Children, teenagers and young adults with mental health problems in Birmingham are "at risk of harm" because services are inadequate, official inspectors have warned.
A number of "urgent improvements" are needed to city services according to the Care Quality Commission (CQC).
Publishing the findings of an inspection, it warned: "Patients were at risk of harm because systems and processes were not in place to keep them safe."
The CQC looked at specialist community mental health services for children and young people provided by Birmingham Women's and Children's NHS Foundation Trust.
The Trust is the main provider of mental health services for people aged up to 25 across the city.
It provides services from four centres known as hubs in the north, south, east and west of Birmingham.
It also provides crisis support across Birmingham for children and young people who are experiencing an acute mental health crisis, offers home visits for patients and runs a "place of safety" for people who may be a risk to themselves or others.
Responding to the report, Sarah-Jane Marsh, Chief Executive of Birmingham Women’s and Children’s NHS Foundation Trust, said: "We are determined to do better".
Dr Paul Lelliott, the CQC's Deputy Chief Inspector of Hospitals, said: "We found that a number of urgent improvements were needed at this service which cares for vulnerable young people and children.
“Staff morale was very low across community services. Staff said they were demoralised by recruitment practice that meant there were vacancies where people had left and had not been replaced.
"Many were worried that care records were not being managed properly and that something may go wrong.
"They also expressed their dissatisfaction with ‘agile working arrangements’, the premises from which they worked and a lack of feedback from higher-level management.
“The trust did not have effective oversight to ensure that all staff who worked within the hubs and urgent care were trained to the appropriate levels in children’s safeguarding.
"There were no robust systems in place to ensure that staff handover of care was safe and timely. We saw instances in care records where care coordinators had left the service and necessary handovers had not been carried out.
“Staff did not always adhere to infection control standards. The kitchen area in the health-based place of safety did not comply with national infection control standards.
“However, most patients and carers told us that staff were kind, respectful and professional. Patients and their families spoke positively about the staff and the interventions they received.
"The trust board knows what it must do to bring about sustainable change to its services to ensure people receive the care they should be able to expect. We will continue to monitor the trust closely. This will include further inspections."
The CQC last inspected these services in 2016 and rated them as "requires improvement". The rating has now been lowered to "inadequate".
Birmingham Women’s and Children’s NHS Foundation Trust runs a range of other services, including the city's Children's Hospital and Women's Hospital, which were not part of this inspection. The Trust continues to have an overall rating of "outstanding".
Following the publication of the report, concerns were raised in the House of Commons.
Birmingham Northfield MP Richard Burden (Lab) asked Ministers whether they accepted that "mental health services are not getting the resources they need either in Birmingham or anywhere else."
In response, Health Minister Jackie Doyle-Price suggested that a different organisation should propvide mental health services in Birmingham until improvements were made.
She told Mr Burden that the CQC report "will enable interventions to be made through the CQC to improve performance and in the meantime, the local commissioners sin Birmingham can buy services from other providers."
Endgbaston MP Preet Gill (Lab) said: "I urge the Trust to now take urgent and sustained action to improve the provision of this service.
"The poor practices described in the recent CQC report raise serious concerns about the quality of care that patients are receiving
"The children and young people accessing the Trust’s mental health services are particularly vulnerable, and a lack of adequate risk assessment or proper medication management will do nothing but increase this vulnerability.
"It is simply unacceptable that patients are currently at risk of harm due to the systems and processes that would keep them safe not being in place."
She said she would write to the Trust's Chief Executive.
Sarah-Jane Marsh, Chief Executive of Birmingham Women’s and Children’s NHS Foundation Trust, said: “It is clear that when the CQC inspected our community mental health service last summer, it was not fulfilling the needs of our children, young people and families, falling short of the standards they rightly expect.
“We pride ourselves on the levels of care and support we offer to all of our patients and families, and since the day we received the CQC’s feedback, our teams have been working hard to put this right, making a range of urgent improvements.
“When we were commissioned to provide this ambitious new service in 2016, we always knew there would be challenges, in part due to the escalating number of children and young people in our city in need of mental health support.
“Making the necessary improvements is proving to be a tough journey, and change will not happen overnight - but ‘inadequate’ is not the Birmingham Women’s and Children’s way, and we are determined to do better with support from our children, young people, families, commissioners and partners.”
