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Stoke-on-Trent
Safeguarding Children Board
GUIDANCE FOR CHILDREN WHO MAY BE PARTICULARLY VULNERABLVE
CHILDREN VISITING
PSYCHIATRIC WARDS AND
HIGH SECURITY HOSPITALS
Section F 15
Version 1
Date January 2015
F 15 Children Visiting Psychiatric Wards and High Security Hospitals /You can scroll through the document or use the links in the contents list below
Contents
01 Legislation and guidance
02 Introduction
03 Visiting Patients in Psychiatric Wards
04 Pre-visit Arrangements
05 The Decision about Visits
06 The Arrangements for Visits
07 Visiting High Security Hospitals eg Ashworth, Broadmoor and Rampton
08 The Child
09 The Request for a Visit
10 Parental Consent to Visit
11 Action by Nominated Officer to Consider a Visit
12 Action by the Advice and Referral Team
13 The Children’s Services Assessment
14 Refusal to cooperate
15 The Decision
16 The Visit
17 Refusing a Visit
01 The legislation and guidance that relate to this procedure are:
· Directions under Section 17 of the National Health Service Act are set out in HSC1999/160 as amended by LAC 2000 (18). These refer specifically to visits to Ashworth, Broadmoor and Rampton Hospitals.
· In the revised Mental Health Act Code of Practice 2008 (19.17), this gives guidance on the visiting of psychiatric patients by children. It states that Hospitals should have written policies on the arrangements about the visiting of patients by children, which should be drawn up in consultation with Children's Services. A visit by a child should only take place following a decision that such a visit would be in the child's best interests. Decisions to allow such visits should be regularly reviewed.
· HSC 1999/222: LAC (99) 32 contains guidance to Health and Children's Services on the visiting of psychiatric patients by children.
02 Introduction
Safe and regular contact for children should be promoted with patients in psychiatric facilities, whenever it is appropriate to maintain relationships which are of importance to the child.
The child's interests must remain paramount and take precedence over the interests of the adults involved when decisions are made about whether visits are appropriate.
Any risks to the child should be identified and managed. These may be from the patient or from the environment in which visiting will take place.
High Security Hospitals contain detained patients who are considered very disturbed and should be seen as potentially dangerous. Patients are likely to remain in the setting for considerable periods of time. The setting is also potentially frightening for a child.
03 Visiting Patients in Psychiatric Wards
When children visit adult patients, all psychiatric in-patient settings should:
· Place child welfare at the heart of professional practice for all staff involved in the assessment, treatment and care of patients.
· Take account of the needs and wishes of children as well as patients.
· Address the whole process, including preadmission assessment, admission, care planning, discharge and after care.
· Assess the desirability of contact between the child and patient, identify concerns and assess the potential risks of harm to the child in a timely manner.
· Establish an efficient procedure for dealing with requests for child visits in those cases where concerns exist.
· Establish a process for child visits which is:
- not bureaucratic
- supportive of both the child and the adult
- does not cause delay in arranging contact
- maximises the therapeutic value of the visit
- ensures the child's welfare is safeguarded
· Set and maintain standards for the provision of facilitiesfor child visiting.
· Ensure that staff are competent to manage the process ofchild visiting.
04 Pre-visit Arrangements
When a compulsory admission is planned for an adult who is a parent, the approved social worker must assess the children's needs and the suitability of arrangements for their care. If there are any concerns, the Children’s Services – Vulnerable Children and Corporate Parenting (VCCP) should undertake an assessment and make recommendations to the hospital about the children visiting and present the views of those with Parental Responsibility about the child visiting.
When a patient has been admitted informally, nursing staff should seek out information about children who may be visiting. If there is a Children's Services (VCCP) worker or an adult mental health care coordinator involved, the nursing staff must discuss the arrangements for any child visiting. This discussion must be clearly recorded. If there are any concerns and if there is no social worker involved, the ward manager must request that the Children's Services (VCCP) undertake an assessment and make recommendations to the hospital about the suitability of the child visiting.
Where Children's Services (VCCP) have been asked to undertake an assessment, their report should be sent back within one week of receipt of the written request/referral from the ward manager in order to avoid delay in arrangements for the child.
05 The Decision about Visits
The ward manager is responsible for the decision to allow a visit by a child.
When a visit by a child is expected, the ward manager should consider the available information about the child alongside the assessment of the patient's needs for treatment and care and of the current state of the patient's mental health. The ward manager should make the decision in consultation with other members of the multi- disciplinary hospital team.
The ward manager must make their decision on the basis of the interests of the child being paramount.
Where a child visits unexpectedly, the visit may be refused if it is not feasible to make a proper assessment while they wait.
A decision to refuse or prohibit visiting by a child may be taken by the ward manager if they have reason to believe that it is not in the child's or patient’s best interest for visits to take place.
Decisions to refuse visits should be given verbally and confirmed in writing and must be supported by clear evidence of concern and the difficulties of managing them.
The decision must be communicated to the patient, the child and those with Parental Responsibility.
Information about procedures to review any decision or make representations about it must be made available including access to assistance and independent advocacy.
06 The Arrangements for Visits
The hospital or mental health trust providing the service must ensure that the facilities for contact are conducive to the child's safety and promotes good quality contact for both child and patient.
