Child and adolescent psychiatric inpatient wards were established because young people with mental illness are often poorly served by admission to general psychiatric wards owing to needs that differ from those adults, different skills needed by staff, and difficulty ensuring young people's safety. 1 The admission of young people with mental illness to paediatric wards also raises concerns about safety and the skills of staff. We estimated the number of inappropriate admissions of young people with mental disorder to adult psychiatric wards and paediatric wards. Participants, methods, and resultsWe chose nine health authorities representative of England and Wales in terms of location, population size, deprivation, and provision of child and adolescent psychiatric wards (see table on bmj.com). These health authorities served 1.13 million people aged under 18, representing 9% of the population of England and Wales (1999 projections of 1991 census).We identified all adult psychiatric wards and paediatric wards. Consultant general psychiatrists and paediatricians completed a questionnaire for each eligible patient (patients aged under 18 on general psychiatric wards and patients on paediatric wards for treatment of mental illness not solely for medical treatment of self harm) admitted between 1 July and 31 December 1999.All 31 adult psychiatric wards replied, yielding 43 eligible admissions (23 male). Five were aged 15, and the remainder were 16 or 17. Sixteen of the 21 paediatric wards replied, with 11 eligible admissions (three male, one aged 3 and the others 8-16). The table presents estimates of the numbers and rates of admissions.The consultants rated whether each eligible admission was appropriate and, if not, why the patient had not been admitted to a more appropriate unit. Twenty six (60%) adult psychiatric admissions and six (55%) paediatric admissions were deemed "inappropriate." The main reasons for these admissions were non-provision of an appropriate facility (n = 25) or the appropriate facility being full or refusing the patient (n = 12). CommentSubstantial numbers of young people with mental disorder are admitted to adult psychiatric wards (955, 95% confidence interval 666 to 1266, per year) and paediatric wards (244, 103 to 398). Over a half of these admissions were considered to be to an inappropriate ward.Although our study population represents 9% of under 18s in England and Wales, the number of admissions was low, so extrapolations must be viewed cautiously. The validity of the estimates depends on the representativeness of the health authorities sampled, so we took care to attempt to ensure this. Five (24%) out of the 21 eligible paediatric units did not reply. We assumed no eligible admissions to non-responding wards; our data are thus a minimum estimate.This study quantifies the use of non-specialist wards for young people with mental disorder. Around 2100 young people are admitted to specialist child and adolescent mental health units each year, 2 so more than a third of all young people adm...

A national approach is needed to the planning and commissioning of this specialist service.

BackgroundLittle is known about the current state of provision of child and adolescent mental health service in-patient units in the UK.AimsTo describe the full number, distribution and key characteristics of child and adolescent psychiatric in-patient units in England and Wales.MethodFollowing identification of units, data were collected by a postal general survey with telephone follow-up.ResultsEighty units were identified; these provided 900 beds, of which 244 (27%) were managed by the independent sector. Units are unevenly distributed, with a concentration of beds in London and the south-east of England. The independent sector, which manages a high proportion of specialist services and eating disorder units in particular, accentuates this uneven distribution. Nearly two-thirds of units reported that they would not accept emergency admissions.ConclusionsA national approach is needed to the planning and commissioning of this specialist service.

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Child and adolescent psychiatric in-patient units are an expensive resource, with personnel absorbing two-thirds of the total costs. Costs per in-patient day vary fourfold and the exploration of cost variations can inform commissioning strategies.