The nation will have “blood on its hands” if an NHS hospital bed cannot be found within days for a teenage girl who is at acute risk of taking her own life, according to the UK’s most senior family judge.

Sir James Munby said he felt “ashamed and embarrassed” that no hospital place had been found that could take proper care of the unnamed 17-year-old when she was due to be released from youth custody in 11 days’ time.

The extraordinary judicial intervention draws attention to the state of mental health provision in the UK. Munby, president of the high court’s family division, said it demonstrated the “disgraceful and utterly shaming lack of proper provision in this country of the clinical, residential and other support services”.

The senior judge described the shortage of specialist accommodation for the teenager, and others like her, as “an outrage”. Despite all the efforts made to find specialist care where she could be monitored safely, Munby said, “I might as well have been talking to myself in the middle of the Sahara”.



His judgment explains that the girl, named only as X, has made a large number of “determined attempts” on her life. She is due to be released from a secure unit, referred to as ZX for legal reasons, and doctors believe she needs to be placed in further care for her own protection. But, so far, none has been found.



“If, when in 11 days’ time she is released from ZX, we, the system, society, the state, are unable to provide X with the supportive and safe placement she so desperately needs, and if, in consequence, she is enabled to make another attempt on her life, then I can only say, with bleak emphasis: we will have blood on our hands,” Munby wrote.



The judge added: “We are, even in these times of austerity, one of the richest countries in the world. Our children and young people are our future. X is part of our future. It is a disgrace to any country with pretensions to civilisation, compassion and, dare one say it, basic human decency, that a judge in 2017 should be faced with the problems thrown up by this case and should have to express himself in such terms.”

It is not the first time that Munby has issued a stark public warning highlighting shortcomings in the justice and care system in Britain. On an earlier occasion, he threw down a direct challenge to the government over legal aid by recommending courts spend money in defiance of Ministry of Justice cuts to ensure justice was done.

This year he drew attention to the plight of women in the family courts who are subjected to direct questioning by men who had previously violently abused them and called on the government to ban the practice.

It was reported later that beds have been identified in three appropriate care settings. Assessments will take place on Friday to ensure the correct care package can be put into place.

According toMunby’s judgment, X was convicted in the youth court and ordered to be placed in custody in a secure unit, from which she was due for release in mid-August. Munby has no power to put her under a care order once she leaves because she is too old and staff at the secure unit readily acknowledge they are not equipped to care for her, meaning that alternative provision needs to be found.

In June, the judge ordered that a proper plan be put in place for her care. She was assessed as not meeting the threshold for a medium secure unit because the risk she posed was primarily to herself, not to others. Instead, she was identified as needing a place in a low secure unit, but only six exist in the country and there was a six-month waiting list for a bed, Munby said.



“If this is the best we can do for X, and others in similar crisis, what right do we, what right do the system, our society and indeed the state itself, have to call ourselves civilised? The honest answer to this question should make us all feel ashamed,” Munby wrote.



He said he felt “shame and embarrassment” at his inability to do more for her; “shame, as a human being, as a citizen and as an agent of the state; embarrassment as president of the family division and, as such, head of family justice”.

Munby ordered that copies of the judgment be sent to the home secretary, Amber Rudd; the health secretary, Jeremy Hunt; the education secretary, Justine Greening, and the justice secretary, David Lidington, as well as the chief executive of NHS England.



No minister has commented on the judgment but Dr Mike Prentice, medical director for the NHS England’s north of England region, said: “The judge is quite right that the relevant agencies need to ensure a safe, new care placement for this young woman, which is suitable given the great complexities of her situation.

“That’s what’s now happening, and a number of options have now been identified, with detailed clinical and social assessments taking place tomorrow to ensure the right package of care can be put in place before her release date.”

There are 124 inpatient beds in England of the low secure type that X needs, out of a total stock of 1,459 child and adolescent mental health service inpatient beds in England. The NHS has pledged to create 150-180 extra beds, adding to the existing 1,459, to meet growing demand for in-hospital mental health services.

The Liberal Democrat former health minister Norman Lamb said: “This is tragically not as unusual a case as people might think. Many lives are lost due to such failures in the system. We have made big advances in reducing death rates among people with heart conditions and HIV/Aids but across the world we have not made the same progress on suicide, one of the biggest killers of young people there is. It is a moral imperative we do more.”

Barbara Keeley, Labour’s shadow minister for mental health, said: “The Tory government has been warned time and again that child and adolescent mental health services are at crisis point. It is simply unacceptable that services have got to a level where it is now a matter of life and death, as in this case. Ministers must act now to safeguard this young person.”

Prof Wendy Burn, president of the Royal College of Psychiatrists, said the case exposed a serious lack of mental health beds. “We can’t speak about individual cases but we know that some mental healthcare units are desperately short of suitable beds. This is not the first time that a young person who requires a specialised, more secure provision has been left without adequate care to meet their needs. This places both them and their carers in a vulnerable position,” she said.

