Adolescent Admissions to Adult Psychiatric Units: Patterns and Implications for Service Provision

Park, Chohye; McDermott, Brett; Loy, Jik H; Dean, Peter J.

doi:10.3109/10398562.2011.601311

Cited by 13 publications

(16 citation statements)

References 10 publications

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“… 7 , 42 , 43 , 44 , 45 However, little attention has been given to the role that structural racism plays in the mental health care of children and adolescents, and the effect on health outcomes of early experiences of discrimination. 46 We were only able to identify seven studies that mentioned the ethnicity of the children and adolescents who were involuntarily detained, 24 , 30 , 32 , 35 , 36 , 37 , 41 compared with 71 studies included in a recent international meta-analysis of ethnic variations in involuntary hospitalisation among adults. 7 …”

Section: Discussionmentioning

confidence: 99%

Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis

Walker

Barnett

Srinivasan

et al. 2021

The Lancet Child & Adolescent Health

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Background Disparities in involuntary psychiatric hospitalisation between population subgroups have been identified in adults, but little is known about the factors associated with involuntary hospitalisation in children or adolescents. We did a systematic review, meta-analysis, and narrative synthesis to investigate the social and clinical factors associated with involuntary psychiatric hospitalisation among children and adolescents.Methods We searched MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials for studies of any type up to July 22, 2020, that compared the characteristics of voluntary and involuntary psychiatric inpatients (mean age of sample ≤18 years). We synthesised results using random effects meta-analysis on unadjusted data and by narrative synthesis. Heterogeneity between studies was calculated using I². This study is registered on PROSPERO, CRD42020099892.Findings 23 studies from 11 countries were included in the systematic review and narrative synthesis, of which 19 studies (n=31 212) were included in the meta-analysis. On meta-analysis, involuntary rather than voluntary hospitalisation of minors was associated with a diagnosis of psychosis (eight studies; odds ratio 3•63, 95% CI 2•43-5•44, p<0•0001), substance misuse (five studies; 1•87, 1•05-3•30, p=0•032), or intellectual disability (four studies; 3•33, 1•33-8•34, p=0•010), as well as presenting with a perceived risk of harm to self (eight studies; 2•05, 1•15-3•64, p=0•015) or to others (five studies; 2•37, 1•39-4•03, p=0•0015). Involuntary hospitalisation was also found to be associated with being aged 12 years or older (three studies; 3•57, 1•46-8•73, p=0•0052) and being from a Black rather than a White ethnic group (three studies; 2•72, 1•88-3•95, p<0•0001). There was substantial between-study heterogeneity for most factors included in the meta-analysis (I² from 51•3% to 92•3%). Narrative synthesis found that more severe illness and poorer global functioning was associated with involuntary hospitalisation.Interpretation Over-representation of involuntary psychiatric hospitalisation in certain groups might begin in childhood, potentially establishing a cycle of inequality that continues into adulthood. Further research into the systemic factors underlying these health-care inequalities and the barriers to accessing less coercive psychiatric treatment is urgently required, with specific consideration of racial and ethnic factors.

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Section: Discussionmentioning

confidence: 99%

Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis

Walker

Barnett

Srinivasan

et al. 2021

The Lancet Child & Adolescent Health

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“…Theme 1: admission Several articles raise the issue of the process and the circumstances by which admission of the young person, under the age of 18 to an adult mental health hospital came about (Worrall et al, 2004;Park et al, 2011;Patil et al, 2013). For studies registering the rates and regularity of admission of young people, one study projected the significance of this for England and Wales, nearly 1,000 admissions per year and increasing (Worrall et al, 2004).…”

Section: Resultsmentioning

confidence: 99%

A scoping review of care received by young people aged 16-25 when admitted to adult mental health hospital wards

