The study, published in The Lancet Child & Adolescent Health journal and funded by the National Institute for Health and Care Research (NIHR) and the NIHR Great Ormond Street Hospital Biomedical Research Centre (NIHR GOSH BRC), analysed data on all admissions of five- to 18-year-olds to medical wards in England from April 1st 2012 to March 31st 2022.
General acute medical wards are specialised hospital wards designed to provide rapid assessment, treatment, and care for patients. These units serve as a bridge between the emergency department, general practitioners, and other hospital wards and are separate to specialised mental health wards such as eating disorder units.
Children and young people are most commonly admitted to general wards from Accident and Emergency because they are too unwell, or it is not safe for them to go home.
The researchers found that over the course of 10 years, mental health admissions increased from 24,198 to 39,925 (a 65% increase). This was in comparison to just a 10.1% increase in all cause admissions – which rose from 311,067 to 342,511.
Increases in admissions were greatest among girls aged 11-15, rising from 9,091 to 19,349 (112.8% increase), and for eating disorders, rising from 478 to 2,938 (514.6% increase).
This study is the first to analyse national trends in mental health admissions of children and young people to acute medical wards. As the study looked at admissions of up to 18 years of age, the acute medical wards included both children’s wards and adult wards.
Senior author, Dr Lee Hudson (UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital) said: “Over the past decade, we've observed a significant rise in mental health admissions among children and young people to acute medical wards. Although there has been attention paid to increased referrals to community mental health services and inpatient mental health settings, admissions to general acute medical settings feels like a piece of the jigsaw missing in the story.
“Acute medical wards are important places for caring for young people with mental health concerns – especially those with co-existing physical health problems like starvation from an eating disorder.
“However, the increased intensity we describe is presenting real challenges for acute wards, both for patients and their families and the staff supporting them. They may not be set up with an appropriate ward environment for this care, and sometimes staff working there need more training and support with relevant skills. This calls for better co-working between physical and mental health professionals across hospital and community teams, including, for example, adequate provision of psychiatrists and mental health trained nurses to support physical medical care on the actual ward.”
The researchers were unable to pinpoint the reasons behind the dramatic increase in mental health admissions in their study from this national level data, but are now in the process of collating more detailed data on reasons for admissions from a selection of children’s wards in England, alongside interviewing young people, their families and staff working on wards.
From this, they hope to better understand the needs and problems for these admissions to guide appropriate and effective interventions and improvements.
Dr Hudson said: “At a bigger level, we are all currently grappling with and trying to figure out why more and more young people are suffering with their mental health but it’s likely the bigger background prevalence of mental health problems, and possibly increased severity of individual cases, leading to increased presentations to hospitals that require an emergency admission to a general ward because it is not safe for the patient to go home.
“Our findings also show that these increases are not solely down to the COVID-19 pandemic, as there have been year on year increases in numbers of admissions since 2012. This is an issue that appears to now be core business for acute wards, and isn’t going to go away, so a focus on improving care is essential. We hope this study and our future work will help with this.
“Beyond that, it is of course crucial to understand the factors driving these presentations to better support the mental health of young patients.”
A recent report from the Health Services Safety Investigations Body (HSSIB), an independent patient safety organisation, highlighted multiple concerns associated with these admissions. For example, 13 out of 18 paediatric units surveyed by the HSSIB described their ward environment as “not safe” for caring for children and young people with high-risk behaviours related to mental health concerns.
Issues raised included a lack of resources to provide therapeutic engagement for children and young people, challenges related to the physical ward space, difficulties managing children and young people who require sedation, and concerns regarding the impact of these admissions on other patients and staff morale. Work is ongoing around the country to address these issues, and researchers hope that their study will highlight the urgent need for better integration of acute, mental health, and social care services to support children and young people admitted with mental health concerns.
By improving coordination and planning, they hope it will be possible to ensure that young patients receive the comprehensive care they need, both in hospital and in the community.
Study limitations
The study's limitations include potential underestimation of mental health admissions due to variations in diagnostic coding and the inability to describe the level of care or use of the Mental Health Act. Additionally, the study could not differentiate between admissions to paediatric or adult wards, nor account for changes in admission criteria during the pandemic.
The MAPS project is currently collecting more detailed information on admissions in a set of hospitals in England, and interviews with children, families and staff experiences and aims to address some of this missing information.
Links
- Research in The Lancet Child & Adolescent Health
- Dr Lee Hudson's academic profile
- UCL Great Ormond Street Institute of Child Health
- UCL Population Health Sciences
Image
- Credit: Mariakray on iStock
Media contact
Poppy Tombs
E: p.tombs [at] ucl.ac.uk
