Tag Archives: Case

Yemen’s cholera outbreak now the worst in history as millionth case looms

The cholera epidemic in Yemen has become the largest and fastest-spreading outbreak of the disease in modern history, with a million cases expected by the end of the year and at least 600,000 children likely to be affected.

The World Health Organization has reported more than 815,000 suspected cases of the disease in Yemen and 2,156 deaths. About 4,000 suspected cases are being reported daily, more than half of which are among children under five, who account for a quarter of all cases.

The spread of the outbreak, which has quickly surpassed Haiti as the biggest since modern records began in 1949, has been exacerbated by hunger and malnutrition. While there were 815,000 cases of cholera in Haiti between 2010 and 2017, Yemen has exceeded that number in just six months.

Save the Children has warned that, at the current rate of infection, the number of cases will reach seven figures before the turn of the year, 60% of which will be among children. In July, the International Committee of the Red Cross predicted there would be 600,000 suspected cholera cases in the country by the end of the year.

Tamer Kirolos, Save the Children’s country director for Yemen, said an outbreak of this scale and speed is “what you get when a country is brought to its knees by conflict, when a healthcare system is on the brink of collapse, when its children are starving, and when its people are blocked from getting the medical treatment they need”.

Kirolos said: “There’s no doubt this is a man-made crisis. Cholera only rears its head when there’s a complete and total breakdown in sanitation. All parties to the conflict must take responsibility for the health emergency we find ourselves in.”

More than two years of fighting between the Saudi-led coalition and Houthi rebels has crippled the country, causing widespread internal displacement, the collapse of the public health system, and leaving millions on the brink of famine.


When I see a mother lose her baby because of cholera, it makes me so angry

Dr Mariam Aldogani, Save the Children

The crisis was exacerbated when sanitation workers whose salaries had gone unpaid went on strike. This meant garbage was left on the streets, which was then washed into the water supply. It is estimated that 19.3 million Yemenis – more than two-thirds of the population – do not have access to clean water and sanitation.

The government stopped funding the public health department in 2016, meaning many doctors and hospital staff have not received salaries for more than a year. Healthcare has since been provided mainly by international organisations, the efforts of whom have been hampered by the conflict.

The spread of the disease has nonetheless slowed. At the beginning of the most recent outbreak, in May this year, between 5,000 and 6,000 new cases were detected daily. That rate has since dropped to just under 4,000 a day. The mortality rate has also declined, from 1% at the beginning of the outbreak to 0.26% now.

“Whatever decline we’re seeing now is due to the heroic efforts of workers at the scene,” said Sherin Varkey, the officiating representative of Unicef Yemen.

Varkey said the situation would not be solved until there was peace in the country.

“There are no signals that give us any reason for optimism. We know that both parties to the conflict are continuing with their blatant disregard of the rights of children,” he said. “We’re at a cliff and we’re staring down and it is bottomless. There seems to be no hope.”

A worker is pictured in a government hospital’s drug store in Sana’a, Yemen


A worker is seen at a government hospital’s drug store in Sana’a, Yemen. Photograph: Khaled Abdullah/Reuters

Cholera should be easily treatable with oral rehydration salts and access to clean water. But Mariam Aldogani, Save the Children’s health adviser for the city of Hodeidah, said conditions in the country had made this very difficult.

Aldogani said: “All the NGOs are trying to increase the knowledge of how to prevent the disease, because it’s preventable, you have to boil the water. But if you don’t have money to buy gas, and you have to walk a long way to get the wood, how can you boil the water?”

Aldogani, who has been a doctor since 2010, said witnessing the suffering of her patients was deeply painful. “I saw one young man, he had cholera and severe dehydration. He was in a coma and he died in front of his mother. We tried our best, but he came too late and she was crying, and I cried. It makes me angry. When I see a mother lose her baby, especially a stillbirth, she waits for this baby for a long time and then she loses it because of cholera, it makes me so angry.

“The war is a big problem for us, it’s a wound. But with the cholera, you have the wound and you put salt in the wound. It hurts. I hope this war can be stopped. We need peace for the children of Yemen. Our situation before the war was not good, but it was not like this.”