Murcott

2016

JPMH

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Purpose The purpose of this paper is to investigate the extent, range and nature of literature concerning the mental health inpatient care of the young adult population (16-25 years) who have been admitted to adult mental health wards. This paper reports the findings and positions these in the context of the broader nature to adult inpatient care, evaluates the quality of the evidence and identify gaps in the literature. Design/methodology/approach This paper uses an adapted scoping review methodology, allowing for a broad search but utilised established steps that allowed for a structured, rigorous approach to be used. CINAHL, Cochrane Library, MEDLINE, PsycINFO, Google Scholar, plus a secondary hand search were conducted resulting in eight papers, of quantitative, qualitative and mixed methods papers. Findings Findings show admissions follow similar paths as to adults; admission reasons are largely unknown beyond simple descriptors; admission lengths are unknown whilst on adult wards; staff feel confident yet lack resources; young people feel the transition from CAMHS ward to adult ward can be beneficial if done sensitively; young people have positive experiences of adult wards, including factors that may not be present on CAMHS wards, e.g. role modelling by older patients; young people feel scared and vulnerable, including when excluded from decision making; however, involving young people can cause stress and be confusing if not done sensitively. Research limitations/implications The scoping review identified a limited amount of research evidence for the care of young people admitted to adult wards. The research methods used in these papers were varied and none was of a high-quality standard. All studies contained methodological gaps which detract significantly from their findings and conclusions. The studies go some way to fill the gaps in knowledge and evidence base for this group, although in doing this scoping review was to unearth more gaps in knowledge. Originality/value This scoping review collates findings from the literature regarding young people’s admissions to adult mental health wards. This sensitive and controversial area of mental health care is shown to be lacking in high-quality research. Young people are being admitted to adult wards in increasing numbers year on year in the UK, yet little research has been conducted to identify when and where treatment has been appropriate. This review provides a start to understanding what is known about admission and treatment for this group and what is not known so that these gaps may be investigated in future research.

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“…The most common diagnoses after mood disorders were psychotic disorders (18.8%), neurodevelopmental disorders (10.6%), and dissociation disorders (10.6%). Mood (%38.2) and psychotic disorders (%25.7) were also the most common conditions in an overseas study evaluating 332 children and adolescents treated as in-patients in the psychiatric unit (20). However, in another overseas study evaluating 233 cases, mood disorders were again the most common diagnostic group, but second place was occupied by anxiety disorder.…”

Section: Discussionmentioning

confidence: 99%

The Diagnoses and Sociodemographic Characteristics of Children and Adolescents Treated in a University Hospital Psychiatry Inpatient Service

Ayaydın

2020

Harran Üniversitesi Tıp Fakültesi Dergisi

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Background: The purpose of this study was to perform a retrospective file examination of the sociodemographic characteristics, symptoms leading to admission, length of stay in the inpatient unit, diagnoses, and psychotropic drugs used by children and adolescents who were treated in the psychiatric inpatient unit. Materials and Methods: The records of patients aged under 18 (n=85) receiving treatment on an inpatient basis at the Harran University Medical Faculty Psychiatry Department inpatient unit between 1 August, 2016, and 1 September, 2018, were screened retrospectively. Case data were assessed using a data form produced by the author in terms of age, sex, parental ages, symptoms resulting in admission, diagnoses received, length of hospitalization, presence of multiple hospitalizations, and psychotropic drug use. Case diagnoses were based on clinical interviews using Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) criteria. SPSS 23.0 software (SPSS Inc., Chicago, USA) was used for statistical analysis. Statistical significance was defined as p<0.05. Results: Fifty-six of the patients included in the study were female and 29 were male. Major depressive disorder was the most frequent diagnosis among the patients (n: 30, 35.3%). The mean duration of hospitalization was 20.6±19.6 days. Eighty-five (100%) of the 85 patients had used one psychotropic agent during treatment. Antipsychotics were the most preferred drug group in our study (87.6%). Conclusions: Mood disorders constituted the most common reason for hospitalization. Psychotropics were used by all patients during hospitalization. Schizophreniform disorder and substance-related disorders were significantly higher in boys, while rates of conduct disorder and borderline personality disorder were significantly higher in girls. Since child and adolescent in-patient units are not available in all provinces, in clinical practice treatment is administered on an inpatient basis in adult psychiatric units. It is important for patients to be followed-up by child and adolescent psychiatry specialists in terms of being treated under emergency conditions without having to wait in line for treatment by being hospitalized in adult psychiatric units in places where there are no in-patient ünits for children and adolescents.

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Adolescent Admissions to Adult Psychiatric Units: Patterns and Implications for Service Provision

Abstract: We identified several reform possibilities, including up-skilling emergency and adult mental health staff in child and adolescent mental health, exploration of alternatives to admissions and specialist service coverage.

Cited by 13 publications

References 10 publications

Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis

Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis

A scoping review of care received by young people aged 16-25 when admitted to adult mental health hospital wards

The Diagnoses and Sociodemographic Characteristics of Children and Adolescents Treated in a University Hospital Psychiatry Inpatient Service

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