Report into care at Scotland’s secure units published

A new report into the care being provided by five secure children’s units across Scotland has been published today.

The report follows joint inspections by the Care Inspectorate and the Mental Welfare Commission over 2014-15.

Care Inspectorate inspections suggest that these services are, overall, providing ‘very good or excellent care’ while the Mental Welfare Commission reported some problems with a  ‘lack of continuity of mental health care for some young people who had an identified mental health problem prior to, and during, their time in secure care accommodation’.

There are five secure accommodation services inspected were:

• St. Mary’s Kenmure Secure Unit
• Kibble Safe Centre
• Edinburgh Secure Services
• Rossie Secure Accommodation Services
• Good Shepherd Centre, Bishopton.

The key findings from the report are:

• The journey into a care setting, including secure care was frequently complex. Many young people in secure care settings are placed outwith their home authority. Their journey is likely to include admission from and into other residential settings or, for those young people completing a custodial sentence, to a young offenders’ institution. The understanding of reasons for admission and sharing of information between agencies and the secure care service is vitally important, as are the transitional arrangements from the service.
• Young people may have experienced a number of moves before admission to secure care, and transitions pose challenges to services in providing consistency. We found that the transition arrangements could be improved, particularly at the point of admission and around the known mental health needs of young people. There was a lack of continuity of mental health care for some young people who had an identified mental health problem prior to, and during, their time in secure care accommodation.
• Information about young people’s mental health needs and supports in place were not always communicated to primary care services at the point of discharge from secure care.
• An initial health assessment usually took place within 72 hours of admission to secure care. Generally, care plans were informative and person-centred. Review of case files showed separate entries on the mental health of each young person and included, where appropriate, multi-disciplinary review notes. There was evidence that appropriate information about a young person’s mental health difficulties was not always being shared between residential care staff. From young people’s perspective, there was a lack of clarity about which staff members knew about their mental health needs and treatment. This was understandably a very important issue for young people.
• There was good evidence that the five secure services actively supported young people and had provided resources to do so. Most services have dedicated mental health teams who link with CAMHS or who sought to provide in-house assessment and interventions as part of the provision of the secure care service. Nurses employed by the services played a pivotal role in conducting initial health assessments and making referrals to specialist support services.
• The provision and access to CAMHS was mixed. Generally, there was evidence of effective communication between professionals providing mental health support and secure accommodation care staff. Significantly, young people felt that this was an important aspect of their care needs being met.
• Although the interface with CAMHS to ensure a personalised intervention – either directly by CAHMS or when carried out by the staff of the secure care service staff – is critically important, there was a general lack of clinical overview of the intervention and treatment models promoted by and delivered by secure care services. We also felt that providing independent advocacy would be an important support for young people in involving them in their treatment decisions and plans.
• Across all five secure care services, young people had opportunities to access independent advocacy. However, this could be improved and developed, particularly for young people with identified mental health issues.
• Young people in crisis felt they were well supported by secure care staff members.

To download the full report, click here: