Inpatient CAMHS admissions occur at times of significant emotional crisis for children and families. While admissions can be necessary, there is increasing emphasis on shorter stays closer to home (Northover, 2021). This gets no argument from me. As a clinician working in this setting, I see both the benefits and harms that admissions can bring. It is essential that clinical teams attend both to the difficulties that lead to admission, and the problems generated by admission. NVR is an invaluable approach for inpatient teams in navigating these complexities (Williams, 2025). Viewing admissions through the lens of parental presence helps anchor me and my colleagues in a campaign of active resistance against the possibility of parental erasure during admission (Dulberger, et al., 2016).
The impact of the “problem” on parental presence
Families often arrive at admission having endured prolonged periods of their child’s distress, including suicidality, self-harm, restrictive eating, or extreme avoidance. Patterns of escalation may develop, and parental roles and boundaries can shift. Parents frequently arrive exhausted, desperate, and unsure of themselves as parents. NVR might suppose that parental presence is already lowered in these situations.
Admission criteria requires demonstrating that community and parental resources are no longer sufficient to manage risk. Although unintended, this process can convey to parents that the situation is beyond their capacity, further undermining parental presence.
The impact of admission on parental presence
Beyond the impact of the problem itself, inpatient admissions physically separate children and parents at a time of intense distress. Families may move abruptly from extreme closeness prior to admission, such as sleeping in the same room to maintain safety, to sudden absence. No matter how close to home the inpatient bed is, there can be logistical, financial, and social barriers that affect parents’ ability to be physically present during the ward visiting times. These challenges disproportionately affect families with fewer resources.
During admission, hospital staff assume an in loco parentis role. It is the staff who are getting children up in the morning, getting them to school, and comforting them when distressed. Our hope of course, is that our staff teams develop safe and supportive relationships with young people that reduce harmful behaviour in hospital, but if we don’t include parents, it’s easy for parents to feel erased, and children may find safety in the ward relationships.
Inpatient CAMHS admissions as opportunities for NVR
Despite the risks, inpatient admissions can provide valuable opportunities to strengthen parental presence and reverse erasure. When teams temporarily hold responsibility for safety, parents may find space to reconnect with self-care and focus on loving, relational gestures. There is time to think about baskets, announcements, and “sit-withs,” with a whole team available to support this work.
Admissions offer opportunities to ensure both parents are supported to remain involved, rather than responsibility defaulting to one caregiver. Facilitating contact with other important adults – such as grandparents and siblings – helps lift the veil of secrecy and communicates systemic presence.
Supporting parents to remain present in the face of rejection is essential. Making a long journey to see a child who refuses to come to the visiting room is a significant challenge to parental presence. While children’s wishes must be respected, staff can help parents tolerate rejection and maintain a visible, calm presence on the ward. We often work with parents to resist beliefs such as “I am upsetting my child, maybe I shouldn’t come” and instead enact Haim Omer’s mantra (2013) “I am your parent, you cannot divorce me.”
Resisting parental erasure during admission
Many families receive very little or no financial support during inpatient admissions, which continues to baffle me. Parents may live in the same county as the hospital yet face multiple journeys by public transport, care for other children at home, and experience reduced income after time away from work, making the act of being physically present regularly difficult, which massively risks erasure. Spending time effectively problem-solving these issues is essential. Physical presence cannot be underestimated.
Professional systems can easily contribute to parental erasure by holding meetings and making decisions without parents present. To resist this in our service, we are intentional in our communication and expectations. Nursing staff speak with parents daily about their child, addressing barriers such as language needs through consistent access to interpreters. We remain clear about what constitutes parenting decisions, reinforcing parents’ roles even during admission. Parental attendance at MDT meetings is prioritised, with practical support offered to overcome technological or confidence-related barriers. Small acts of resistance—such as not starting meetings without parents present, letting young people know that we have spoken with their parents and simply asking “What do parents think?” are small but powerful acts of resistance that communicate how much parents matter to us and to their child.
These practices require constant attention and a whole team working together to resist erasure. When they slip, parental erasure can take hold, and the journey to discharge becomes far more difficult. When these practices come together, the result is truly remarkable and humbling. I have witnessed parents completely erased find support, strength and confidence to be the parents they want to be. I’ve witnessed parents become commanding forces in their child’s care system, and most wonderfully, I’ve witnessed parents and children find their way back to each other with small, intentional steps. Dan Dulberger is clear that parental erasure is a temporary state, and I bear witness to this being the case even in the most challenging circumstances, which gives me hope, confidence and conviction in this task for inpatient admissions.
Written by Rachel Horn
Consultant Clinical Psychologist
NVR Association (NVRA) Accredited Practitioner
Accreditation Module Participant, 2025
References:
Dulberger, D., Fried, M., & Jakob, P. (2016, May 26–27). The presence mind: Functional states of consciousness and responsiveness. Paper presented at the 4th International Conference on Non-Violent Resistance, Malmö, Sweden.
Northover, G. (2021). Children and young people’s mental health services: GIRFT programme national specialty report. Getting It Right First Time (GIRFT).
https://gettingitrightfirsttime.co.uk/wp-content/uploads/2025/01/CYP-Mental-Health-National-Report-22-11h-FINAL.pdf
Omer, H., Steinmetz, S. G., Carthy, T., & von Schlippe, A. (2013). The anchoring function: Parental authority and the parent–child bond. Family Process, 52(2), 193–206. https://doi.org/10.1111/famp.12019
Williams, C. (2025). NVR: Finding an anchor, a map, and a compass in inpatient CAMHS. Partnership Projects UK. https://www.partnershipprojectsuk.com/nvr-in-inpatient-camhs/
