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2.24 Children's Visits to Special Hospitals/Psychiatric Units

SCOPE OF THIS CHAPTER

This chapter sets out the procedures for managing risks and safeguarding the well being of children and young people, who may be visiting or having contact with adults or other young people who are in a psychiatric ward or special hospital.

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 1999 (26.3), 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 Social Care 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 Social Care Services on the visiting of psychiatric patients by children.

AMENDMENT

In September 2017 this chapter was updated to make it more child focussed.


Contents

  1. Introduction
  2. Visiting Patients in Psychiatric Wards
  3. Pre-visit Arrangements
  4. The Decision about Visits
  5. The Arrangements for Visits
  6. Visiting High Security Psychiatric Services - Ashworth, Broadmoor and Rampton
  7. The Child
  8. The Request for a Visit
  9. Parental Consent to Visit
  10. Action by Nominated Officer to Consider a Visit
  11. Assessment by Children's Social Care Services
  12. The Decision
  13. The Visit
  14. Refusing a Visit
  15. Medium Secure Hospitals

    Appendix 1: Process for assessing children's visits to patients in special hospitals and medium secure units

    Appendix 2: Process for Managing Visits by Children to Local Psychiatric Facilities (other than Arnold Lodge)


1. 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.

Visits by children to psychiatric wards need to be assessed, planned and managed to ensure that they are not exposed to physical, sexual or emotional harm.

Any risks to the child should be identified and managed. These may be from patients, or other individualsĀ  from the environment in which visit will take place.

N.B. Ward areas are not suitable environments for visits from children to take place.

Special 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.


2. 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;
  • Prioritise 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 all cases, this is especially important 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 for both the child and the patient;
    • Ensures the child's welfare is safeguarded;
    • Ensure that the child remains safe during the visit.
  • Set and maintain standards for the provision of facilities for child visiting;
  • Ensure that staff are competent to manage the process of child visiting.

For flow chart relating to children visiting general psychiatric units, please see Appendix 2: Process for Managing Visits by Children to Local Psychiatric Facilities (other than Arnold Lodge)

The revised Mental Health Act Code of Practice January 2015 chapter 11 (implemented April 2015), 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 Social Care Services. A visit by a child should only take place following an assessment that concludes that such a visit would be in the child's best interests. Decisions to allow such visits should be regularly reviewed.


3. Pre-visit Arrangements

When a compulsory admission is planned for an adult who is a parent, the approved mental health practitioner must assess the children's needs and the suitability of arrangements for their care. If there are any concerns, Children's Social Care Services 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 must seek out information about children who may be visiting. If there is a Children's Social Care Services 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 Children's Social Care Services undertake an assessment and make recommendations to the hospital about the suitability of the child visiting.

Where Children's Social Care Services has been asked to undertake an assessment, their report should be sent back within ten working days of receipt of the written request/referral from the ward manager in order to avoid delay in arrangements for the child.


4. The Decision about Visits

The Hospital should identify a Manager/ senior clinician who is responsible for the decision to allow a visit by a child. This may be the Ward Manager.

When a visit by a child is expected, the ward manager or senior clinician should consider the available information about the child alongside the assessment of the patient's risk and needs for treatment and care and of the current state of the patient's mental health. The ward manager or senior clinician should make the decision in consultation with other members of the multi-disciplinary hospital team, as to whether the visit can proceed.

If circumstances on the day of the planned visit arise which indicate that the visit may not be in either the child's or adult's best interests, the visit can also be refused / cancelled.

The ward manager or senior clinician 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 or senior clinician if they have reason to believe that it is not in the child 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.


5. 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, or an appropriate adult for example a grandparent or social worker. The suitability of the adult accompanying the child should be assessed.

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.


6. Visiting High Security Psychiatric Services - Ashworth, Broadmoor and Rampton

High Secure 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.


7. The Child

Prior to any visit being agreed there must always be an assessment by the relevant Children's Social Care Services for the area where the child lives, in order to determine whether it is in the best interests of the child for a visit to take place.


8. The Request for a Visit

There may be cases where the patient has been:

  • Convicted of murder or manslaughter, or an offence which leads to them being identified (by probation / youth offending services, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child; or
  • Found unfit to be tried or not guilty by reason of insanity, in respect of a charge of murder or manslaughter or an offence which leads to them being identified (by probation / youth offending services, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child.

