'Far Away from Home': adolescent inpatient admissions far from home, out of area or to adult wards: a national surveillance study.

Holland, Josephine; Roe, James; Guo, Boliang; Dasilva-Ellimah, Morenike; Burn, Anne-Marie; Dubicka, Bernadka; Ford, Tamsin; Wagner, Adam P.; Nazir, Saeed; James, Anthony; Morriss, Richard; Sayal, Kapil

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., Roe, J., Guo, B., Dasilva-Ellimah, M., Burn, A.-M., Dubicka, B., …Sayal, K. (2023). 'Far Away from Home': adolescent inpatient admissions far from home, out of area or to adult wards: a national surveillance study. 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: Dec 14, 2023
• Deposit Date: Jan 31, 2024
• Publicly Available Date: Jan 31, 2024
• 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
• Keywords: Psychotic Disorders, Child, Adolescent, Inpatients, Adult, Hospitalization, Female, Hospitals, General, Autism Spectrum Disorder, Male, Child & adolescent psychiatry, PSYCHIATRY, Humans
• Public URL: https://nottingham-repository.worktribe.com/output/29259352
• Publisher URL: https://mentalhealth.bmj.com/content/26/1/e300843.info
• Additional Information: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.