Lack of secure accommodation sees teenager living under four-to-one supervision in hospital

A 15-year-old girl with a history of self-harming so extreme she has to be watched by four people is living in hospital because of the national shortage of secure accommodation.

The child, called “Claire” in court papers to protect her privacy, has repeatedly hurt herself, attempted suicide and gone missing, judge Simon Burrows said in a ruling which follows a series of hearings in the Family Division of the High Court.

After questioning doctors’ decisions not to detain her under the Mental Health Act (MHA) and highlighting the lack of places at secure children’s homes nationally, with dozens said to be waiting for about a year for a handful of beds, the judge made a fresh order authorising the girl’s detention at the unnamed Midlands hospital.

But unless proper accommodation is found, he said there could be “further self-harm, further destruction, further attempts to escape and further admissions to hospital if she is lucky enough not to kill herself in the process”.

“The risks she poses to herself are quite simply catastrophic,” he added.

Claire, who has had a turbulent childhood, has been diagnosed with attention deficit hyperactivity disorder (ADHD) and is vulnerable to sexual exploitation, and went into care in the north west of England after her mother died, the judge said.

She has been in and out of hospital and had a number of failed welfare placements because of her risk-taking behaviour.

She is “troubled, traumatised and, I would add, completely unable to cope with her feelings”, the judge said.

Claire is staying on a children’s unit at the hospital, where she has “settled to a degree” and is “receiving some education remotely” and having “daily meetings with play therapists” – although she had “tried to leave the hospital by climbing on the toilet seat and through the false ceiling”.

Professionals in the case described the restrictions put on Claire as “the most intense they had seen in their cumulatively long careers”, the judge said, but “they were entirely at a loss to think that any lesser restrictions could safely be imposed upon her”.

“She was then, and still is subject to four-to-one supervision,” he said, adding: “It must be difficult for somebody who is in good mental health to have four people with them all the time, but for somebody with the terrible difficulties that Claire has it must be awful.

“However, what else can be done when a person is trying to harm themselves as determinedly and seriously as Claire is?”

Experts believe Claire needs treatment that is “best achieved in a social setting which is stable, safe and secure”, the judge said.

During one assessment, “there was no evidence of an acute mental disorder that would likely respond to treatment in an acute mental health inpatient setting”, a letter from one NHS trust said.

“There was no objective evidence of mood disorder, acute anxiety or psychotic features,” it added, with Claire’s self-harm said to be “in the context of emotional dysregulation linked to social stressors, namely… attachment difficulties and feelings of stabilisation due to multiple placement moves, and removal from family and usual social support networks”.

But, as well as saying he remained “troubled” that Claire “is not detainable under the MHA”, the judge said: “This position appears to ignore what is almost universally recognised elsewhere, namely that there is a chronic lack of secure accommodation for our young people with serious mental health and behavioural problems.”

As of October 11, there were only seven beds available nationally – one of which was for males only – and 48 pending live referrals, including Claire’s, the judge said.

“I was told that it is within the knowledge of one of the social workers for one child referred for secure accommodation to be waiting for 12 months for a secure bed,” he added.

Had Claire been detained under the MHA, she would have been looked after in a healthcare facility for mentally ill children and young people who need hospital admission, the county council responsible for her said.

The term “secure accommodation”, meanwhile, refers to secure children’s homes, which fall under the remit of social care.

The judge said the “local authority find themselves once again at the brick wall against which they have been banging their heads consistently for some months because of the lack of adequate provision of secure accommodation”.

Concerns have been raised before about a shortage of secure accommodation.

In July 2021, one of Britain’s most senior judges described the lack of “proper provision” for children who need it as “scandalous”.

Supreme Court justice Lord Stephens said the issue had “all the ingredients for a tragedy”.

And at the start of 2023, the country’s most senior family judge, Sir Andrew McFarlane, said high court judges were spending “a fair proportion of their time on cases of this nature, and much of that time is generated because there are not sufficient, suitable secure children’s homes for those who need secure accommodation”, The Guardian reported.

The judge in Claire’s case said “there is nothing this court can do to require the use of the MHA”, though her legal guardian was “pondering whether judicial review of the sectioning decision is a feasible option”.

One in five eight to 25-year-olds have had a probable mental disorder this year, a report revealed in November.

Commenting at the time on the paper’s findings, NHS mental health director Claire Murdoch said they show the “continued unprecedented pressures faced by young people” and reflect “the increased demand for NHS children’s mental health services”.

She said: “The NHS is providing support for more children and young people than ever before – we have already supported over 700,000 children and young people with their mental health this year and also seen a 47% increase in young people being treated for eating disorders compared to pre-pandemic.”

On Claire’s case, an NHS spokesperson said: “While we cannot comment on individual cases, we remain committed to working with our patient and clinical stakeholders to improve access and quality of care for the record number of children and young people seeking mental health support.

“Mental health inpatient services are only offered when a group of clinical experts determine that it is in the best interests of the patient.”

A county council spokesman said: “The welfare of the children in our care is always our topmost priority and we are working hard to support this girl in the best way possible.

“We are grateful for the time and attention this case has been given by the courts.”

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