In these circumstance, the child must be within the permitted categories of relationship set out in Guidance on the High Security Psychiatric Services (Arrangements for Visits by Children) Directions 2013.

Each High Secure Hospital will identify a Senior Manager to assume the role of Nominated Officer.

If the patient's circumstances are not those in section above or 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's Social Care Services 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) explaining that a request for a visit has been made and that the person with Parental Responsibility will be contacted.

If a child is Looked After and is subject to a Care Order, Children's Social Care Services has responsibility for providing consent but the decision should be taken following consultation with those others who also have Parental Responsibility.

Where a child is Looked After but not subject to a Care Order (i.e. Accommodated), the person with Parental Responsibility is required to give their consent to the visit.


9. 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.


10. 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 Head of Children's Social Care Services for the area 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 Social Care Services 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 Social Care Services has been asked to make contact with them.

The request by the Special Hospital to the Director of Children's Social Care Services should be passed to the relevant area team manager.


11. Assessment by Children's Social Care Services

On receipt of the request from the hospital the Referral and Assessment Service will:

  • Evaluate the information;
  • Check existing Children's Social Care Services records to see if the child is known; and
  • Undertake the assessment and prepare a report for the nominated officer at the hospital.

The social worker undertaking the assessment should contact those with Parental Responsibility and those caring for the child (if they are different) 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/ies and any knowledge the Probation Provider 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 who is Looked After, 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.

Refusal to cooperate: where the person with Parental Responsibility refuses to cooperate with the assessment, legal advice should be sought.

If the child is known to Children's Social Care Services, 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.

In order to maintain up-to-date records, the Quality Development Unit needs to be informed of the outcome of the assessment once it is completed. A copy of the recommendations must be sent to the Service Manager of the Quality Development Unit.


12. The Decision

The completed assessment report must be sent within ten working days to the nominated officer at the hospital, who will discuss the recommendations with Children's Social Care and make a decision about the visit taking into account any potential risk posed by the patient and the potential risk of Significant Harm being suffered by the child.

The decision should take account of:

  • The nature (for example, quality and duration) of the child's attachment to the patient;
  • Past abuse and/or risk of Significant Harm to the child from the named patient;
  • The views of the child, taking account of his age and understanding, and of those with Parental Responsibility and, if different, those with day to day care for the child;
  • The opinions of professionals who have knowledge of the child;
  • The hospital assessment.

A clear judgment should be made whether the visit is, overall, in the child's best interests and if so, the frequency of contact that would be appropriate.

The suitability of the adult or adults who are to accompany the child on a hospital visit should also be considered.


13. The Visit

Where visits are agreed, the hospital remains responsible for maintaining an overview of the risks, which may vary according to the health of the patient, other environmental factors and the impact on the child if visiting is allowed. This may involve further liaison with the Children's Social Care Services.

All visits must be properly supervised and all unauthorised contacts are to be prevented.

No children are to visit on ward areas.

The nominated officer must ensure that a child's contact with a patient within the hospital takes place at a frequency, which is in the child's best interest.

All visits by children shall be specifically authorised by the nominated officer and clear records must be kept.


14. Refusing a Visit

There are five circumstances in which the nominated officer must refuse to allow a child to visit.

These are if:

  • The relationship between the child and the patient is not within the permitted categories of relationship as set out in the Directions. The nominated officer must notify the patient of the decision and reasons for it in writing. However the patient has no right to make representations against this decision;
  • The person/s with Parental Responsibility responds to the nominated officer stating that they do not agree to the child visiting the patient. The decision and the reasons for the decision must be put in writing to the patient;
  • The hospital's assessment indicates that the patient's mental health state and /or risk to children is such (in the immediate or longer term) that it would not be appropriate for the child to visit the patient. The decision to refuse the visit must be put in writing to the patient and the person with Parental Responsibility and include details of the complaints procedure;
  • The relevant Children's Social Care Services concludes that a visit is not or may not be in the child's best interests. The decision to refuse the visit must be put in writing to the patient, the child (if appropriate), those with Parental Responsibility, person/s with day to day care of the child if different and Children's Social Care Services. Details of the review procedure should be given;
  • There are concerns about the patient's mental state at the time of the visit. The reasons for the refusal should be explained to the patient, those with Parental Responsibility, person/s with day to day care of the child, if different, and, if appropriate, the child.

