The Mental Health Act Code of Practice highlights that behaviours perceived as “challenging” (including self harm) in children and young people with SEND, are often a communication of unmet need, sensory distress, or emotional overwhelm, not a sign of mental illness that requires hospitalisation.
This is why for children and young people with SEND:
There are strong preventative processes designed to step in early, coordinate services, and reduce the need for inpatient care wherever safely possible.
Two of the most important tools are:
The Dynamic Register and CETR's are a way of ensuring children and young people with unmet needs, sensory distress, or emotional overwhelm do not end up in hospital.
A Dynamic Support Register is a local health and social care list that helps identify children and young people with learning disabilities, autism, or both who may be at risk of crisis or potential admission to a mental health hospital. This includes young people whose behaviour or distress may escalate without the right help.
Every area in England keeps one. This register is used to keep track of who needs extra support, who is at growing risk, and what actions agencies must take.
A Dynamic Support Register is a local health and social care list that helps identify children and young people with learning disabilities, autism, or both who may be at risk of crisis or potential admission to a mental health hospital. This includes young people whose behaviour or distress may escalate without the right help.
Every area in England keeps one. This register is used to keep track of who needs extra support, who is at growing risk, and what actions agencies must take.
Being on the register means:
Being on the register means:
A child or young person can be added to the DSR with:
If you believe your child is at risk of crisis, you can ask your CAMHS lead professional or social worker whether they are on the register and request that they are added if they are not.
A child or young person can be added to the DSR with:
If you believe your child is at risk of crisis, you can ask your CAMHS lead professional or social worker whether they are on the register and request that they are added if they are not.
A CETR is a structured meeting that brings together:
The purpose of the meeting is to stop unnecessary admissions and ensure your child gets the right help in the community wherever possible.
A CETR is a structured meeting that brings together:
The purpose of the meeting is to stop unnecessary admissions and ensure your child gets the right help in the community wherever possible.
A CETR should take place when:
If things are deteriorating quickly a Local Area Emergency Protocol Review, also called a 'Blue Light meeting', can be used to create a rapid, temporary plan instead.
The Local Area Emergency Protocol Review is triggered when a CETR cannot take place due to not enough time, extreme risk, or the need for immediate action.
It functions as a crisis management system, aiming to identify alternative community-based care to prevent admission.
A CETR should take place when:
If things are deteriorating quickly a Local Area Emergency Protocol Review, also called a 'Blue Light meeting', can be used to create a rapid, temporary plan instead.
The Local Area Emergency Protocol Review is triggered when a CETR cannot take place due to not enough time, extreme risk, or the need for immediate action.
It functions as a crisis management system, aiming to identify alternative community-based care to prevent admission.
The panel must consider three key questions:
The panel must consider three key questions:
A CETR will help:
Every recommendation is written down, and services are expected to act on them.
A CETR will help:
Every recommendation is written down, and services are expected to act on them.
Being on the DSR leads to earlier action
The DSR flags your child as needing monitoring and possibly urgent help. It ensures your child’s situation is regularly discussed at a strategic level, not only in their usual appointments.
A CETR creates a concrete prevention plan
If risks increase, a CETR gathers everyone needed to put preventative support in place—quickly, clearly and collaboratively.
Together, these measures mean the focus is:
Being on the DSR leads to earlier action
The DSR flags your child as needing monitoring and possibly urgent help. It ensures your child’s situation is regularly discussed at a strategic level, not only in their usual appointments.
A CETR creates a concrete prevention plan
If risks increase, a CETR gathers everyone needed to put preventative support in place—quickly, clearly and collaboratively.
Together, these measures mean the focus is:
You can request:
Who to ask
If things are escalating and you are not getting a response, families can also contact the Integrated Care Board for your area.
You can request:
Who to ask
If things are escalating and you are not getting a response, families can also contact the Integrated Care Board for your area.
Children and young people with severe mental health needs may sometimes require admission to a specialist mental health hospital. This happens when community support can no longer keep a child safe or well because they are in crisis, pose a danger to themselves or others, or require urgent, 24/7 specialist care that cannot be managed in the community. It is a last resort, aimed at providing a safe environment when outpatient treatment is insufficient.
Having a child in hospital – or preparing for them to be admitted – can bring up a lot of emotions. You might feel extremely worried or distressed, but you may also feel some relief knowing they’re in the right place to get the care they need. Whatever you’re experiencing, it’s important to remember that for many young people, spending time in hospital is an important part of their recovery.
Hospitals can be busy places, and it’s normal to feel overwhelmed by the environment and the number of professionals involved in your child’s care. This information aims to answer common questions about what to expect on the ward, where to find guidance, how to raise concerns, and how you can continue to support your child during their stay.
Informal (Voluntary) Admission
A child/young person can be admitted voluntarily to a mental health hospital if give consent. A young person can consent to being admitted if:
Gillick Competence means that the child or young person under 16 years old has enough intelligence, competence and understanding to fully appreciate what's involved in their treatment so can can consent to it.
