The temporary dual use of the accommodation at the Greenfields site as two separate units; the current unit providing secure care for children and young people[1] and an adolescent in-patient psychiatric unit for young people during the COVID-19 crisis.
Introduction
This development is a response to the unprecedented situation with the rapid development of the COVID-19 virus.
Children and young people who present with an acute mental health crisis or need, may currently be supported on Robin Ward in the Jersey General Hospital. There is an urgent requirement to ensure hospital paediatric medical beds are available during this exceptional crisis. Furthermore, UK providers that currently take Jersey CAMHS in-patient children and young people have indicated no places will be available until the crisis has ended.
Health and Community Services (HCS) and Children, Young People, Education and Skills (CYPES) Departments are working together to urgently and proactively find solutions to support this small group of children and young people. This is a small number of individuals with a high level of complex needs and requirement for specialist care and treatment
The intention is to meet where possible the Quality Standards for Inpatient CAMHS Services (QNIC)[2]. This requires access for example to:
- An indoor space for recreation, which is large enough to accommodate all young people(1.1.4)
- Designated safe outdoor space which young people are able to access every day, where clinically appropriate (1.1.5)
- If seclusion is required, a designated room will be available that allows clear observation, is safe and secure and allows two-way communication with the team. (1.1.9)
Consideration has been given to all CYPES accommodation stock across the Island.
Accommodation at Greenfields meets the QNIC Quality Standards, whereas all other sites considered require considerable adaption to meet standards and cannot be made ready in the required timescales.
The proposal therefore is to use one (unused) unit of the Greenfields building and run two separate provisions on the same site. The first unit will remain registered by the Care Commission as it currently operates as secure care for children and young people in terms of both the Children (Jersey) Law 2002 and the Criminal Justice (Young Offenders) (Jersey) Law 2014, the second unit will operate as a separate and distinct in-patient Tier 4 CAMHS provision accommodating up to a maximum of three children.
The Greenfields site broadly meets QNIC Standards and will keep in-patient CAMHS patients, comfortable, safe and secure during this unprecedented time.
Background
The Greenfields site was built in 2006, it is currently commissioned as a secure unit to provide care to children and young people in line with the duties and powers set out in the Children’s (Jersey) Law 2002 and the Criminal Justice (Young Offenders) (Jersey) Law 2014. The unit is organised into two separate distinct areas or units with four bedrooms in each. Secure care has only operated during recent years using part of the building - that is, using one of the units (four bedrooms) rather than the eight possible and the provision is registered accordingly in terms of Regulation of Care Law 2014 with the Jersey Care Commission to take up to four children and young people at any one time.
The unit is currently considered as broadly compliant with the United Nations Convention on the Rights of the Child (UNCRC), 1989.
In recent years there has been a change in the ethos of youth justice in Jersey as best practice is applied. The numbers of young people being detained in secure accommodation through the youth justice system has declined. As a result, it is not exceptional that only one young person is in Greenfields at any one time (and exceptionally two), and the unit is often empty. Greenfields is currently in use as a secure unit.
There is urgent consideration due to the crisis being progressed for with Jersey Care Commission for a ‘relaxation’ in regulation so that the site will continue to be registered as secure children’s home/youth justice facility accommodating up to four children in one wing and a separate Inpatient Tier 4 CAMHS provision can be set up in the other wing during the COVID emergency period only.
The new inpatient CAMHS unit will operate 24 hours a day, 7 days a week. The unit will provide specialist assessment, treatment and psychotherapeutic intervention services for young people in Jersey with serious mental health difficulties requiring treatment in an in-patient setting.
Staffing Requirements and dual use arrangements
The two units will operate on a separate and independent basis. The Greenfields secure unit will continue to operate separately in line with legislation, policy and registration requirements.
The core care team of nursing and support staff will operate on a rotational shift system. This will be supported by dedicated medical input during normal hours with support from medical team out of hours. In addition, other specialist practitioners including Psychology, Psychotherapy, Family Therapy and Occupational Therapy will be part of the team and work to support the service. Other services for example children’s social work will also support young people as appropriate.