Guidance on the High Security Psychiatric Services (Arrangements for Visits by Children) Directions 2013 sets out the assessment process to be followed when deciding when a child can visit a named patient in these hospitals; and Local Authority Circular LAC(99)23 which refers to the specific tasks to be undertaken by local social service authorities in receipt of a request from the hospital for advice on whether it is in the best interests of a child to visit a named patient. Local Authority Circular LAC (2000)18 which refers to who can accompany a child on a visit to a named patient. It is issued as statutory guidance under section 7 of the Local Authority Social Services Act 1970.


15. Medium Secure Hospitals

Medium secure hospitals have patients who are detained under the Mental Health Act who are significantly disturbed and may be in hospital for lengthier periods of time, often in excess of a year. The process for agreeing visits operates with a similar degree of formality as those for special hospitals.

The local medium secure hospital is Arnold Lodge. It has procedures for dealing with urgent compassionate requests for a child visit which involves the clinical director and general manager reaching a speedier decision in advance of the paperwork being completed. (Such a decision will not be made in contradiction of clinical assessment).

Medium secure units also have a nominated officer who administers all requests for children to visit. Where the hospital clinical team concludes, from its own assessments, that a visit is not in the interests of the child, the visit is refused.

Where the hospital clinical team supports the application for a child to visit, a specific member of the clinical team, usually the forensic social worker, will liaise with Children's Social Care Services which has responsibility for the child if the child is Looked After or the Children's Social Care Services for the area in which the child resides.

The written request from the hospital will ask whether the local authority has information, which would suggest that a visit to the named patient would be against the best interests of the child.

Any subsequent assessment carried out by Children's Social Care Services should cover the same considerations as outlined above in the section on special hospitals.

Where the conclusion of the assessment by Children's Social Care Services is that the visit is not in the best interests of the child, then the visit will not be allowed. It is the social worker's responsibility to advise the child and family. The hospital will advise the patient.

If visiting is agreed, it remains the responsibility of the clinical team to oversee that the visit remains safe and appropriate for the child, and to take action if the assessment of risk changes. Previous risk assessments from other institutions may not take account of changes in the patient's current risk assessment and/or a child's current circumstances.

It is the nominated officer who authorises visits when the assessments have been completed and who will ensure that the child's best interests will remain paramount.

All medium secure units will have systems in place to oversee that visits by a child are conducted in a safe and appropriate environment and that there are records maintained of all visits. This will include a record of the patient's behaviour, any problems which occurred, any concerns regarding the behaviour of the parent and the response of the child.

The decision to refuse visits to children in these facilities should be a rare exception and one which identifies clear risk to the child, either physically or emotionally, which would negate the value of the visit for the child.

For all patients the hospital clinical team will assess, at the point of admission, the specific needs of the patient and the child with regards to child visiting arrangements. In most instances this will lead to a decision that visiting can proceed.

The facility will ensure that visits by a child are conducted in safe and appropriate conditions. For example, each ward will provide an appropriate area for use as a visiting venue. Records should also be maintained of all visits, which include notes of the patient's behaviour, any problems which occurred, any concerns regarding the behaviour of the parent and the response of the child.

If there are specific concerns that the patient may pose a risk to a child who visits, Children's Social Care Services should be contacted and asked to assess these risks. The assessment will then cover the same issues as outlined in the previous section.

The outcome of the assessment needs to be communicated directly to the nominated officer at the Hospital. This should include a statement about whether, in the view of Children's Social Care Services, it is in the interests of the child for visits or other types of contact to be permitted and the reasons for the decision are to be set out.

In order to maintain up-to-date records, the relevant Children's Social Care Team needs to be informed of the outcome of the assessment once it is completed. A copy of the recommendations must be sent to the Service Manager of that Team.


Appendix 1: Process for assessing children's visits to patients in special hospitals and medium secure units

Click here to view Appendix 1: Process for assessing children's visits to patients in special hospitals and medium secure units


Appendix 2: Process for Managing Visits by Children to Local Psychiatric Facilities (other than Arnold Lodge)

Click here to view Appendix 2: Process for Managing Visits by Children to Local Psychiatric Facilities (other than Arnold Lodge)

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