Child on tier 4 CAMHS. AIBU to be furious with staff’s mistake?

[CaptainAwkward]

DD is a voluntary patient on an impatient ward and 15 years old.
Part of her illness involves self harming, risk taking behaviour, psychosis and disassociation episodes. She also has complex PTSD.

Under 16s can only leave the ward with parents and/or staff. Over 16s are able to go to the shops etc as long as they aren’t held under the MH Act.

Last night DD left the ward on her own. The nurse in charge ‘thought’ she was over 16.

DD ended up taking part in self harming/disassociated.

I’m fucking furious. The night shift last night failed to safeguard her. I’m going to get her soon.
Has anyone got any advice?

Well she should be working alongside the nursing team to devise a safety plan and in my past experience pts being more involved and feeling a sense of responsibility helps, but obviously I don’t know the ins and outs of it as care is patient centred. I’ve obv struck a nerve though by daring to suggest ur daughter has some level of responsibility towards her care so I’ll not comment again.

Also as an informal pt she is able to do so, different if she was detained under the MHA then by all means I would be going ape shit at how this had happened.

The staff made a mistake and you are quite reasonable to raise this (although the rule you describe of not allowing informal patients under 16 off the ward is probably not legal if they are competent to decide to leave)

I think your dd holds quite a chunk of the blame here, though.

I am sorry this has happened to your daughter. You are quite right to complain. However I think you need to acknowledge there will be two sides to this. Previous posters have made the point that your daughter also needs to take some responsibility. Also are you absolutely sure your daughter is telling the truth about what was said to her about being discharged?

Good point actually...staff would be acting illegally keeping someone on a ward who isn’t detainable. Also if they so much as laid a finger on ops daughter trying to keep her on the ward it would be assault and op would be raging at this also I’m sure lol. So many grey areas in mental health, everything isn’t black and white.

She’s an unwell child @Crabbypaddy. The nurse made a mistake.

But you’re not understanding the legal aspects of this...if she is an informal patient there is bugger all nursing staff can do if she decides she wants to leave the ward. She will have been risk assessed and decided there is no need for detention therefor she is deemed to have capacity. Like it or lump it, I don’t make the rules

I might be completely barking up the wrong tree but could you ask for her to be held under the MH Act if there is a serious risk that she could try to leave and self harm again? Particularly if she's hearing voices compelling her to and she is able to procure alcohol. Obviously what happened is appalling and you are totally right to complain. I'm so sorry you're going through all this :(

@Crabbypaddy

But you’re not understanding the legal aspects of this...if she is an informal patient there is bugger all nursing staff can do if she decides she wants to leave the ward. She will have been risk assessed and decided there is no need for detention therefor she is deemed to have capacity. Like it or lump it, I don’t make the rules

@Crabbypaddy

Actually, I very much understand the law surrounding this.
I wonder if a capacity assessment was undertaken and recorded when the DD requested her leave.
I wonder what her risk assessment and management plan actually says.

People can’t just be detained under the mha Willy nilly, there is a criteria that has to be met to legally detain someone and if she doesn’t fall under any of the 5 points then peoples hands are tied with regards to detaining someone despite family/friend concerns etc.

As do I...like I said I can’t comment specifically in this instance as she isn’t my pt...but I imagine this will have been done on admission by duty doc or whoever was admitting her.

Could the nurse not have used Sec 5(4) @Crabbypaddy ?

I'm not taking sides, I used to work in Tier 4 many years ago and it had happened in the past that a YP would go AWOL knowing there was bugger all we could do but call the parents, call the out of hours Manager, call police, do a risk incident form, etc as it wasn't a locked ward and they weren't sectionable. Perhaps Tier 4 is different now though.

Yes nurses holding power still an option for doc to review for imminent threat but I really couldn’t comment as I wasn’t there, I was merely pointing things out to op that things aren’t always as black and white as they seem, which I’m sure u know with ur experience in the field

Section 5(4) or the nurses holding power could only be used if the nurse thinks that there is immediate danger to the patient if they left the ward and lasts for up to six hours ,and the patient would have to be assessed for usually a section 5(2) Drs holding power at the weekend which lasts for up to 72 hours ,but it depends whether she was detainable or not .

My DD was held on a locked ward a couple if years ago, and she was only a few months older than your DD, OP. There was no way any of the children could have got off that ward - electronic locks, windows that only opened an inch, staff double-checking identification every time a door was opened and an "airlock corridor " to stop anyone getting free. My DD managed to smuggle alcohol and OTC medication back onto the unit, and OD'd again. After that, they strip-searched her back onto the unit after every period of leave.

It was awful but it was safe, and I am so sorry to hear that your DD wasn't kept safe. I hope she is as OK as she can be. Definitely get some answers from the consultants and the main care staff.

Thanks @funnylittlefloozie

The unit has about a million doors like air locks. Kids can’t just wander off the ward without them being opened by key holders

We asked ages ago what would happen if a child (not sectioned) wanted to leave. Their policy is to say ‘you can go, but only if your parent comes for you/we get their permission so please come and have a brew whilst we wait’.

I was thinking about this thread today and to me it is incredibly shocking and the outcome could have been so much worse! I am shocked and disgusted TBH.

I’m an RMN and have been for 20 years, never worked in CAMHS but worked in inpatient care throughout. Even on adult wards, we would routinely ask that people stay on the ward at night and would be concerned if a patient demanded to go out. Alarm bells would be ringing and I would be doing a thorough risk assessment. Of course people have a right to liberty snd freedom but we also have a duty of care and I would be negotiating that they go out with someone, staff get what they want or they wait until daytime. If they continued to insist, I would be asking why and considering what options I had in terms of keeping them safe.

Ultimately if I allow someone out who goes and harms themselves or someone else, I am accountable for the decisions I have made.

The rule that those over 16 can go out alone would really worry me, never mind the fact they didn’t check your dd’s age! I have a 16 year old and I absolutely would not want them going out at night alone without me knowing where they were going, never mind if they were in a mental health unit! No good can come of that.

We would take such an incident very seriously in my Trust and I suspect there will be a serious incident review as the outcome could have been very different.

I hope your DD is okay and wish you all the best.

Having had a lot of experience with adolescent mental health wards through a relative's illness, the feeling used to be that someone was voluntary but if they tried to leave, then they would section them.

So many young people escaped, sometimes for days. It's not unusual even for sectioned patients. Nurses sometimes threatened discharge if patients spoke about their mistakes so the reality is it's kept quiet.

I would think about complaining as your d's safety was at risk. You're unlikely to get anywhere though and you risk your d being blocked from care if you do (we did). Mental health care is another world, as we found out. Doing the right thing isn't always rewarded.

I hope your d is feeling better and will be out soon. It's such a stressful time for both of you, I wish you well.