Visits to Psychiatric Wards and Facilities by Children
This chapter was added in June 2022.
Visits by children to psychiatric wards or hospitals should be undertaken to maintain a positive relationship for the child with the patient, who will usually be their parent or more rarely a family member such as a sibling. A visit by a child should only take place if it is in the child's best interest and this must remain paramount and take precedence over the interests of the adults involved when decisions are made about whether visits are appropriate. Any risks to the child should be identified and managed. These may be from the patient or from the environment in which visiting will take place.
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.
This guidance applies to children visiting all patients receiving in-patient treatment and care from specialist psychiatric services, whether or not they are detained under the Mental Health Act 1998.
2. Visiting Patients in Manannan Court
There is a Standard Operational Procedure (SOP) in place for children and young people who visit Manannan Court. The purpose of the SOP is to provide instruction and assign responsibility for the visiting of children and young people. The SOP applies to all areas where children and young people can visit relatives who are inpatients and is intended for all staff responsible for clinical and non-clinical areas.
The revised Mental Health Act 1998 Code of Practice 2011 states under paragraph 26.3 that ‘hospitals should have written policies on the arrangements about the visiting of patients by children, which should be drawn up in consultation with Social Services (Manx Care). A visit by a child should only take place following a decision that such a visit would be in the child’s best interest. Decisions to allow such visits should be regularly reviewed’ It also states under paragraph 26.4 that ‘facilities provided for visitors should be comfortable and welcoming, and for children, child-friendly’.
On admission to Manannan Court staff should establish if patients have children or siblings that are under 18 years of age and should confirm their ages, whether other agencies are involved with the family and who has parental responsibility for the children.
The above should be recorded within the patient’s electronic records and consideration given as to which agencies need to be aware of the patient’s admission.
A visit with a child can be positive, not only for maintaining family relationships but for promoting emotional wellbeing for all concerned. However, a visit with a child should only take place after a multi-disciplinary discussion to ascertain the appropriateness of contact, to identify any concerns and assess any risks of harm to the child. The discussion and outcomes should be clearly recorded on the electronic record for the patient.
Information about visiting should be explained to children and young people in a way that they are able to understand.
When children visit adult patients, Manannan Court should:
- Place child welfare at the heart of professional practice for all staff involved in the assessment, treatment and care of patients;
- Prioritise the needs and wishes of children which could include a telephone call;
- If it is not within the child’s best interests to make a physical visit then an alternative policy
- If required explain about what Manannan Court provides for patients and answer questions the child may have to alleviate their concerns when visiting;
- 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 way;
- 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 the child;
- Ensures the child's welfare is safeguarded.
- Set and maintain standards for the provision of facilities for child visiting;
- Ensure that staff are competent to manage the process of child visits.
The best interests and safety of the children and young people concerned should always be considered and that visits by children and young people are not allowed if visiting a patient is not in their best interests.
Any risks to the child should be identified and managed. These may be from the patient or from the environment in which visiting will take place.
If an emergency situation arises during a visit and the child is in immediate danger the police should be called.
On the Isle of Man, an Approved Social Worker (ASW) is a professional who has been approved to carry out certain duties under the Mental Health Act 1998. They are responsible for co-ordinating assessment and admission to hospital if an individual requires this due to their mental health needs. Central to the role of the ASW is the ability to make sound legal decisions around the use of compulsory powers in a way that is both lawful and promotes the autonomy of the individual, while safeguarding the person, the family and the wider public.
When a compulsory admission is planned for an adult who is a parent, the ASW should give consideration to the needs of children in the household, their planned immediate care arrangements, and the suitability of them if their parent is being admitted into Manannan Court. If there are concerns about the safety or care arrangements of the child/ren, the ASW should make a referral to the Initial Response Team, Children and Families Division. (see Referrals Procedure)
The ASW should inform Manannan Court that a referral has been made to Children and Families Division and whether the child/children are already known to that service. If the child has an allocated social worker, then their details should be provided.
The views of those with parental responsibility regarding their child/children visiting Manannan Court must be sought and clearly recorded on the patient’s electronic file.
Expected visit by a child
There is a duty of care towards patients, visitors and staff therefore, the ward/clinical environment and population at the time of the requested visit must be considered including:
- Mental state and behaviour of the patient being visited as this could potentially have a significant impact on the child;
- General level of ward disturbance;
- Staffing levels and numbers of patients on observations;
- Other patients who may distress or pose a risk to a child, for example sex offenders, violent individuals and patients with distressing symptoms.
All visits must be prearranged with the ward manager/nurse in charge and should take place in the reception or communal area of Manannan Court. Visits of children to the clinical ward must only occur in exceptional circumstances and arrangements will be made for the visit to take place in the multipurpose room outside of the ward area.
