Manchester city council is setting up two special children’s homes to house the increasing number of vulnerable young people who end up stuck in hospital because no residential providers will take them.
The homes, believed to be the first of their kind, aim to undercut private operators which sometimes demand tens of thousands of pounds each week to look after children with the most complex needs. A Guardian investigation earlier this year found that Knowsley council in Merseyside was charged almost £50,000 a week for the care of one teenager.
Five Manchester children with complex emotional needs spent many weeks in hospital in 2022 because no children’s homes would take them because of their challenging behaviour, according to the city council’s director of children’s services.
The children, all girls, did not need medical care and were not deemed psychiatrically ill.
One of them, a 14-year-old with autism, managed to break into a hospital treatment room where a dying infant was receiving palliative care. She spent a month on a locked ward, watched over by two security guards and two carers and unable to go to the toilet in private.
Another, a suicidal 13-year-old with autistic spectrum disorder and attention deficit hyperactivity disorder, ended up in hospital for three months because she was turned down by every single provider the council contacted. During her chaotic stay she assaulted hospital staff, damaged property, regularly self-harmed and threatened to jump off a bridge after escaping from her ward.
Both cases ended up in the high court. In the first case, a judge ordered Manchester city council to obtain a placement for the 14-year-old after finding that she was illegally being deprived of her liberty in hospital.
In the second case, the judge sanctioned the use of an unregulated, unlawful placement for the teenager. He accepted that since the council had spent many weeks searching for a suitable home only to be met with repeated refusals, an unlawful placement was “the only hope” for the child to be discharged from hospital.
As a result of these cases and others like them, Manchester council has developed what it calls the Take a Breath model.
Two houses are being renovated to house up to four children in total, with the first hopefully moving in by March. The idea is that when children first turn up at hospital – often at accident and emergency after a suicide attempt or self-harming incidents – once their injuries have been treated they can be discharged straight into the new homes rather than occupying a paediatric bed they do not need.
Paul Marshall, the council’s strategic director of children and education services, gave the Guardian a tour of the first house, a small three-bed end-of-terrace property in north Manchester owned by a housing association. Though currently bare, Marshall promised a “warm loving home”, where two children aged 12 to 18 would be able to decorate the bedrooms and pick their bedding as they wished.
Two staff would always be on site to work with the children, who Marshall said would arrive having “come through a period of stress and trauma” and may take a while to get settled.
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Jointly commissioned by the council and the NHS, the two homes will cost £1.4m a year. Of that, MCC expects to spend £5,500 a week for each child.
It represents a huge cost saving compared with some external placements. Last year the council was charged £16,550 a week by one private provider to look after a young profoundly autistic person with learning difficulties deemed a danger to themselves and to others.
“Profiteering, and making money off the back of the most vulnerable children, is what we are most upset about,” said Marshall.
As well as cutting out private sector profit, Take a Breath is designed to encourage the children and their carers to “take a deep breath and step back, rather than lurching from one crisis placement to another”.
In the UK and Ireland, Samaritans can be contacted on 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org.