Noel Conway’s case illustrates the difference between living and surviving | Letters

Noel Conway’s plight is desperately moving, and he argues his case with great lucidity (Terminally ill man loses high court fight for help to end life, 6 October). By contrast we hear from Not Dead Yet UK that what is needed is “a proper discussion on ensuring proper palliative care is provided for the terminally ill”.

Yet again the argument is trotted out that with proper palliative care Mr Conway and patients like him will no longer want to have control over the time and circumstances of their death.

This is wrong on two counts.

First, as a retired GP with 33 years’ experience I saw that no matter how solicitous, expert and comprehensive palliative care was, it could not always ensure a “good death”. Second, even if Mr Conway could be guaranteed a good death, he would still be denied the control over it that he seeks.

Other countries seem perfectly able to legislate to provide this basic human right to have a say over one’s own death, while protecting the vulnerable in society, and it’s high time the UK woke up to this.
Dr Philip Cuttell
London

Fay Schopen makes the point that “quality of life should underpin any and all medical research. For what is the point of simply surviving – not living – if your existence is a painful, feeble and miserable one?” (Cancer patients need more than survival, 6 October). This is the very point that those like Noel Conway, who know they are facing a traumatic, painful and long-drawn-out death, are trying to make; it is a truly nightmare situation to find oneself in. Yet judges continue steadfast in their resistance to offering such people a compassionate solution. Those of us trying to get the law changed do recognise the potential risks for abuse, but safeguards can be robust. With the best will and the best resources available – which are by no means universal – palliative care can only do so much; it is certainly not enough.
Dr Brigid Purcell
Norwich

I am in my 90th year and frequently worry when I read of research that shows more and more people are living to 100. They suggest we are all going to say “hurrah”. I would like to hear from all these 100-year-olds. Is the extended life they have been given a “quality of life worth living”? The “quality of life” should indeed be the key to all medical research.
Joan Carter
Torrington, Devon

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Noel Conway’s case illustrates the difference between living and surviving | Letters

Noel Conway’s plight is desperately moving, and he argues his case with great lucidity (Terminally ill man loses high court fight for help to end life, 6 October). By contrast we hear from Not Dead Yet UK that what is needed is “a proper discussion on ensuring proper palliative care is provided for the terminally ill”.

Yet again the argument is trotted out that with proper palliative care Mr Conway and patients like him will no longer want to have control over the time and circumstances of their death.

This is wrong on two counts.

First, as a retired GP with 33 years’ experience I saw that no matter how solicitous, expert and comprehensive palliative care was, it could not always ensure a “good death”. Second, even if Mr Conway could be guaranteed a good death, he would still be denied the control over it that he seeks.

Other countries seem perfectly able to legislate to provide this basic human right to have a say over one’s own death, while protecting the vulnerable in society, and it’s high time the UK woke up to this.
Dr Philip Cuttell
London

Fay Schopen makes the point that “quality of life should underpin any and all medical research. For what is the point of simply surviving – not living – if your existence is a painful, feeble and miserable one?” (Cancer patients need more than survival, 6 October). This is the very point that those like Noel Conway, who know they are facing a traumatic, painful and long-drawn-out death, are trying to make; it is a truly nightmare situation to find oneself in. Yet judges continue steadfast in their resistance to offering such people a compassionate solution. Those of us trying to get the law changed do recognise the potential risks for abuse, but safeguards can be robust. With the best will and the best resources available – which are by no means universal – palliative care can only do so much; it is certainly not enough.
Dr Brigid Purcell
Norwich

I am in my 90th year and frequently worry when I read of research that shows more and more people are living to 100. They suggest we are all going to say “hurrah”. I would like to hear from all these 100-year-olds. Is the extended life they have been given a “quality of life worth living”? The “quality of life” should indeed be the key to all medical research.
Joan Carter
Torrington, Devon

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Noel Conway’s case illustrates the difference between living and surviving | Letters

Noel Conway’s plight is desperately moving, and he argues his case with great lucidity (Terminally ill man loses high court fight for help to end life, 6 October). By contrast we hear from Not Dead Yet UK that what is needed is “a proper discussion on ensuring proper palliative care is provided for the terminally ill”.

Yet again the argument is trotted out that with proper palliative care Mr Conway and patients like him will no longer want to have control over the time and circumstances of their death.

This is wrong on two counts.

