Appendix 20 - Visits by Children to Psychiatric Patients |
Contents
1. Introduction
As commissioners, all PCTs should have a designated doctor and nurse to take a strategic, professional lead on all aspects of the health service contributions to safeguarding children across the PCT area, which includes all providers. Designated professionals are a vital source of professional advice on safeguarding children matters to the PCT, health professionals, local authority children's services departments and the LSCB.
Named Professionals
All NHS Trusts, NHS Foundation Trusts, and public, third sector, independent sector, social enterprises and PCTs providing services for children should identity a named doctor and a named nurse - and a named midwife if the organisation provides maternity services - for safeguarding. In the case of NHS Direct, Ambulance trusts and independent providers, this should be a named professional. Named professionals have a key role in promoting good professional practice within their organisation, and provide advice and expertise for fellow professionals. They should have specific expertise in children's health and development, child maltreatment and local arrangements for safeguarding and promoting the welfare of children.
- The Department of Health has issued general guidance entitled "Mental Health Act 1983 Code of Practice: guidance on the visiting of psychiatric patients by children", as HSC 1999\222: LAC (99)32. This guidance is separate from the guidance governing visits by children to Ashworth, Broadmoor and Rampton Special Hospitals, which was issued as circular LAC (99)23 HSC1999/160 as amended by LAC 2000 (18).
- The following detailed guidance has been agreed by Wolverhampton Healthcare Trust, Wolverhampton Safeguarding Children Board, and Wolverhampton Children & Young People's Service and outlines the procedure to be followed when deciding whether a child under 16 years should be allowed to visit a patient in a Wolverhampton in-patient mental health unit
- The guidance applies to all situations where children visit patients at the in-patient mental health unit, whether the patient is detained or not.
2. Principles
| 1. | The following principles should be followed when deciding on the desirability of and arrangements for visits by children to patients at the in-patient mental health unit:
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Procedure for deciding whether a visit is desirable
- When a patient is admitted under a compulsory section of the Mental Health Act 1983, information about the patient's children should be included in the social circumstances report provided by the Approved Social Worker on admission. The Approved Social Worker has a specific duty to consider the issue of child contact during their assessment. Nursing staff should establish with the Approved Social Worker the likely visiting arrangements for any children of the patient
- Where practicable, the Approved Social Worker should also provide the hospital with the views of all persons with parental responsibility for the child on contact of that child with the patient
- When a patient has been admitted on an informal basis, nursing staff should seek out information about children who may be visiting. When nursing staff are aware that a patient has a child, and there is a social worker involved, nursing staff should check with the social worker about the desirability of the child/ren visiting and the arrangements to be made. The social worker should be asked to describe the arrangements for child/ren visiting by completing the "Children Visiting Patient" form
- When nursing staff are aware that a patient has a child/ren and they are concerned about the possible impact of visiting on the child/ren, and there is no social worker involved, they should contact the Children & Young People's Service where the patient is ordinarily resident. If this is Wolverhampton, they should contact the Duty and Assessment Team (Telephone 01902 555392) to establish if there is relevant information about any children and views about visiting arrangements. Form Notification of a Child in Need (SC1) will need to be completed
- Recommendations made by the social worker about visiting arrangements regarding child/ren should be followed, subject to medical team review. Any concerns about these recommendations should be referred to the In-Patient Coordinator for Mental Health, or, in their absence, the Ward Manager or duty Senior Nurse
- Any information about the child/ren should be given to the nurse in charge of the ward where the patient is staying who has delegated responsibility for making decisions about child visits. The Nurse Manager should consult with other members of the multidisciplinary hospital team, taking into account the initial assessment of the patient's need for treatment and care before taking a decision on whether a visit by a child/ren is appropriate. The nurse in charge of the ward should record their decision in writing in the patient's nursing record
- When a visit by a child/ren is anticipated, the multi-disciplinary team should identify any concerns about child/ren visiting which may be present. In the vast majority of cases where no concerns are identified, arrangements should be made to support the patient and child/ren and to facilitate contact.
Dealing with concerns
| 1. | Concerns about the desirability of child/ren visiting may arise in a number of areas:-
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| 2. | Decisions to refuse visits, which will only be taken exceptionally, should be explained in person to the patient. This decision can be made on a one-off basis by the nurse in charge of the ward. Further refusals should be referred to the Consultant Psychiatrist. The Consultant Psychiatrist should record their decision in the case notes and the decision should be confirmed in writing by letter from the in-patient co-ordinator\ mental health to the patient. This letter should give the reasons for the refusal, say when this decision will be reviewed, and describe the process for appealing against this decision |
| 3. | Where the patient wants to appeal against this decision, they should do so by speaking to the in-patient coordinator or by writing to:- The Chief Executive, |
The approach to considering the best interests of child/ren is set out in the publication "Framework for the Assessment of Children in Need and their Families".
Making arrangements for the visits
- Child/ren under the age of 16 are not allowed to visit patients at the in-patient mental health unit without the expressed agreement of the nurse in charge of the ward where the patient is resident
- In most circumstances, child/ren under the age of 16 are only allowed to visit patients on the ward where they are accompanied by an adult who is not employed by the Health Directorate, such as a relative, friend or social worker. This person must accept responsibility for the welfare and supervision of the child/ren, while the child/ren remains on the ward. A child under 16 may only be allowed to visit without an accompanying adult where this has been approved in advance by the multi-disciplinary team and the consultant psychiatrist.
- When a child/ren under 16 arrives unannounced on the ward wanting to see a patient, and this has not been approved in advance, the visit should not be permitted. Nursing staff should ensure that arrangements are made for the child/ren's safe return home.
- When it has been agreed that a child/ren under the age of 16 can visit a patient at the inpatient mental health unit, nursing staff should arrange for the visit to take place in a private room away from the ward, which is appropriate for child/ren.
- Visiting normally takes place at the in- patient mental health unit between 2.30 pm and 8.00 pm, but special arrangements can be made for visits to take place outside these hours.
- During visits, nursing staff should make every effort to minimise the contact child/ren have with patients other than the one they have come to visit.
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