Poor care in privately-run child and adolescent mental health units is putting vulnerable young people at risk, a Sky News investigation has found.
Patients, parents and whistleblowers have shared their experiences of privately-run facilities paid directly by the NHS to care for some of the most challenging mental health patients, including those with serious eating disorders and engaged in persistent self-harm and suicidal behaviour.
One former patient told us she had experienced “brutal” physical restraints and had been able to inflict life-threatening self-harm while in a privately-run unit.
Former staff at another facility run by the same company, until it was closed last month, described a culture of self-harm that was “out of control”.
They also alleged employees were directed to downplay serious incidents.
Sky News can also reveal that a former member of staff at a third unit, also now closed, is subject to a police investigation.
NHS England spent almost half of its specialist mental health budget buying services from privately-run care providers last year, but analysis of official inspection shows they were less likely to be highly-rated by inspectors.
Every year tens of thousands of under-18s in England are referred to Child and Adolescent Mental Health Services, known as CAMHS.
The most unwell are sent to “tier four” in-patient mental health units, many of which are privately-run but paid for by the NHS to provide specialist treatment.
Children are often placed in units many miles from home and family because of a shortage of appropriate services in their local area.
More than 1,200 under-18s are receiving inpatient treatment in tier four units according to the latest figures, three-quarters of them girls.
In 2017-18 NHS England paid private providers £156.5m for specialist mental health services, some 44% of its specialist budget.
Analysis of inspection reports for tier four units reveals that those that are privately run are less likely to be rated “good” or “outstanding” by the Care Quality Commission (CQC) than NHS units.
Inspection reports for 60 CAMHS units compiled since 2016 show that 88% of NHS-run units were rated “good” or “outstanding”, while just 58% of units runs by the largest private recipients of NHS funding were rated “good”.
No privately-run unit was rated outstanding, five were rated “inadequate”, and five have been closed since 2017.
Natasha was just 12 when she first suffered from mental health problems including an eating disorder.
She was initially not referred to CAMHS, an oversight she says made her condition worsen.
When she was finally referred, suffering from anorexia and beginning to self-harm, she was too ill for community care and was admitted to a specialist inpatient unit.
She was to spend most of the next decade in units dotted around the country, many of them privately-run, with her fees paid for by the NHS.
Natasha said: “My commissioner, who was a lovely woman, referred to me as the million dollar baby because they (private providers) made millions out of the NHS for my care.”
Her low point came in 2012 when she was admitted to a hospital in Maidenhead, run by private care provider The Huntercombe Group, where she was supposed to be under one-to-one supervision to prevent self-harm.
“I was supposed to be on one-to-one (observation) but I was left unattended.
“I’d hidden a load of razors that were supposed to be taken off of me like on my return to hospital. But they weren’t.
“I managed to cut myself probably about 36 times, probably more. And I hit arteries.”
Natasha said restraint was also routinely used: “I was subjected to very, very brutal restraints.
“They would pin you up against walls, smack your head off the wall, drag you across floors, they’d wrap you around door frames. You’d have people pretty much sat on your head, sat on your legs and these would be like big men, not just women.”
Natasha sued the hospital and was awarded significant damages for their failure to provide appropriate psychiatric treatment.
The Huntercombe Group told Sky News they apologise for the points she raised related to her care in 2012.
“We learned lessons from her experience at the time. Maidenhead hospital is rated as good by the CQC and has held that rating since the inspections ratings were introduced.”
Our investigation also raised concerns about units run by The Huntercombe Group in Devon.
Devon and Cornwall Police have told Sky News that they have opened an investigation into Watcombe Hall, a mental-health unit that closed in October 2017 after a CQC inspection rated it “inadequate”.
The investigation is understood to relate to a former employee.
The Crown Prosecution Service said: “We are in discussions with police about this investigation and are currently awaiting a full case file.”
The Huntercombe Group said: “Due to an ongoing investigation into an ex-employee we are unable to go into any detail at this time. We always do everything we can to support all relevant authorities in relation to any investigation.”
After Watcombe Hall closed The Huntercombe Group opened a similar unit in Torquay called Meadow Lodge.
Last month it also closed, and former employees have told us it was too short-staffed to adequately protect patients.
Ian Summers, an experienced mental health nurse who previously worked with the highest security patients at Broadmoor Hospital, said Meadow Lodge had a culture of self-harm among adolescent girls including the use of ligatures, a means of strangulation.
He described the kind of incident he says was common.
“I had (a patient) banging their head against the wall, another cutting herself, and another tying a ligature.
“Now I don’t have enough staff to deal with all these people so I have to risk assess who is closer to death. We all believed that someone was going to die there.”
A second former employee, healthcare assistant Chris Tremlett, echoed his account.
“Ligatures were happening daily, the same with restraints. Too much.
“We didn’t have the staff to cope with the amount going on.
“Nobody wants to find themselves holding down a child but we had to do what we were told to.”
Mr Summers says he was sacked after raising concerns that staff were being asked to downplay serious incidents to avoid having to inform the CQC, a mandatory requirement for some instances of restraint.
A CQC inspection of Meadow Lodge, carried out earlier this year, found: “Staff were not making appropriate safeguarding referrals consistently to the relevant authorities.
“Some incidents were not categorised as safeguarding that should have been and stakeholders told us that staff had not always referred some cases that they should have.”
The Huntercombe Group said in a statement: “Mr Summers raised a number of issues with regard to our service, now closed, at Meadow Lodge.
“At that time the issues raised were thoroughly investigated and we took immediate action on those that were upheld. Not all of Mr Summers concerns were found to be accurate. Separately Mr Summers was dismissed for gross misconduct.
“We closed Meadow Lodge following an NHS England review to re-organise capacity of Child and Adolescent Mental Health Services in the South region which determined that this small service was no longer needed in Devon. Our decision to close Meadow Lodge predated the CQC’s report.”
The Huntercombe Group said a funding agreement with creditors will ensure continuity of care for all residents and patients, after its parent company Four Seasons Health Care went into administration last month.
The Huntercombe Group said in a statement: “The group sale and refinancing process had no bearing on any historic decision to close services.
“We pride ourselves on the levels of care and support we offer to all of our patients and families.
“Across The Huntercombe Group we have thousands of dedicated colleagues who work tirelessly to offer a high standard of acute care in sometimes challenging circumstances.
“All of our CAMHS services are rated as good by the CQC.
“These allegations and historical incidents do not provide a true or accurate reflection of the high standard of care they provide every day.”
NHS England and the Department of Health declined Sky News’ requests for interview.
But NHS England said in a statement: “Young people and their families would where possible like specialist care closer to home and the NHS has responded with well over 100 additional tier four mental health beds opened in areas of greatest need during the last two years – and plans for another 36 beds by the summer.
“We have been quite clear that we expect all services to provide good quality and safe care and deliver on the commitments in their contracts, irrespective of whether it is NHS or independent sector led and we continue to work closely with the CQC to monitor, identify and take appropriate action wherever necessary.”