The staffing complement is one Registered General Nurse, or one Registered Mental Health Nurse and Two Support Workers, accommodating up to three young people at any one time, will staff the Tier 4 CAMHS Inpatient area. This client to staffing ratio meets QNIC best practice standards.
The two units are divided by a locked, secure door, access to the Tier 4 CAMHS in-patient area is via a separate entrance/door at the rear of Greenfields building.
It is proposed to make one of the four bedrooms in this unit into a staff area with tea/coffee making facilities and a fridge. The staff area also has a separate staff toilet. There is space in this unit for a table and chairs, recreational area and television. Staff from the in-patient area will access the main kitchen area, which is shared with the secure unit facility to prepare meals, this will be undertaken at set agreed time so as not to present any disruption.
Each young person will have their own bedroom with en-suite facilities with access to the outside areas and other facilities. Young people will not be held in secure conditions.
Access criteria
The in-patient Tier 4 CAMHS unit of Greenfields will operate a single point of access system, with the aim of providing a rapid and flexible response to young people with the most complex needs, wherever possible within the limits of service. A clear operational procedure has been developed to manage the unit and ensure effective service provision. Young people in mental health crisis in Jersey will have access to a 24-hour consultation, assessment and generic inpatient admission and treatment service.
Staff will work collaboratively with referring services to ensure that admission is appropriate to the individual’s needs. There will be no more restrictions on a person’s freedom than is warranted by his or her clinical condition.
Children and Young People will only be admitted where their mental state or clinical behaviour seriously compromises their physical or psychological well-being, or that of others, and which cannot be safely assessed or treated in a community setting.
The needs and resulting presentation that results in the need for admission to the unit will be as a direct result of an acute mental health condition, or an acute exacerbation of an existing mental disorder, which is expected to respond to the treatment approaches available to the unit in a relatively short period of time.
Inclusion Criteria for admission to Greenfields Tier 4 CAMHS inpatient Unit includes:
- Young person must be aged up to 18 years
- Young person must be detained under the appropriate completed assessment or treatment article or is able to give consent to admission
- High risk to self
- High risk to others
- Non-compliance with treatment
- Absconding risk
Avoiding restriction of liberty
A critical issue for children and young people in the Tier 4 CAMHS Inpatient Unit is that there is no restriction of their liberty without lawful authority in providing care and treatment, which would be in breach of Article 5 of the Convention on Human Rights as incorporated into Jersey Law by the Human Rights (Jersey) Law 2000.
Most young people who are admitted to the unit are considered ‘voluntary / informal’ patients. As an informal patient, young people are not subject to any restrictions on leaving the unit. Young people are able to leave the unit area or discharge themselves through consultation with the duty staff and caregivers. While they are an inpatient, CAMHS will continue to have a duty of care towards them.
As an informal patient the young person has a right to refuse the proposed treatment. If they are under the age of 16 their parents or legal guardians can consent for them. This includes any medication that might be prescribed for them whilst on the unit. Despite this right to refuse, it is hoped that young people would discuss the reasons for this refusal. As an informal patient they are not subject to statutory powers and cannot be held on the unit against their will.
There are some important related issues: Exit doors are locked similar to the way most households lock their front doors. It is not to prevent young people from leaving and they have a right to request them to be opened to allow them to leave (subject to normal safeguarding procedures). Clinical staff have a responsibility to know the whereabouts of all current inpatients at all times. Bedroom doors will not be locked.
Conclusion
It is proposed that the Minister for Health to agree to HCS and CYPES setting up and operating an CAMHS In-patient Provision on the Greenfields site. This provision will support up to three children and young people up to the age of 18.
Staffing and facilities for the children and young people will be separately operated and managed from the secure unit reporting to the Director of Safeguarding and Care
This provision will operate for the period of the COVID-19 emergency only
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