Mental health rights: a life and death issue

The Care Programme Approach needs to change if the rights of young people and young adults with mental health needs to decent care are to be upheld, argues young person’s solicitor Chris Callender.

As a lawyer, having worked with children and young people in police stations, courts, prisons and in care, I have dealt with and challenged a wide range of “systems” and services put in place for the young.  I am struck by the lack of care and appreciation for the needs of the child or young person.  Often these systems are created by adults for adults and thoughtlessly adapted for children and young people.  It smacks of “adults know best” – and it doesn’t work. 

Children in care have a complex system that is often difficult to understand, even for lawyers and social workers, and harder still to implement.  But these children do have a process which provides for an assessment of their needs and a care plan specifically saying how those needs will be met.  They will have a social worker allocated to manage that care.  There will be regulated reviews every six months monitored by an independent person who will meet them before the review to check how they are.  They can have an independent advocate to help them make their feelings and wishes known.  The language, law and rules around the care system are not child-friendly, but the intention is good and, with the right team, a child could get decent care.

By contrast, young people with mental health problems, who are possibly the most vulnerable, do not have any dedicated system.   I am particularly concerned by how young people are consistently let down by the “Care Programme Approach” (“CPA”); the NHS “system” designed for treating adults with severe or complex mental health problems. 

Local mental health trusts publish how they will provide the Care Programme Approach.  Under the CPA the patient’s needs should be assessed and a care plan prepared about how those needs will be met.  The patient should be allocated a “care coordinator” to make sure that the care plan is put in place.  The CPA care plan is reviewed at a meeting called a CPA review.    

I have met young people and the families of young people who have taken their lives after being let down by this process.  The patterns of dissatisfaction are repeated throughout my cases. 

The CPA meetings and reviews are attended by a bank of professionals discussing the young person as though they were not present.   The young person is pushed pillar to post, from one agency to the next, from one tier to the next, meeting more and more professionals, repeating their stories without feeling any benefit. 

The crisis plans rely on telephone numbers that are unanswered and end in congested A&E departments with little time to meet the needs of the young person, who may be medicated, often with little insight into the affect and risks.  There is no voice of the young person or of their parents and carers who are left isolated and lost amidst “professional” reports, reviews and referrals.  The young person does not have the confidence or opportunity to express their feelings.  At best they become disengaged, at worst they take their life. 

Children and young people with mental health problems are entitled to a care system that respects their feelings, wishes and vulnerability.  It is time that the mental health system caught up with our young people, upheld their rights and gave them the care that they need. 

Chris Callender is a public law solicitor at Steel & Shamash specialising in representing children and young people