Young people needing beds urgently for their mental health needs are waiting for long periods on acute general hospital wards, before being placed on wards far from where they live, according to a new study.
The research, which was led by experts from the University of Nottingham, found that more than 40% of young people experienced waits of seven days or more to be admitted to an adolescent mental health unit, with the majority waiting in acute hospital settings such as pediatric or general medical wards or the emergency department.
The study, which is published in BMJ Mental Health, investigated young people’s admissions to mental health units far away from home to a general adolescent mental health unit either more than 50 miles from home, or in another NHS region, or to an adult mental health ward. It found that more than half of young people admitted at a distance were placed in a mental health unit between 50 and 100 miles from home, with the majority of young people remaining in the same unit throughout their admission. At a six-months follow-up, 20% were still in hospital.
“Young people are waiting a long time for a mental health bed, something which those who have assessed them feel they need as a matter of emergency. This forces them to wait in places which are not quite right for a young person experiencing a mental health crisis,” says Dr. Josephine Holland.
Professor Kapil Sayal, also from the School of Medicine, and senior author on the study, said, “The findings of our study also show that admission at distance contributed to delays to discharge in over a third of these cases. A longer time in hospital means more time away from family, friends and school. The fact that discharge was delayed for over a third of these young people means that they spent even longer away from these important support networks.”
Clinical risk was frequently a key driver in these admissions with suicide risk present in 80% of those admitted. Depression was the most common diagnosis among those admitted, over half showed significant emotional regulation difficulties and a fifth had a diagnosis of psychosis.
The study collected data through the Royal College of Psychiatrists Child and Adolescent Psychiatry Surveillance System. The team collected information on 290 admissions of 13- to 17-year-olds to general adolescent units, (i.e., a general mental health ward for under-18s), far away from home (more than 50 miles from home or to another NHS Region), or to adult psychiatric wards between February 2021 and February 2022.
The data showed that more than a fifth of the young people waited over 10 days for a bed and a further 18% of waited for 7–10 days. Only 9% of young people experienced a wait of less than a day for a bed.
The majority of these young people waited in general hospital settings (40% pediatric ward, 8% adult medical ward and 7% Emergency department); 1 in 10 (11%) had to wait in Section 136 suites—a specialist holding suite usually located at an adult psychiatric hospital, designed to hold people for no longer than 24 hours while awaiting a Mental Health Act assessment.
Professor Kapil Sayal added, “Going forward, the further development of service models which aim to enhance mental health crisis care provision in community settings, and more intensive therapeutic input for young people who are waiting in general hospital settings, could help address some of the challenges our study has highlighted.”
Josephine Holland et al, ‘Far Away from Home’: adolescent inpatient admissions far from home, out of area or to adult wards: a national surveillance study, BMJ Mental Health (2023). DOI: 10.1136/bmjment-2023-300843
BMJ Mental Health
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