Cyclic variations in demand for out-of-hours services in child and adolescent psychiatry: implications for service planning

Abstract

Paediatric psychiatric emergencies typically comprise self-harm, acute manifestations of mental illness and severe behavioural disturbances including violence. 1 Frequently, young people in psychosocial crisis situations also present to hospital. Accident and emergency (A&E) departments have aptly been described as 'the only game in town' outside normal working hours.2 This is where young people in a crisis situation take themselves or are taken by others, and their numbers are increasing even though professional help is not always sought. 3,4 Often help is initially offered by paediatric nurses and doctors, who then liaise with child and adolescent psychiatrists. Guidance regarding the management of paediatric psychiatric emergencies has mainly been published with regard to self-harm; and the need for a comprehensive specialist psychosocial assessment has been emphasised in the UK since 1998. 6,7 Although improved and timely access to specialist services is a UK government target, currently only a quarter of child and adolescent mental health services (CAMHS) provide emergency cover outside normal working hours. 8,9 Many CAMHS still have to establish emergency duty services. A good understanding of when demand is likely to be at its greatest will help with service planning. So far, research into cyclic variations in psychiatric emergencies has mainly focused on adults and self-harm. How often and when individuals present to psychiatric emergency services is influenced by the organisation of the wider support networks, referral pathways and admission policies. Considerable variation in these service-dependent factors has been reported. [10][11][12] However, fluctuations in emergency presentations have also been linked to service-independent factors such as diurnal, seasonal and meteorological variations. For example, more individuals present in the evening and at weekends, in spring, and on days with nice weather. [13][14][15][16] This study set out to investigate cyclic variations in demand for paediatric psychiatric provision outside normal working hours in a large and diverse urban population. We wanted to find out whether service-dependent factors such as the availability of liaison daytime cover, the introduction of A&E waiting targets or high A&E workload were associated with demand for out-of-hours provision. We also investigated whether service-independent factors such as school holidays, the season and the weather related to demand. ORIGINAL PAPERSHillen & Szaniecki Out-of-hours services in child and adolescent psychiatry The Psychiatrist (2010) Aims and method We examined peaks and troughs in demand for out-of-hours consultations and assessments in child and adolescent psychiatry and whether these have implications for service development. All out-of-hours referrals in three teaching hospitals providing services to a large and diverse inner-city population were prospectively registered from 1 January 2002 to 31 December 2005.Results In total, 323 individuals under 18 years were referred; 21.6 (95% CI 1...

Emergency Presentations to an Inner-city Psychiatric Service for Children and Adolescents

“…In the older group, 23.4% of children were aged between 16 and 18 years, compared with 46% of adolescents in this age group found in another study (Hillen & Szaniecki, 2010).…”

Indicadores de actividad durante cinco años en un servicio de urgencias de atención voluntaria de un hospital psiquiátrico mexicano

“…Para confirmar las observaciones en la bibliografía de que la afluencia de urgencias psiquiátricas y ciertos diagnósticos psiquiátricos pueden tener un patrón cíclico de estacionalidad o aumento de demanda, 31 Las cifras representan la tasa de actividad del servicio de urgencias por cada 100,000 habitantes según la población referente de cobertura. La diferencia porcentual se obtuvo del porcentaje acumulado por semestre entre los primeros y segundos semestres durante el quinquenio.…”