Inspectors call for safeguarding improvements at teenage mental health unit

Inspectors have asked managers at a young people’s mental health unit to improve safeguarding after some patients reported feeling “scared and unsafe” at times.

The Mental Welfare Commission for Scotland carried out a follow-up visit to the Melville Unit at the Royal Hospital for Children and Young People in Edinburgh in March, after a previous visit raised concerns around the use of restraint, particularly in relation to nasogastric tube (NGT) feeding.

They found there have been improvements since that visit in May last year, but made a number of recommendations in their report, published on Wednesday.

They latest report found that some young people in the unit had been experiencing high levels of stress and distress, which at times led to violence and aggression towards staff and, on occasion, other young people.

Some patients described feeling “scared and unsafe” at times, while some parents and carers the Commission spoke to also raised concerns about safety in the unit.

A number of them reported that their child had been subject to physical aggression from other young people or that they had witnessed staff being assaulted.

The Commission has issued a recommendation stating that managers must ensure that all safeguarding processes are consistently followed and that all available options to manage risk are considered.

This can include “proportionate and therapeutic use of restrictive interventions where necessary”, to maintain the safety of young people, staff, and others on the unit.

NHS Lothian said that the safety of its patients and staff is its “top priority”, and that it takes any concerns and recommendations “extremely seriously”.

Inspectors noted improvements at the unit and also reported positive comments from young people who described the approach from staff as “compassionate,” “empathetic,” and “positive”.

The 12-bed inpatient service is designed for 12 to 17-year-olds with mental ill health.

At the previous visit last year inspectors identified the safe and proportionate use of restraint, as a measure of last resort, as a “significant issue” in the unit, with this being particularly relevant for young people with a diagnosed eating disorder who required NGT feeding.

Inspectors said that on their visit this year the senior management team showed them a report which noted that the use of restraint had dropped by 84%.

However they said while it was “evident that the service had made progress overall”, there were situations where the application of restraint required further review to ensure that all appropriate alternatives had been explored.

They issued a recommendation calling on managers to ensure all restraint incidents are fully recorded in care records.

Jillian Torrens, services director for Royal Edinburgh Hospital and Associated Services, NHS Lothian said: “We welcome the Mental Welfare Commission’s report, which recognises the notable improvements made at the Melville Unit.

“The safety of our patients and staff is our top priority, and we take any concerns and recommendations extremely seriously.

“Mental health is complex and can at times present very specific challenges.

“We work closely with young people and their families to understand their needs and manage risk and recovery and always take prompt action to support anyone affected by challenging behaviour by providing additional care, separate safe spaces, increased staffing, one-to-one and enhanced nursing support and regular care reviews.

“We will continue to strengthen our safeguarding processes and keep patients and families informed as we work through our focussed improvement plan.”