At Christmas, children’s wards and hospitals are inundated with gifts—from the public, community organisations, and private companies. Yet, some children who are in hospital over Christmas, are not in children’s wards or children’s hospitals, but in child and adolescent mental health services (CAMHS) inpatient units. They are often admitted far from home, and sometimes detained in hospital under a section of the Mental Health Act for their own safety or wellbeing. Some are just too unwell to be allowed home over Christmas, and need intensive support from CAMHS staff. The festive period can be particularly difficult for some children in mental health units—eating disorders can worsen given the association of Christmas with food, and for those without stable family relationships, the emphasis on family at this time of year can be a cause of distress.
CAMHS units rarely receive donations of Christmas gifts; and if they do, it’s a tiny proportion of those received by children’s wards in acute hospitals.
I first wondered about this discrepancy after I spent two Christmases as a junior doctor in different children’s hospitals, and saw the enormous amounts of gifts donated. One hospital still had leftover gifts in June! (They were used for inpatients’ birthdays.) Yet the following year, working in an adolescent mental health unit, I found myself wondering where the donated gifts were. I realised there weren’t going to be any. I saw the occupational therapists concerted efforts to spend the unit’s allocated £10 per child, from the therapeutic activity/OT budget, on suitable presents for each inpatient, knowing how unlikely it was that acute children’s wards would have to do that. I was frustrated at what felt like public neglect of my adolescent inpatients, and raised it on social media, asking what were the reasons for this contrast with medical wards. To my surprise, it struck a chord with others, many of whom had never realised that children were inpatients in CAMHS over Christmas.
The disparity in the number of gifts received may simply be due to a lack of awareness that children are in mental health units over Christmas. This is despite the fact that young people’s mental health and insufficient provision of services and rising demand have been highlighted in the media. Perhaps it is because this coverage largely focuses on milder, more easily understood conditions, like stress and anxiety, or bullying and exam worries, and neglects the more severe issues of self-harm, suicide attempts, or young people who have experienced trauma, or who have psychosis.
Despite this increased media coverage, little reference is made to young people in mental health units. We are used to seeing images of children in hospital undergoing gruelling treatment, or with visible disabilities used in media appeals. Children with mental health issues don’t usually look any different from their peers, and if they do, for example with scarring from self-harm scars or frighteningly low body weight, this is not portrayed as frequently in the media. We see feel-good TV stories of Father Christmas and children’s favourite TV stars visiting the medical wards, but has Father Christmas ever landed at a mental health ward?
We know that stigma around mental health is pervasive in our society, even if the situation is now improving. Possibly the perception is that children in CAMHS units are less deserving, that their type of illness makes them less worthy of sympathy, or even that it is “self-inflicted?” The stigma may mean the general public just don’t like to think about children with mental health problems in hospital. Perhaps it is too frightening—medicine can heal sick children, but how can the doctors fix what people don’t understand? If people don’t want to think about it, they won’t be giving gifts.
Subsequently, the motivation of others in response to my frustration meant that together, we founded a small charity, Christmas for CAMHS. We can’t compete with levels of corporate donations to children’s hospitals, but we can ensure that CAMHS patients know they’re not forgotten about. In 2017, we donated to 40 CAMHS wards, and the majority told us we were their only donors. Some staff were shocked and touched to hear from us, having worked in CAMHS for years with no donations for their patients. This year one unit has told us they’re very tight on budget so may not have a Christmas tree or decorations. Can you imagine a general children’s ward without any decorations? Because we know we’re likely to be the only donors, we need to ensure that we provide enough suitable gifts for every child on the unit. We would love to raise awareness, tackle stigma, and help every child and young person in a CAMHS unit over Christmas know they are valued and not forgotten.
Rosanna Bevan is a CT2 psychiatry trainee in London, joining psychiatry after working as a clinical fellow in paediatrics for a few years, and intends to pursue a career in child and adolescent mental health. She founded a small charity (Christmas for CAMHS) and also enjoys volunteer youth work.
Competing interests: None declared