First, as a retired GP with 33 years’ experience I saw that no matter how solicitous, expert and comprehensive palliative care was, it could not always ensure a “good death”. Second, even if Mr Conway could be guaranteed a good death, he would still be denied the control over it that he seeks.

Other countries seem perfectly able to legislate to provide this basic human right to have a say over one’s own death, while protecting the vulnerable in society, and it’s high time the UK woke up to this.
Dr Philip Cuttell
London

Fay Schopen makes the point that “quality of life should underpin any and all medical research. For what is the point of simply surviving – not living – if your existence is a painful, feeble and miserable one?” (Cancer patients need more than survival, 6 October). This is the very point that those like Noel Conway, who know they are facing a traumatic, painful and long-drawn-out death, are trying to make; it is a truly nightmare situation to find oneself in. Yet judges continue steadfast in their resistance to offering such people a compassionate solution. Those of us trying to get the law changed do recognise the potential risks for abuse, but safeguards can be robust. With the best will and the best resources available – which are by no means universal – palliative care can only do so much; it is certainly not enough.
Dr Brigid Purcell
Norwich

I am in my 90th year and frequently worry when I read of research that shows more and more people are living to 100. They suggest we are all going to say “hurrah”. I would like to hear from all these 100-year-olds. Is the extended life they have been given a “quality of life worth living”? The “quality of life” should indeed be the key to all medical research.
Joan Carter
Torrington, Devon

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Noel Conway’s case illustrates the difference between living and surviving | Letters

Noel Conway’s plight is desperately moving, and he argues his case with great lucidity (Terminally ill man loses high court fight for help to end life, 6 October). By contrast we hear from Not Dead Yet UK that what is needed is “a proper discussion on ensuring proper palliative care is provided for the terminally ill”.

Yet again the argument is trotted out that with proper palliative care Mr Conway and patients like him will no longer want to have control over the time and circumstances of their death.

This is wrong on two counts.

First, as a retired GP with 33 years’ experience I saw that no matter how solicitous, expert and comprehensive palliative care was, it could not always ensure a “good death”. Second, even if Mr Conway could be guaranteed a good death, he would still be denied the control over it that he seeks.

Other countries seem perfectly able to legislate to provide this basic human right to have a say over one’s own death, while protecting the vulnerable in society, and it’s high time the UK woke up to this.
Dr Philip Cuttell
London

Fay Schopen makes the point that “quality of life should underpin any and all medical research. For what is the point of simply surviving – not living – if your existence is a painful, feeble and miserable one?” (Cancer patients need more than survival, 6 October). This is the very point that those like Noel Conway, who know they are facing a traumatic, painful and long-drawn-out death, are trying to make; it is a truly nightmare situation to find oneself in. Yet judges continue steadfast in their resistance to offering such people a compassionate solution. Those of us trying to get the law changed do recognise the potential risks for abuse, but safeguards can be robust. With the best will and the best resources available – which are by no means universal – palliative care can only do so much; it is certainly not enough.
Dr Brigid Purcell
Norwich

I am in my 90th year and frequently worry when I read of research that shows more and more people are living to 100. They suggest we are all going to say “hurrah”. I would like to hear from all these 100-year-olds. Is the extended life they have been given a “quality of life worth living”? The “quality of life” should indeed be the key to all medical research.
Joan Carter
Torrington, Devon

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Noel Conway’s case illustrates the difference between living and surviving | Letters

Noel Conway’s plight is desperately moving, and he argues his case with great lucidity (Terminally ill man loses high court fight for help to end life, 6 October). By contrast we hear from Not Dead Yet UK that what is needed is “a proper discussion on ensuring proper palliative care is provided for the terminally ill”.

Yet again the argument is trotted out that with proper palliative care Mr Conway and patients like him will no longer want to have control over the time and circumstances of their death.

This is wrong on two counts.

First, as a retired GP with 33 years’ experience I saw that no matter how solicitous, expert and comprehensive palliative care was, it could not always ensure a “good death”. Second, even if Mr Conway could be guaranteed a good death, he would still be denied the control over it that he seeks.

Other countries seem perfectly able to legislate to provide this basic human right to have a say over one’s own death, while protecting the vulnerable in society, and it’s high time the UK woke up to this.
Dr Philip Cuttell
London

Fay Schopen makes the point that “quality of life should underpin any and all medical research. For what is the point of simply surviving – not living – if your existence is a painful, feeble and miserable one?” (Cancer patients need more than survival, 6 October). This is the very point that those like Noel Conway, who know they are facing a traumatic, painful and long-drawn-out death, are trying to make; it is a truly nightmare situation to find oneself in. Yet judges continue steadfast in their resistance to offering such people a compassionate solution. Those of us trying to get the law changed do recognise the potential risks for abuse, but safeguards can be robust. With the best will and the best resources available – which are by no means universal – palliative care can only do so much; it is certainly not enough.
Dr Brigid Purcell
Norwich

I am in my 90th year and frequently worry when I read of research that shows more and more people are living to 100. They suggest we are all going to say “hurrah”. I would like to hear from all these 100-year-olds. Is the extended life they have been given a “quality of life worth living”? The “quality of life” should indeed be the key to all medical research.
Joan Carter
Torrington, Devon

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

X’s case is only latest in shocking saga of children’s mental health care

Sir James Munby’s 19-page judgment on X’s situation contains many views expressed with notably more candour than appeal court judges usually deploy.

But one in particular will resonate with children with mental health problems and their families who have endured frustration, agony and even fear from experiencing the postcode lottery of trying to find what in NHS-speak is a tier 4 CAMHS bed – a place in a children and adolescent mental health services inpatient unit for an under-18 whose condition means they require round-the-clock care.

“What this case demonstrates, as if further demonstration is still required of what is a well-known scandal, is the disgraceful and utterly shaming lack of proper provision in this country of the clinical, residential and other support services so desperately needed by the increasing numbers of children and young people afflicted with the same kind of difficulties as X is burdened with. The lack of proper provision is an outrage,” he said.

The facts are as follows. There are 1,459 CAMHS beds in England, of which 124 are classed as “low secure”, the type that 17-year-old X needs to be in. Just over half are provided by the NHS, the rest by various private health firms. CAMHS beds have increased by 71% since 1999, according to research published last week by the Education Policy Institute (EPI).

Yet, with more under-18s suffering serious psychological distress, including some with psychiatric disorders, no one thinks that the 1,459 are enough. Some areas – the south-west and Yorkshire and the Humber – have particularly low numbers of beds. Suicide has replaced accidents as the biggest killer of teenagers and those aged under 25.

NHS England has promised to create 150 to 180 more tier 4 beds, which mental health bodies have welcomed. But that does not help X, or the many health professionals and social workers trying to find her a place in a unit that will be safe and, crucially, therapeutic.

However, as Munby has found: “There are, across the country, six low secure units at which X could in theory be placed – if any of them had an available bed. Absent an unexpected early discharge, however, none has an available bed for several months.” The unit deemed best for her has a six-month waiting list.

Beds do not become free often, partly because there are too few, but also because those in CAMHS low secure units tend to have conditions – such as personality disorders and suicidal thoughts – that require long-term care. For example, psychiatrists say that X needs at least 12 to 18 months of intensive residential treatment before she can even be considered for discharge.

She has had to be restrained 117 times in the last six months and has committed 102 “significant” acts of self-harm and 45 assaults on staff in that time. Her chances of recovery, and indeed of staying alive, clearly require her to be in the right place once she leaves detention on 14 August. But at the moment X’s situation looks bleak; “desperate”, says Munby. Weeks of intensive effort by Cumbria county council officials and senior NHS mental health specialists have failed to turn up a suitable bed.

Could X end up being treated on an adult ward, perhaps as a stop-gap until a low secure CAMHS bed becomes free? That should be unthinkable; seeing adults with serious mental illness can further worsen a child’s condition. But 83 under-18s were treated on adult wards for 2,700 days in all in the last quarter of 2016. The other possible alternatives, notably treatment on a paediatric or adult ward in an acute (general) hospital, would be even less appropriate – and more risky.

Inquiries by learned bodies have been highlighting the CAMHS beds shortage since 1997. Just last week the EPI revealed that the entire south of England ran out of CAMHS beds twice in April 2016, and London once in June 2016.

The failure to make more beds available is partly due to the low priority historically given to CAMHS, though that has changed in recent years. Many specialists in the field agree with the sentiment expressed by one, that “if mental health services are the NHS’s Cinderella, then CAMHS are Cinderella’s Cinderella”.

