3.12 Children Visiting High Security Psychiatric Services
Mental Health Act Code of Practice
- All hospitals should have written policies and procedures regarding the arrangements for children and young people who visit patients in hospital and for visits to patients who are children or young people. Policies should be drawn up in consultation with local authorities and local safeguarding children boards.
- Local policies should ensure that the best interests and safety of the children and young people concerned are always considered and that visits by children and young people are not allowed if they are not in their best interests. Within that overarching framework, and subject to risk assessments, hospitals should do all they can to facilitate the maintenance of children and young people’s contact with friends and family and offer privacy within which that can happen.
- Information about visiting should be explained to children and young people in a way that they are able to understand. Environments that are friendly to children and young people should be provided.
Procedure for deciding requests for visits
The Department of Health Guidance on the High Security Psychiatric Services (Arrangements for Visits by Children) Directions 2013 - procedure is intended to work as follows:
- The patient makes a request in writing for a child to visit. This request must be forwarded promptly to the nominated officer (paragraph (3)(2) of Directions). Staff in the hospitals must be aware that some patients may require support in making a written application (either from their family or their clinical team). There may be a role for an advocate from an independent agency to provide this.
- If the patient is judged to be a risk, or potential risk of harm, to children, the child must be within the permitted categories of relationship as set out in paragraph (2)(2)(b) of the Directions. If it is clear from the written application that the child does not satisfy the relationship criteria, the nominated officer must refuse the visit (paragraph (3)(11) of the Directions). The nominated officer must notify the patient in writing of the decision and reasons for it. However, the patient has no right to make representations against this decision.
- If (ii) does not apply, the nominated officer should obtain written permission from the patient to contact those with parental responsibility for the child. The nominated officer should then write to the person(s) with parental responsibility for the child explaining that a request for a visit has been made. The leaflet produced by the provider should be enclosed. Those with parental responsibility should be asked to confirm the relationship between the patient and the child, and to state whether they agree to the child visiting the patient. It should be explained that the nominated officer is required to contact their local authority to ask them for advice on the child's best interests. This advice assists them to make a decision on whether the request for visits should be approved. If more than one person has parental responsibility for the child, it is the person with parental responsibility with whom the child lives who is required to give their consent.
- In the case of a child who is looked after by the local authority and subject to a care order (with parental responsibility shared by the local authority and the parent(s)), the designated local authority has responsibility for providing consent but their decision should be taken following consultation with those with parental responsibility. Where a child is looked after by the local authority but is not subject to a care order, the person with parental responsibility is required to give their consent.
- In the case of a child living with someone who does not have parental responsibility (e.g. the child lives with a grandparent), the nominated officer should write also to the person with day-to-day care for the child explaining that a request for a visit has been made and that the person with parental responsibility will be contacted as in (iii) above.
- If the person(s) with parental responsibility responds to the nominated officer stating they do not agree to the child visiting the patient, the nominated officer must refuse the visit. The decision and the reasons for the decision must be put in writing to the patient.
- If those with parental responsibility state they are prepared to agree that their child may 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 him or her to children and to the particular child for whom the visit request has been made. The voice of the child, their feelings and wishes about the visit should be taken into account. Procedures for undertaking this type of assessment should be agreed with both the local authority children’s services departments and local safeguarding children’s boards.
- If the provider’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 nominated officer should refuse the request for the visit (paragraph (3)(5)(a) of the Directions). 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.
- If the provider’s assessment does not rule out a visit on the grounds of (viii) above, the nominated officer must in all cases contact the local authority where the child resides, to seek their advice on whether it is in the best interests of the child involved to visit the patient (paragraph (3)(5)(b) of the Directions). The written request for this advice should be addressed to the local authority and include a copy of the provider’s assessment. The nominated officer should share any relevant information about the patient with the local authority in the area in which the child resides, in order to assist the local authority to undertake its assessment of the child's best interests with regard to the proposed visit. If the nominated officer has knowledge of any other local authorities which have relevant information about the child or the child's family, this information should be shared also with the relevant local authority.
- On receipt of the request from the provider, if the request falls within the local authority’s statutory responsibilities, the local authority should contact those with parental responsibility (and those caring for the child if they are different) to arrange to undertake an assessment. In relation to the proposed visit to the named patient, this assessment should establish:
- the child's legal relationship with the named patient;
- the quality of the child's current relationship with the named patient and prior to their hospitalisation;
- whether there has been past, alleged or confirmed abuse of the child by the patient;
- future risks of significant harm to the child if the visit took place;
- the child's wishes and feelings about the visit, taking account of his/her age and understanding;
- the views of those with parental responsibility and, if different, person(s) with day to day care for the child;
- if it is known the child has lived in other local authority areas, what other relevant information is known about the child and family; and
- the frequency of contact that would be appropriate.
- Once the assessment has been completed the local authority should send a report to the nominated officer at the hospital stating whether, in its opinion, the visit would be in the best interests of 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, person(s) with day to day care for the child;
- the opinions of professionals who have knowledge of the child; and
- the provider’s assessment.
- If the person(s) with parental responsibility refuses to co-operate with the local authority assessment, the local authority should consider its legal position. If the child is known to the local authority, it could make its report on the basis of the information it has already, but make it clear that the information is not up to date and does not take account of the wishes and feelings of the child. If the local authority holds no information about the child, it will be unable to make any report to the hospital. This information should be conveyed to the hospital.
- If the relevant local authority concludes that a visit is not or may not be in the child's best interests, the nominated officer must not allow the visit to take place (paragraph (3)(7) of the Directions). 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 for the child, if different, and the local authority. Details of the complaints procedure should be given. If the local authority advises that, in their view, a visit would be in the child's best interests, the nominated officer should make a decision following discussion with the local authority. This should take account of shared information relating to any potential risk posed by the patient, and the potential risk of significant harm being suffered by the child (paragraph (3)(6) of the Directions).
- Any visits by children must take place in an appropriate setting designated for visits by children and not in ward areas. Visits must be properly supervised. A child visiting a hospital may only have contact with the named patient for whom a visit has been approved. Areas designated for child-visiting should be child-centred and child-friendly, taking account of the age of the children, whilst maintaining the required level of security. The nominated officer must ensure there are sufficient staff, of an appropriate grade and with requisite knowledge and understanding, present to supervise children's visits at all times and to prevent unauthorised contacts (paragraph (7)(1)(e) of the Directions). Paragraph (7)(1)(d) of the Directions allows for a visit to take place in exceptional circumstances in an area or place not designated for child visits. This is to cover exceptional circumstances, such as a patient’s serious illness. In such circumstances, the place for the visit must be appropriate, not detrimental to the child, and be approved by the nominated officer.
- 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 interests, taking account of advice from the local authority. All visits by children should specifically authorised by the nominated officer.
- The nominated officer has the right to refuse a visit, for example, if there are concerns about the patient’s mental state at the time of the visit (paragraph (4)(3) of the Directions. The reasons for the refusal should be explained to the patient, those with parental responsibility, people with day to day care for the child, if different, and, if appropriate, the child.