Paediatric mental health: a nurse's perspective

CCCU BSc Child Nursing alumna Kim Cunningham discusses the unique mental health care needs of children, and her experience as a hospital lead for the ‘We Can Talk’ initiative.

I studied paediatric nursing at Canterbury Christ Church University (CCCU) and during my time as a student nurse I came across lots of children and young people with mental illness admitted onto the paediatric ward. Quite often they were just there for a short time, whilst assessed and discharged back to the community. However, sometimes those with more complex mental health needs, their admission stays were for a few days and sometimes weeks, whilst awaiting an inpatient bed.

It was often noticeable how staff members on the children’s ward felt inexperienced looking after these children and young people, with the little teaching we had as student nurses, most of us felt the same.

Mental health training was minimal for pre and post graduate paediatric nurses, and paediatric wards were seen as an inappropriate place for these patients to be admitted as staff felt they did not know how to adequately care or talk to these patients. It is quite often felt that people feel they could say the wrong thing, and because they are in with mental illness, this could make them worse so choose not to say anything at all.  

Over the three years, I became more interested into looking into our services as paediatrics more, and what could be done to help change and improve these. I started by focussing my dissertation on this subject, and undertook lots of research on the appropriateness of looking after children and young people with mental illness on the children’s wards. This covered such things as safety on the unit and staff confidence and training in caring for these young people and children.  

My dissertation gave me an opportunity to explore this further so that when I finished my training I could try to implement change and develop paediatric nurses skills within my place of work to improve the experiences for both the patients and staff. Improving the skill set of paediatric nurses was of an importance as this was a re-occurring issue within the research that I did as most felt incompetent and untrained in caring for children and young people with mental health-illness.

A few years after becoming qualified and working within a general paediatric ward,  I could see that as a unit we were still struggling with child and adolescent mental health, but We Can Talk was offered to our trust and I found this a great opportunity to start to implement change!

We can Talk is a project funded by NHS England and has been developed directly in response to the views and experiences and needs of young people, an those in acute hospital settings. Healthcare professionals working in hospital settings report a lack of confidence and competency in caring for children with mental health needs, and research shows children and young people have overwhelmingly negative experiences of presenting to hospital due to their mental health. Therefore, We Can Talk has been co-produced with young people with lived experience of mental health difficulties, hospital staff and mental health professionals.

The We Can Talk family tries to ensure that every child and young person who attends A&E or other acute hospital settings, are supported by staff with the confidence and competence to support them in mental health crisis. Attendees described that We Can Talk “made an extremely difficult topic easy to discuss and empowered me to realise that we ALREADY do a lot to assist children and young people with mental health issues”.

There has also been much more positive feedback from children and young people saying they felt happy with the service from paediatric units as the staff wanted to engage with them and didn’t look at them as the ‘elephant in the room’.

The impact We Can Talk has had on acute paediatric units is brilliant. Post training surveys have revealed that:

More than four hundred acute hospital staff across seven hospital sites have attended the one day We Can Talk training with 96% reporting it would make a difference to the way they do their job.

“What I will take from this is talk and listen to young people”, "Better to say something rather than nothing."”

So far organisations involved in the project have also reported: 

• Reduction in the use of Registered Mental Health Nurses to ‘special’ Children and Young People
• Improved management of children and young people awaiting assessment
• Reduction in ‘conflict’ between wards and with local Child and Adolescent Mental Health Services (CAMHS)
• Improved quality of referrals to CAMHS

Research has also shown that if young people have better experiences in hospital when attending due to their mental health they are more able to cope on discharge and are more likely to attend follow-up appointments with community CAMHS.

This project has so far had great feedback from the clinicians on our paediatric unit, and for me, I was able to break down a very difficult barrier with a young person and enabled a conversation to happen and for her to gain trust between us. When she left she gave me a hug and said thank you for listening, and that was the best feedback I have achieved from starting this project.