X’s plight has gained attention because a prominent judge has spoken about it in dramatic terms. But she is certainly not the first young person in an extremely vulnerable mental state to be denied potentially life-saving care because what is available is woefully inadequate to meet rising need. Sadly, she will not be the last.

Unmet need caused by patients experiencing an overloaded A&E unit, or a GP surgery where getting an appointment takes weeks, often involve relatively minor illnesses. But failure to diagnose and treat quickly someone who is mentally ill can have disastrous consequences. As Norman Lamb, who was care minister in the coalition government, points out in relation to X’s case: “This is tragically not as unusual a case as people might think. Many lives are lost due to such failures in the system.”

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

X’s case is only latest in shocking saga of children’s mental health care

Sir James Munby’s 19-page judgment on X’s situation contains many views expressed with notably more candour than appeal court judges usually deploy.

But one in particular will resonate with children with mental health problems and their families who have endured frustration, agony and even fear from experiencing the postcode lottery of trying to find what in NHS-speak is a tier 4 CAMHS bed – a place in a children and adolescent mental health services inpatient unit for an under-18 whose condition means they require round-the-clock care.

“What this case demonstrates, as if further demonstration is still required of what is a well-known scandal, is the disgraceful and utterly shaming lack of proper provision in this country of the clinical, residential and other support services so desperately needed by the increasing numbers of children and young people afflicted with the same kind of difficulties as X is burdened with. The lack of proper provision is an outrage,” he said.

The facts are as follows. There are 1,459 CAMHS beds in England, of which 124 are classed as “low secure”, the type that 17-year-old X needs to be in. Just over half are provided by the NHS, the rest by various private health firms. CAMHS beds have increased by 71% since 1999, according to research published last week by the Education Policy Institute (EPI).

Yet, with more under-18s suffering serious psychological distress, including some with psychiatric disorders, no one thinks that the 1,459 are enough. Some areas – the south-west and Yorkshire and the Humber – have particularly low numbers of beds. Suicide has replaced accidents as the biggest killer of teenagers and those aged under 25.

NHS England has promised to create 150 to 180 more tier 4 beds, which mental health bodies have welcomed. But that does not help X, or the many health professionals and social workers trying to find her a place in a unit that will be safe and, crucially, therapeutic.

However, as Munby has found: “There are, across the country, six low secure units at which X could in theory be placed – if any of them had an available bed. Absent an unexpected early discharge, however, none has an available bed for several months.” The unit deemed best for her has a six-month waiting list.

Beds do not become free often, partly because there are too few, but also because those in CAMHS low secure units tend to have conditions – such as personality disorders and suicidal thoughts – that require long-term care. For example, psychiatrists say that X needs at least 12 to 18 months of intensive residential treatment before she can even be considered for discharge.

She has had to be restrained 117 times in the last six months and has committed 102 “significant” acts of self-harm and 45 assaults on staff in that time. Her chances of recovery, and indeed of staying alive, clearly require her to be in the right place once she leaves detention on 14 August. But at the moment X’s situation looks bleak; “desperate”, says Munby. Weeks of intensive effort by Cumbria county council officials and senior NHS mental health specialists have failed to turn up a suitable bed.

Could X end up being treated on an adult ward, perhaps as a stop-gap until a low secure CAMHS bed becomes free? That should be unthinkable; seeing adults with serious mental illness can further worsen a child’s condition. But 83 under-18s were treated on adult wards for 2,700 days in all in the last quarter of 2016. The other possible alternatives, notably treatment on a paediatric or adult ward in an acute (general) hospital, would be even less appropriate – and more risky.

Inquiries by learned bodies have been highlighting the CAMHS beds shortage since 1997. Just last week the EPI revealed that the entire south of England ran out of CAMHS beds twice in April 2016, and London once in June 2016.

The failure to make more beds available is partly due to the low priority historically given to CAMHS, though that has changed in recent years. Many specialists in the field agree with the sentiment expressed by one, that “if mental health services are the NHS’s Cinderella, then CAMHS are Cinderella’s Cinderella”.

X’s plight has gained attention because a prominent judge has spoken about it in dramatic terms. But she is certainly not the first young person in an extremely vulnerable mental state to be denied potentially life-saving care because what is available is woefully inadequate to meet rising need. Sadly, she will not be the last.

