Sir Martin Narey’s Review of Residential Care: Children trapped as revolving door patients.
There is a particular grouping of young people who can become “marooned” in tier 4 adolescent psychiatric provision, both within NHS adolescent psychiatric units and with private providers. Some children end up staying on these units for periods in excess of a year, others become “revolving door patients” who are regularly stabilised with drugs and then sent back to their family homes or into foster settings where they cannot cope and repeat the psychiatric behaviours that led to their original admission. These repeating scenarios often reflect intractable difficulties within the young person’s family system. Generally these children have limited access to education and sometimes the risky psychiatric behaviours that led to their admission become more ingrained through prevailing culture in these settings. This is particularly true for para-suicidal and self-harming behaviours. It is also worth noting that fees for these settings are often in excess of £1000 per day and so represent an enormous cost.
It is possible for these young people to be looked after within a group-based residential environment with the capacity to contain these high-risk behaviours. This can be achieved through the maintenance of a culture in which young people learn to prioritise the welfare of the group within which they live. This helps them manage their own urge toward self-destructive behaviour through concern about the effect it might have on other residents. Alongside this treatment work, the young people can engage in education with the explicit aim to ensure they continue in further education on discharge. It is important to note that the designation of student enables a care-leaver to access support precisely because of their success in education, rather than because they are vulnerable and struggling to cope. This experience of success is a powerful mechanism to establish and secure good outcomes for these young people. The costs of this kind of service will be significantly lower than those within the psychiatric sector.
This pathway is laid out in the diagram below:
Crucially the planning framework underpinning this pathway depends on the perspective held within the commissioning process, and then effective inter-agency collaboration across health, social care, and education. When it is possible to work with commissioners to establish this kind of vision, it then becomes possible for young people to evolve a vision for their own good future, and dare to hope they might achieve it.
I am currently conducting doctoral research to better understand the processes of complexity that obstruct this kind of perspective, and have established a consultancy to work with providers to improve these processes.
Mark Waddington Dec 2015
Mark Waddington is a doctoral researcher and specialist in residential therapeutic childcare.
07751 702814