When a visit by a child is expected, the ward manager/nurse in charge should consider the available information about the child. The assessment of the patient’s risk and need for treatment and care. The current state of the patient’s mental health should be fully considered before the decision is made as to whether the visit can proceed.
Risk assessments regarding contact with children should be fully completed by the ward manager/nurse in charge and stored on the patient’s electronic file prior to any contact between the patient and a child. Specific consideration should be given, but not limited to:
- The age, development and overall needs of the child;
- The wishes of the child
- The response of the child to the parent;
- The relationship between the parent and child – it is anticipated that patients will only receive visits from children whom they have a close relationship with;
- Level of understanding of the situation;
- Patient’s history and family situation;
- Views of those with parental responsibility;
- The mental state and behaviour of the person being visited;
- Staffing levels
- Any conditions regarding contact, for example restrictions due to risks posed by the patient to the child;
- Other patients on the ward who may pose a risk and cause distress.
The ward manager/nurse in charge must make their decision about contact on the basis of the interests and safety of the child.
Unexpected visit by a child
If a child visits unexpectedly, the ward manager/nurse in charge is responsible for deciding whether it is feasible, whilst they wait, to consider all of the available information about the child (as outlined in Pre-visit Arrangements), alongside the assessment of the patient's needs for treatment and care and an assessment of the current state of the patient's mental health. The ward manager/nurse in charge should then make the decision in consultation with other members of the multi-disciplinary hospital team. If this is not feasible, the visit must be refused.
Patients admitted informally Most patients are admitted informally. 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 an appointed children's social worker or adult mental health support worker already working with the patient, nursing staff should check with the social worker / support worker about the desirability of children visiting and the arrangements which have been made. Such discussions should be clearly documented.
If there are concerns about the safety or care arrangements of the child/ren (see Identifying concerns below, and there is no social worker involved from the Children and Families Division, the ward manager/nurse in charge should make a referral to the initial Response Team, (see Referrals Procedure)
The ward manager/nurse in charge is responsible for the decision to allow a visit by a child, and must follow the same decision making process for informal admissions and for compulsory admission (see Expected visit by a child above).
In the vast majority of cases where no concerns have been identified, arrangements should be made to support the patient and child and to facilitate contact.
Concerns about the desirability of a child visiting may arise in a number of areas. These could relate to:
- Consideration of the child's best interests;
- The pre-existing relationship between the patient and the child;
- The patient's history and family situation;
- The patient's current mental state (which may differ from an assessment made immediately prior to or on admission);
- The response by the child to the patient's illness;
- The wishes and feelings of the child;
- The developmental age and emotional needs of the child;
- The views of those with parental responsibility;
- The nature of the service and the patient population as a whole;
- Availability of a suitable environment for contact.
A range of options may present themselves when concerns are identified in any of the areas above, and the concerns need not automatically result in a refusal of visiting. The hospital multi-disciplinary team must obtain a balance between the management of risk of harm (which will be identified within the risk assessment) and the interests of the child/ren and patients.
Research in the UK has highlighted the dangers of loss of contact with children for people who are psychiatric in-patients in hospital.
Decisions to refuse a child's visits
The ward manager/nurse in charge may refuse to allow a child to visit if they have reason to believe it is not in the best interest of the child or patient.
Decisions to refuse or suspend visits should be confirmed in writing as well as verbally and should be supported by clear evidence of concerns, such as the outcome of the risk assessment.
The in-patient multi-disciplinary team should agree how decisions are communicated to the patient, child and those with parental responsibility. If the child is an open case to the Division of Children and Families, they should be informed of the reason to refuse or suspend a visit.
The standard operational procedure for children visiting Manannan Court should clearly set out the steps to be taken in making the decision to refuse visiting, including the process for:
- Consulting with the patient, the child (depending on age and understanding), those with parental responsibility and, if different, person/s with day to day care for the child, advocates and, where relevant, Children and Families Division;
- Communicating the decision to the patient, other family members, the child and those with parental responsibility;
- Reviewing any decision and the means of communicating this to the patient, advocate or other person or agency involved in the decision;
- Enabling a patient and others with parental responsibility to make representation against any decision not to visit, including access to assistance and independent advocacy. Such a system should be consistent with the complaints procedure.
Manannan Court should ensure that the facilities for all patients to have contact with their children in a venue which is conducive to the child's safety and good quality contact for both child and patient.
Children should have appropriate supervision according to their age and need when they are visiting mental health service users. They should normally be accompanied by someone who has parental responsibility for their care and wellbeing.
3. Visiting Patients in the High Security Psychiatric Services: Ashworth, Broadmoor and Rampton based in the UK
Children visiting a High Secure hospitals must adhere to their policies and procedures that have been developed specifically for that service. Decisions about whether to permit a child from the Isle of Man to visit a unit in the UK. Services on the Isle of Man will risk assess if the need arises.