Unmet need caused by patients experiencing an overloaded A&E unit, or a GP surgery where getting an appointment takes weeks, often involve relatively minor illnesses. But failure to diagnose and treat quickly someone who is mentally ill can have disastrous consequences. As Norman Lamb, who was care minister in the coalition government, points out in relation to X’s case: “This is tragically not as unusual a case as people might think. Many lives are lost due to such failures in the system.”

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

X’s case is only latest in shocking saga of children’s mental health care

Sir James Munby’s 19-page judgment on X’s situation contains many views expressed with notably more candour than appeal court judges usually deploy.

But one in particular will resonate with children with mental health problems and their families who have endured frustration, agony and even fear from experiencing the postcode lottery of trying to find what in NHS-speak is a tier 4 CAMHS bed – a place in a children and adolescent mental health services inpatient unit for an under-18 whose condition means they require round-the-clock care.

“What this case demonstrates, as if further demonstration is still required of what is a well-known scandal, is the disgraceful and utterly shaming lack of proper provision in this country of the clinical, residential and other support services so desperately needed by the increasing numbers of children and young people afflicted with the same kind of difficulties as X is burdened with. The lack of proper provision is an outrage,” he said.

The facts are as follows. There are 1,459 CAMHS beds in England, of which 124 are classed as “low secure”, the type that 17-year-old X needs to be in. Just over half are provided by the NHS, the rest by various private health firms. CAMHS beds have increased by 71% since 1999, according to research published last week by the Education Policy Institute (EPI).

Yet, with more under-18s suffering serious psychological distress, including some with psychiatric disorders, no one thinks that the 1,459 are enough. Some areas – the south-west and Yorkshire and the Humber – have particularly low numbers of beds. Suicide has replaced accidents as the biggest killer of teenagers and those aged under 25.

NHS England has promised to create 150 to 180 more tier 4 beds, which mental health bodies have welcomed. But that does not help X, or the many health professionals and social workers trying to find her a place in a unit that will be safe and, crucially, therapeutic.

However, as Munby has found: “There are, across the country, six low secure units at which X could in theory be placed – if any of them had an available bed. Absent an unexpected early discharge, however, none has an available bed for several months.” The unit deemed best for her has a six-month waiting list.

Beds do not become free often, partly because there are too few, but also because those in CAMHS low secure units tend to have conditions – such as personality disorders and suicidal thoughts – that require long-term care. For example, psychiatrists say that X needs at least 12 to 18 months of intensive residential treatment before she can even be considered for discharge.

She has had to be restrained 117 times in the last six months and has committed 102 “significant” acts of self-harm and 45 assaults on staff in that time. Her chances of recovery, and indeed of staying alive, clearly require her to be in the right place once she leaves detention on 14 August. But at the moment X’s situation looks bleak; “desperate”, says Munby. Weeks of intensive effort by Cumbria county council officials and senior NHS mental health specialists have failed to turn up a suitable bed.

Could X end up being treated on an adult ward, perhaps as a stop-gap until a low secure CAMHS bed becomes free? That should be unthinkable; seeing adults with serious mental illness can further worsen a child’s condition. But 83 under-18s were treated on adult wards for 2,700 days in all in the last quarter of 2016. The other possible alternatives, notably treatment on a paediatric or adult ward in an acute (general) hospital, would be even less appropriate – and more risky.

Inquiries by learned bodies have been highlighting the CAMHS beds shortage since 1997. Just last week the EPI revealed that the entire south of England ran out of CAMHS beds twice in April 2016, and London once in June 2016.

The failure to make more beds available is partly due to the low priority historically given to CAMHS, though that has changed in recent years. Many specialists in the field agree with the sentiment expressed by one, that “if mental health services are the NHS’s Cinderella, then CAMHS are Cinderella’s Cinderella”.

X’s plight has gained attention because a prominent judge has spoken about it in dramatic terms. But she is certainly not the first young person in an extremely vulnerable mental state to be denied potentially life-saving care because what is available is woefully inadequate to meet rising need. Sadly, she will not be the last.

