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Our analysis of the latest NHS England data shows a shocking 319 children and adolescents in England were forced to travel out of their area for mental health treatment from December 2023 to November 2024. This represents nearly one child every day.¹

These children and young people (under 18s) spent a total of 35,845 days away from their local area, also known as inappropriate Out of Area Placement (OAP)² bed days, as a result of beds being unavailable in their local area.

To mark Children’s Mental Health Week, the 免费黑料网 is calling on the UK Government to set a target date to end OAPs in child and adolescent mental health services (CAMHS) across England.

Extremely vulnerable children and young people with serious mental illnesses, such as eating disorders, self-harm and psychosis, are being treated miles away from their loved ones and support networks, as a result of inappropriate OAPs. With family and friends having to travel so far, visiting often becomes impossible, which only leaves unwell children feeling more isolated, lonely and can be harmful to their recovery.

Lengthy out of area inpatient stays can also be detrimental to their education during a critical time of development. When a child or adolescent is treated as an inpatient in local CAMHS services, stays tend to be shorter.

With so few specialist CAMHS beds available and services overstretched, many children are being treated in paediatric wards, without access to specialist mental health services during their stay, or even after discharge. These environments can feel overwhelming, particularly for those with neurodevelopmental conditions such as autism.

In addition to setting a target to end the use of OAPs for children, RCPsych is calling for increased availability of NHS CAMHS beds in areas where there is the greatest need. This can be achieved through the intelligent commissioning of beds in areas with persistently high occupancy rates, using models like provider collaboratives.

We must develop community-based intensive treatment teams, in parallel with greater bed provision, to ensure patients are only admitted when there is a clinical need and not due to a lack of local community services.

Dr Guy Northover, Deputy Chair of the 免费黑料网’ Child and Adolescent Faculty, said:

“It is unacceptable that sick and extremely vulnerable children and young people with mental illness are still being sent miles away from their family and friends, sometimes for months on end, simply because they need treatment that is either not available as community care or within a local inpatient setting. Although we know that some improvements have been made compared to last year these figures are still unacceptably high. One child being sent away from home almost every day is simply unacceptable.

“At a time when these children are having to cope with a mental illness, the last thing they need is to be left isolated, lonely and unsupported. It is also counterproductive as it will take longer for them to recover, lengthening their stay out of area and putting more pressure on overstretched services.

“This practice can also put parents and carers under immense pressure when they will already be overwhelmed with worry.”

Rachel Bannister’s 15-year-old daughter was diagnosed with an eating disorder in 2014. She was sent to several hospitals far from the family home in Nottingham, including one in Scotland, hundreds of miles away. She was there for six months, including over Christmas.

Rachel said:

“The whole family were devastated when she went away. I felt as if my heart had been ripped out and I had failed her. We are all still processing the trauma of it all many years later.

“During her time away, our telephone conversations revealed her longing for simple gestures such as a hug or a walk in the park. It was heart-wrenching for us to be unable to fulfil those basic needs.

“The lack of consistency in her care and treatment have hugely impacted her recovery. Additionally, it has been difficult and often impossible to involve wider family members or her social network in treatment, which I believe is fundamental to recovery.

“Years later, the challenges persist. It is essential to move away from inappropriate and distressing placements and instead embrace compassionate approaches within communities. This would enable children and young people to maintain their friendships and support networks, which are crucial for their long-term recovery.”

Support for children and young people

We're working with the on a project aimed at addressing inappropriate out of area placements for children and young people and working age adults. The project will develop a policy report and a practical toolkit for the members of both organisations to assist them with efforts to reduce inappropriate OAPs.

This work, due to be published in the spring, is being informed by roundtables of senior healthcare leaders and those with lived experience, plus case study interviews.

References

1. RCPsych analysis of , 2023-2024, on inappropriate out of area placements for patients under 18 years of age.

   • 319 new inappropriate OAPs for children and young people aged 0 to 17 years were recorded in the year to November 2024, almost one new placement every day.

   • 79 children under the age of 18 were still in inappropriate OAPs at the end of November 2024, as a result of a bed being unavailable in their local area.

   • There were 35,845 inappropriate OAP bed days for children and young people from 1 December 2023 to 30 November 2024 – a decrease of 15.8% from 42,573 in 2022/23 and equating to 6.8% of inappropriate OAP bed days across all ages.

2. An inappropriate out of area placement (OAP) for acute Child and Adolescent Mental Health Services (CAMHS) inpatient care can be defined as when a child or young person with assessed acute mental health needs, who requires mental health acute inpatient care, is admitted to a unit that does not form part of their local community mental health service.