Consideration of the following in your day-to-day practice may be useful:
- Acknowledge the shared challenge and place CYP and their families/carers at the centre of care; avoiding compartmentalised (i.e. viewing the problem solely as physical or mental) or judgemental responses
- Discuss alternatives to acute hospital care, e.g. all-age 24/7 urgent mental health helplines; places of safety outside of hospital setting. Mental health providers and acute providers should collaborate closely along the pathway, with a view to avoiding long stays in A&E for CYP with mental health needs.
- Identify a clinical mental health lead in emergency/paediatric departments; this individual should also link in with the CCG Transforming Care lead for CYP with learning disabilities and/or autism, where possible
- Organise regular meetings between teams, including: paediatric department and emergency department, CYP mental health teams, and Local Authority senior management teams; adjusting frequency, as required
- Identify particular concerns and risks and support with data, where possible, e.g. Emergency Care Data Set; Hospital Episode Statistics; Mental Health Services Data Set
- Review existing protocols for referrals or advice (see guidance above and good practice examples below)
- Ensure policies are in place for managing distressed patients and/or those requiring restraint, including any reasonable adjustments for CYP with a learning disability and/or autism
- Where the child is currently allocated within Children’s Social Care, the social worker should be contacted and involved in planning for the child. If the child is not currently allocated but there are potential concerns about safeguarding or a need for other services, a referral should be made to the Multi Agency Safeguarding Hub. You should seek advice from your Trust’s Child Protection Lead. Where cases require escalation, the Local Safeguarding Partnership will have an escalation procedure.
- Consider strengthening your local training offer; national offers may be helpful in addition, e.g. We Can Talk
It may be helpful to signpost CYP, or their parent/carer, to the following services:
- NHS urgent mental health helplines offer 24/7 advice and support for CYP and their parent/carer
- Public Health England’s Better Health – Every Mind Matters website provides support, including tips on how to improve mental wellbeing.
- YoungMinds Crisis Messenger provides free crisis support during a crisis – this is available every day of the week, at any time day or night. All that is required is to text YM to 85258. All texts are answered by trained volunteers, with support from experienced clinical supervisors. Texts are free from EE, O2, Vodafone, 3, Virgin Mobile, BT Mobile, GiffGaff, Tesco Mobile and Telecom Plus.
- Papyrus (Prevention of Young Suicide) provides advice and support for young people who feel like they want to take their own life, and all their advice is confidential. Their helpline – HOPELineUK – can be reached on 0800 068 41 41 or one can text them on 07786 209 687 (lines are open every day from 9am to midnight).
- Childline offer support to CYP under 19, and they confidentially call, email, or chat online about any problem, big or small. Their freephone 24-hour helpline is 0800 1111. You can sign up for a Childline account on their website and you will then be able to message a counsellor anytime without using an email address. Or you can have a one-to-one chat with an online advisor.
- SHOUT provides free, confidential, 24/7 text message support in the UK for anyone who is struggling to cope and anyone in crisis. Text SHOUT to 85258. This service is free on all major mobile networks.
- Samaritans are an organisation who are available at any time of the day or night. They will help the CYP and listen to how they are feeling. They can be reached on 116 123 or via email at firstname.lastname@example.org.
We would also like to draw your attention to existing guidance and standards that may prove helpful to you:
- RCPCH position statement on role of paediatricians in supporting CYP’s mental health
- RPsych ‘Quality Standards for Children and Young People for Liaison Psychiatry Services’
- RCPCH ‘Facing the Future: standards for children in emergency care settings’
- CYP Eating Disorder guidance
- DHSC ‘Integration and innovation: working together to improve health and social care for all’