"Far Away from Home": Adolescent inpatient admissions far from home, out- of-area or to adult wards: A national surveillance study.) in collaboration with the CAPSS Scientific Committee

Holland, Josephine; Dubicka, Bernadka; Ford, Tamsin; Wagner, Adam

Abstract

Background: The increasing prevalence and acuity of mental disorders among children and adolescents have placed pressure on services, including inpatient care, and resulted in young people being admitted at-distance or to adult wards. Little empirical research has investigated such admissions.

Objective: To determine the incidence, clinical characteristics and 6-month outcomes of patients aged 13–17 years old admitted at-distance (>50 miles from home or out of region) to general adolescent psychiatric wards or to adult psychiatric wards.

Methods: Surveillance over 13 months (February 2021–February 2022) using the Child and Adolescent Psychiatry Surveillance System including baseline and 6-month follow-up questionnaires.

Findings: Data were collected about 290 admissions (follow-up rate 99% (288 of 290); sample were 73% female, mean age 15.8 years). The estimated adjusted yearly incidence of at-distance admission was 13.7–16.9 per 100 000 young people 13–17 years old. 38% were admitted >100 miles from home and 8% >200 miles. The most common diagnoses at referral were depression (34%) and autism spectrum disorder (20%); other common referral concerns included suicide risk (80%), emotional dysregulation (53%) and psychotic symptoms (22%). Over two-fifths (41%) waited ≥1 week for a bed, with 55% waiting in general hospital settings. At 6-month follow-up, 20% were still in hospital, the majority in at-distance placements.

Conclusions: At-distance and adult ward admissions for patients aged <18 remain an ongoing challenge for healthcare provision and have an impact on acute hospital resource use.

Clinical implications: Long waits in non-specialist settings increase pressure across the healthcare system, highlighting the need to improve local service provision and commissioning to reflect identified clinical needs.

Citation

Holland, J., Dubicka, B., Ford, T., & Wagner, A. (2023). "Far Away from Home": Adolescent inpatient admissions far from home, out- of-area or to adult wards: A national surveillance study.) in collaboration with the CAPSS Scientific Committee. BMJ Mental Health, 26(1), Article e300843. https://doi.org/10.1136/bmjment-2023-300843

• Journal Article Type: Article
• Acceptance Date: Nov 11, 2023
• Online Publication Date: Dec 14, 2023
• Publication Date: 2023
• Deposit Date: Nov 15, 2023
• Publicly Available Date: Dec 14, 2023
• Journal: BMJ Mental Health
• Electronic ISSN: 2755-9734
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 26
• Issue: 1
• Article Number: e300843
• DOI: https://doi.org/10.1136/bmjment-2023-300843
• Public URL: https://nottingham-repository.worktribe.com/output/27373095
• Publisher URL: https://mentalhealth.bmj.com/content/26/1/e300843