Children should have appropriate supervision when they are visiting mental health service users. They should normally be accompanied by someone who has Parental Responsibility.
In some cases it may be better for visiting to take place away from the hospital. In the case of detained patients, this will require due consideration of the need for leave. Staff must be aware of protection and child welfare issues in granting leave of absence under Section 17 of the Mental Health Act 1983.
07 Visiting High Security Hospitals eg Ashworth, Broadmoor and Rampton
Specialist hospitals have procedures specifically developed for the service about child visiting. The decision to permit a child to visit a unit must always be based on:
· The interests of the child.
· The service user's offending history.
· The clinical history of the service user.
· The conditions under which the visit will take place.
A hospital may not allow a child to visit any patient unless the hospital authority has approved the visit in accordance with the directions pertaining to the patient's admission and in particular is satisfied that the visit is in the child's best interest.
The only exception is where there is a Contact Order made under the Children Act 1989 which specifies that the child may visit the patient in the special hospital. In such cases, visits should be allowed except where there are concerns about the patient's mental state at the time of the proposed visit; such that the nominated officer decides the visit would not be in the child's best interest.
08 The Child
The request for a child to visit must be in respect of a child within the permitted categories of relationship as set out in the Directions and associated guidance to Ashworth, Broadmoor and Rampton Hospital Authorities (HSC 1999/160 as amended by LAC 2000 (18)).
Prior to any visit being agreed there must always be an assessment by the relevant Children's Services where the child lives, in order to determine whether it is in the best interests of the child for a visit to take place.
09 The Request for a Visit
The Directions impose a duty on the Hospital to appoint a nominated officer to consider a request by a patient for a child to visit.
If the child is within the permitted categories of relationship the nominated officer should:
· Obtain written permission from the patient to contact those with Parental Responsibility for the child.
· Write to the person/s with Parental Responsibility for the child:
- explaining that a request for a visit has been made.
- asking for confirmation of the relationship between the patient and the child.
- requesting consent for the child to visit the patient.
- explaining that before a visit can proceed Children'sServices in their area will be asked to assess whether the visit is in the child's best interest.
· Write to any person without Parental Responsibility but with day-to-day care for the child (e.g. grandparent) explainingthat a request for a visit has been made and that the personwith Parental Responsibility will be contacted.
If a child is in local authority care and / or is subject to a Care Order, Children's Services (VCCP) have responsibility for providing consent but the decision should be taken following consultation with those others who also have Parental Responsibility.
Where a child is in care but not subject to a Care Order, the person with Parental Responsibility is required to give their consent to the visit.
10 Parental Consent to Visit
If those with Parental Responsibility state that they are prepared to allow their child to visit the patient, the nominated officer should arrange for the patient's clinical team to undertake an assessment.
This assessment is to judge the level of risk, if any, presented by the patient to children and to the particular child for whom the visit request has been made.
11 Action by Nominated Officer to Consider a Visit
If the previous steps have been taken and the hospital's assessment of risk of harm posed by the patient to the child does not rule out a visit, the nominated officer must:
· Contact the Assistant Director Children’s Services (VCCP) where the child resides to request advice on whether the visit is in the child's best interest.
· Include in the request a copy of the hospital's assessment and any other relevant information about the patient, to assist Children's Services (VCCP) to carry out the assessment.
· Include in the request any information about other local authorities which have relevant information about the child and the family.
· Inform the parents that Children's Services (VCCP) have been asked to make contact with them.
The request by the Special Hospital will be made to the Assistant Director, Children's Services but should be passed to the Advice and Referral Team Manager (ART) immediately, unless this is an open case and therefore the request should go directly to the supervising social worker.
12 Action by the Advice and Referral Team (ART)
On receipt of the request from the hospital the ART Manager will:
· evaluate the information;
· check any information across electronic and manual records held by the Children's Services (VCCP) to see if the child is known; and
· contact the relevant Children's Services (VCCP) team who will undertake the assessment and prepare a report for the nominated officer at the hospital.
13 The Children’s Services Assessment
The Children's Services should contact those with Parental Responsibility and those caring for the child (if they are different) as part of the assessment and should seek to establish:
· The child's legal relationship with the named patient.
· The quality of the child's relationship with the named patient prior to hospitalisation and currently.
· Whether there has been past abuse of the child, alleged or confirmed, by the patient.
· The likelihood of future risks of Significant Harm to the child if the visit takes place.
· The child's wishes and feelings about the visit taking account of their age and understanding.
· The views of those with Parental Responsibility and, if different, those with day to day care for the child.
· If it is known the child has lived in other local authority areas, relevant information about the child and family from the relevant local authority and any knowledge the probation service in that area may also have of the patient, the child's family or the accompanying adults.
· The frequency of contact that would be appropriate.
· In the case of a child in care, the assessment should determine who will accompany the child.
The assessment must make clear recommendations based on the information gathered and must set out clearly the grounds for contact to take place or not, bearing in mind at all times the child's best interests.
14 Refusal to cooperate
Where the person with Parental Responsibility refuses to cooperate with the assessment by the Children's Services (VCCP), legal advice should be sought.
If the child is known to Children's Services (VCCP) it could make its report on the basis of the information it has already but make clear that the information is not up to date and does not take account of the wishes and feelings of the child. Alternatively, if there is no information about the child, it should inform the hospital that it is unable to make any report.
15 The Decision