More information on voluntary admission from Mind
Sectioned (Detained) Under the Mental Health Act
This happens when a young person cannot be kept safe otherwise. The two main sections are:
A specially trained professional (an AMHP) and two doctors must agree on the decision. Parents may have rights as the “nearest relative”, including the power to object to some sections.
Informal (Voluntary) Admission
A child/young person can be admitted voluntarily to a mental health hospital if give consent. A young person can consent to being admitted if:
Gillick Competence means that the child or young person under 16 years old has enough intelligence, competence and understanding to fully appreciate what's involved in their treatment so can can consent to it.
More information on voluntary admission from Mind
Sectioned (Detained) Under the Mental Health Act
This happens when a young person cannot be kept safe otherwise. The two main sections are:
A specially trained professional (an AMHP) and two doctors must agree on the decision. Parents may have rights as the “nearest relative”, including the power to object to some sections.
Young people are usually admitted to an Assessment and Treatment Unit (ATU) or occasionally a A Psychiatric Intensive Care Unit (PICU) if there is very high risk.
Assessment and Treatment Units (ATU) are specialist inpatient units designed to assess and treat autistic people, learning disabled people and people with mental health challenges.
A Psychiatric Intensive Care Unit (PICU) is a secure, locked, high-staffed, and often single-sex ward that provides short-term, intensive care for individuals (usually adults aged 18-65) in the most acute, disturbed phase of a mental illness. These units focus on stabilizing severe symptoms like extreme aggression, risk of self-harm, or suicide, aiming for a quick, safe, and positive transition to less restrictive care.
The first days in both a ATU or PICU usually include:
Families should receive:
Young people have the right to an Independent Mental Health Advocate (IMHA) if they are detained.
Young people are usually admitted to an Assessment and Treatment Unit (ATU) or occasionally a A Psychiatric Intensive Care Unit (PICU) if there is very high risk.
Assessment and Treatment Units (ATU) are specialist inpatient units designed to assess and treat autistic people, learning disabled people and people with mental health challenges.
A Psychiatric Intensive Care Unit (PICU) is a secure, locked, high-staffed, and often single-sex ward that provides short-term, intensive care for individuals (usually adults aged 18-65) in the most acute, disturbed phase of a mental illness. These units focus on stabilizing severe symptoms like extreme aggression, risk of self-harm, or suicide, aiming for a quick, safe, and positive transition to less restrictive care.
The first days in both a ATU or PICU usually include:
Families should receive:
Young people have the right to an Independent Mental Health Advocate (IMHA) if they are detained.
Young people admitted to hospital—voluntarily or under section—have the right to:
Parents with parental responsibility have rights to be involved unless a competent young person refuses information sharing and there is no safeguarding risk.
Young people admitted to hospital—voluntarily or under section—have the right to:
Parents with parental responsibility have rights to be involved unless a competent young person refuses information sharing and there is no safeguarding risk.
Welcome Meeting
Within the first week there will be an introduction to the team and a care plan will be created or updated if one already exists.
CETR (Care, Education and Treatment Review)
CPA (Care Programme Approach) Meetings
This meeting coordinates care, risk and discharge planning. It will be held at least every 6 months.
Welcome Meeting
Within the first week there will be an introduction to the team and a care plan will be created or updated if one already exists.
CETR (Care, Education and Treatment Review)
CPA (Care Programme Approach) Meetings
This meeting coordinates care, risk and discharge planning. It will be held at least every 6 months.
Young people may access:
Stopping Over Medication of People (STOMP) is a plan from the NHS to help stop people with a learning disability or autistic people being given too much medicine, or the wrong kind of medicine, for behaviour or mental health. It tries to make sure people only get medicine when they really need it.
Supporting Treatment and Appropriate Medication in Paediatrics (STAMP) is a similar plan for children and young people. It makes sure autistic children and those with a learning disability get the right medicine, in the right amount, and only for as short a time as needed.
Young people may access:
Stopping Over Medication of People (STOMP) is a plan from the NHS to help stop people with a learning disability or autistic people being given too much medicine, or the wrong kind of medicine, for behaviour or mental health. It tries to make sure people only get medicine when they really need it.
Supporting Treatment and Appropriate Medication in Paediatrics (STAMP) is a similar plan for children and young people. It makes sure autistic children and those with a learning disability get the right medicine, in the right amount, and only for as short a time as needed.
Sometimes, for safety, staff may use:
These must be:
Families should be involved in developing Positive Behaviour Support Plans to reduce the need for restrictive practices.
Sometimes, for safety, staff may use:
These must be:
Families should be involved in developing Positive Behaviour Support Plans to reduce the need for restrictive practices.
Discharge planning starts early. If your child was detained under certain sections (e.g., Section 3), they are legally entitled to free Section 117 aftercare, which may include:
Young people should not be discharged until:
Discharge planning starts early. If your child was detained under certain sections (e.g., Section 3), they are legally entitled to free Section 117 aftercare, which may include:
Young people should not be discharged until:
Start by raising concerns informally with the ward. You can then:
Families are encouraged to keep written records of concerns.
Downloadable Carer’s Monitoring Form
Start by raising concerns informally with the ward. You can then:
Families are encouraged to keep written records of concerns.
Downloadable Carer’s Monitoring Form