What do we know about the risks for young people moving into, through and out of inpatient mental health care? Findings from an evidence synthesis

Abstract

BackgroundYoung people with complex or severe mental health needs sometimes require care and treatment in inpatient settings. There are risks for young people in this care context, and this study addressed the question: ‘What is known about the identification, assessment and management of risk in young people (aged 11–18) with complex mental health needs entering, using and exiting inpatient child and adolescent mental health services in the UK?’MethodsIn phase 1 a scoping search of two electronic databases (MEDLINE and PsychINFO) was undertaken. Items included were themed and presented to members of a stakeholder advisory group, who were asked to help prioritise the focus for phase 2. In phase 2, 17 electronic databases (EconLit; ASSIA; BNI; Cochrane Library; CINAHL; ERIC; EMBASE; HMIC; MEDLINE; PsycINFO; Scopus; Social Care Online; Social Services Abstracts; Sociological Abstracts; OpenGrey; TRiP; and Web of Science) were searched. Websites were explored and a call for evidence was circulated to locate items related to the risks to young people in mental health hospitals relating to ‘dislocation’ and ‘contagion’. All types of evidence including research, policies and service and practice responses relating to outcomes, views and experiences, costs and cost-effectiveness were considered. Materials identified were narratively synthesised.ResultsIn phase 1, 4539 citations were found and 124 items included. Most were concerned with clinical risks. In phase 2, 15,662 citations were found, and 40 addressing the risks of ‘dislocation’ and ‘contagion’ were included supplemented by 20 policy and guidance documents. The quality of studies varied. Materials were synthesised using the categories: Dislocation: Normal Life; Dislocation: Identity; Dislocation: Friends; Dislocation: Stigma; Dislocation: Education; Dislocation: Families; and Contagion. No studies included an economic analysis. Although we found evidence of consideration of risk to young people in these areas we found little evidence to improve practice and services.ConclusionsThe importance to stakeholders of the risks of ‘dislocation’ and ‘contagion’ contrasted with the limited quantity and quality of evidence to inform policy, services and practice. The risks of dislocation and contagion are important, but new research is needed to inform how staff might identify, assess and manage them.

Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability

“…Findings from a meta-analysis meta-analysis 72 Not available Corrigan et al (2012) [ 44 ] Challenging the public stigma of mental illness: A meta-analysis of outcome studies meta-analysis 72 Europe, North America, South America, Asia, Australia. Dalky (2012) [ 45 ] Mental illness stigma reduction interventions: Review of intervention trials quantitative systematic review with assessment of methodological quality 14 Not available de Mendonca Lima & Lopes (2012) [ 46 ] Systematic review on origin of stigma and discrimination against old persons with mental disorders integrative review 59 Not available Doley et al (2017) [ 47 ] Interventions to reduce the stigma of eating disorders: A systematic review and meta-analysis quantitative systematic review with no assessment of methodological quality and meta-analysis 18 Australia, US, UK, Indonesia Edwards et al (2015) [ 48 ] What do we know about the risks for young people moving into, through and out of inpatient mental health care? Findings from an evidence synthesis integrative review 40 USA, UK, Finland, Canada, Norway Ellison et al (2013) [ 49 ] Bipolar disorder and stigma: A systematic review of the literature integrative review 25 Public Stigma: UK, Germany, USA, Hong Kong, Malaysia, Canada, Japan, Singapore, Pakistan.…”

Stakeholder involvement in systematic reviews: a scoping review

“… Four events. – No information provided No information provided Edwards et al [ 43 ] Individual interviews—aimed at identifying topics for review to focus on. Meeting—descriptive maps from initial scoping review/mapping exercise were presented.…”

Evaluation of the EssenCES in a neurodevelopmental inpatient service for adolescents

“…Patients reported stepping in when staff had not noticed or were not available to meet the needs of their peers on the ward but also reported intrusive aspects of peer relationships on the ward. Similarly, an evidence synthesis by Edwards et al (2015) found that alongside positive experiences of inpatient peer relationships, young people spoke about negative aspects of living with people with mental health difficulties, alongside ambivalence and fear. It is thus possible that negative aspects of patient encounters on the locked ward may not have been not fully observed or attended to by staff, and that this alongside generally less intensive staff support may have led to staff overestimating the TH of the locked rehabilitation ward.…”