures from NHS Digital show the number of under 18s attending EDs in England with mental health issues has soared in recent years, from 9,328 in 2010-11 to 21,989 in 2015-16.

Out of these unplanned attendances, 6,319 young people were admitted into a bed within the hospital they had visited in 2015-16, up from 2,705 in 2010-11.

To try and alleviate the pressures caused by the volume of cases, SCH brought in band 7 mental health liaison nurse for children’s ED Sam Evans, who has been in post since last October.

Ms Evans makes clinical decisions about children presenting in ED, works with community mental health teams to help develop crisis pathways and does liaison work with schools.

Growing pressures

She said she feels pressures on young people are growing.

‘I would say 70% of what I see is to do with bullying and a lot of that is [related to] social media,’ said Ms Evans.  

Evelina London lead nurse for children’s ED Caroline McKenna said there had been at least a 20% rise in young people presenting with mental health conditions between 2015-16. ‘We have recognised an increase in complexity as well,’ she said.

Nottingham Children’s Hospital divisional nurse for family health Dorothy Bean agreed rising numbers of young people arriving at ED with mental health issues presented ‘an additional challenge’ for the hospital. 

‘Out of the young people who come in to ED with mental health issues, 50% have been in before in the previous 12 months.’

Biggest weakness

Support from local CAMHS nurses is strong but, at the same time, some of the teams were ‘very skinny’, explained Ms Bean.

She added that the unwell were not the only children with mental health conditions within acute services.

‘We have got children with eating disorders being treated in our hospitals and about 10-15% of children with long-term conditions require some mental health input – and that support is probably patchy.’

Last year, health secretary Jeremy Hunt said CAMHS was currently the NHS’s ‘biggest single area of weakness in NHS provision’.


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