Unmet need caused by patients experiencing an overloaded A&E unit, or a GP surgery where getting an appointment takes weeks, often involve relatively minor illnesses. But failure to diagnose and treat quickly someone who is mentally ill can have disastrous consequences. As Norman Lamb, who was care minister in the coalition government, points out in relation to X’s case: “This is tragically not as unusual a case as people might think. Many lives are lost due to such failures in the system.”

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

X’s case is only latest in shocking saga of children’s mental health care

Sir James Munby’s 19-page judgment on X’s situation contains many views expressed with notably more candour than appeal court judges usually deploy.

But one in particular will resonate with children with mental health problems and their families who have endured frustration, agony and even fear from experiencing the postcode lottery of trying to find what in NHS-speak is a tier 4 CAMHS bed – a place in a children and adolescent mental health services inpatient unit for an under-18 whose condition means they require round-the-clock care.

“What this case demonstrates, as if further demonstration is still required of what is a well-known scandal, is the disgraceful and utterly shaming lack of proper provision in this country of the clinical, residential and other support services so desperately needed by the increasing numbers of children and young people afflicted with the same kind of difficulties as X is burdened with. The lack of proper provision is an outrage,” he said.

The facts are as follows. There are 1,459 CAMHS beds in England, of which 124 are classed as “low secure”, the type that 17-year-old X needs to be in. Just over half are provided by the NHS, the rest by various private health firms. CAMHS beds have increased by 71% since 1999, according to research published last week by the Education Policy Institute (EPI).

Yet, with more under-18s suffering serious psychological distress, including some with psychiatric disorders, no one thinks that the 1,459 are enough. Some areas – the south-west and Yorkshire and the Humber – have particularly low numbers of beds. Suicide has replaced accidents as the biggest killer of teenagers and those aged under 25.

NHS England has promised to create 150 to 180 more tier 4 beds, which mental health bodies have welcomed. But that does not help X, or the many health professionals and social workers trying to find her a place in a unit that will be safe and, crucially, therapeutic.

However, as Munby has found: “There are, across the country, six low secure units at which X could in theory be placed – if any of them had an available bed. Absent an unexpected early discharge, however, none has an available bed for several months.” The unit deemed best for her has a six-month waiting list.

Beds do not become free often, partly because there are too few, but also because those in CAMHS low secure units tend to have conditions – such as personality disorder and suicidal thoughts – that require long-term care. For example, psychiatrists say that X needs at least 12 to 18 months of intensive residential treatment before she can even be considered for discharge.

She has had to be restrained 117 times in the last six months and has committed 102 “significant” acts of self-harm and 45 assaults on staff in that time. Her chances of recovery, and indeed of staying alive, clearly require her to be in the right place once she leaves detention on 14 August. But at the moment X’s situation looks bleak; “desperate”, says Munby. Weeks of intensive effort by Cumbria county council officials and senior NHS mental health specialists have failed to turn up a suitable bed.

Could X end up being treated on an adult ward, perhaps as a stop-gap until a low secure CAMHS bed becomes free? That should be unthinkable; seeing adults with serious mental illness can further worsen a child’s condition. But 83 under-18s were treated on adult wards for 2,700 days in all in the last quarter of 2016. The other possible alternatives, notably treatment on a paediatric or adult ward in an acute (general) hospital, would be even less appropriate – and more risky.

Inquiries by learned bodies have been highlighting the CAMHS beds shortage since 1997. Just last week the EPI revealed that the entire south of England ran out of CAMHS beds twice in April 2016, and London once in June 2016.

The failure to make more beds available is partly due to the low priority historically given to CAMHS, though that has changed in recent years. Many specialists in the field agree with the sentiment expressed by one, that “if mental health services are the NHS’s Cinderella, then CAMHS are Cinderella’s Cinderella”.

X’s plight has gained attention because a prominent judge has spoken about it in dramatic terms. But she is certainly not the first young person in an extremely vulnerable mental state to be denied potentially life-saving care because what is available is woefully inadequate to meet rising need. Sadly, she will not be the last either.

Unmet need caused by patients experiencing an overloaded A&E unit, or a GP surgery where getting an appointment takes weeks, often involve relatively minor illness. But failure to diagnose and treat quickly someone who is mentally ill can have disastrous consequences. As Norman Lamb, who was care minister in the coalition government, points out in relation to X’s case: “This is tragically not as unusual a case as people might think. Many lives are lost due to such failures in the system.”

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here