Barnardo’s set out to learn from the experiences of young people who have been discharged from Child and Adolescent Mental Health Services (CAMHS) Tier 4 units. The aim was to enable young people’s voices to influence emerging and ongoing service developments in local authorities and Integrated Care Systems areas particularly in England, where we had observed of growing demand for services for young people being discharged from Tier 4 units through contact with commissioners and partner agencies.
We carried out and analysed semi-structed interviews with six young people and equivalent questionnaire responses from one young person. All seven young people had recent experiences of leaving a Tier 4 unit. Our analysis led to four key findings as follows:
- Young people asked for discharge planning to start as soon as possible after their admission to a Tier 4 unit and for the process to be transparent, so that they are involved in and understand all discharge planning and decisions. Unfortunately, most of the discharges experienced by this group of young people were lacking in these areas and young people reported much increased anxiety, fear and a sense of a lack of care, as a direct result.
- Young people wanted discharge planning to include identifying trusted adults to create support networks for when they leave the unit. Their support networks might include family, caregivers and professionals with whom they have built a strong relationship, and these people could also act as advocates. Young people reported that their personal contacts in their support networks need emotional and practical support, advice and guidance to play a positive role in their recovery after leaving the unit.
- For the most part, young people did not feel listened to when they tried to communicate what aftercare services and support would help them. Young people told us that the crisis, community and aftercare services offered were inadequate and unavailable at key times, creating a sudden drop-off immediately after discharge, often leaving young people feeling isolated and unsupported when they were most concerned about their mental health. Young people want access to aftercare services which are more individualised with professionals they know and trust and this should include access to mental health specialists which meet their specific needs.
- Young people found the experience of Tier 4 to be traumatic and wanted to be able to look forward to positive futures whilst on the unit. Young people, their families and care givers need help with recovering from that trauma and moving on, including support with the impact on family relationships, the loss of peer and social networks, reengaging in activities, jobs and/ or education and feeling able to talk about what they have been through. Young people’s recovery benefited from opportunities and support to reclaim their voice and sense of autonomy.
Our recommendations aim to identify areas for improvements in discharge planning and aftercare services based on our findings and the analysis of the themes that informed those findings.